Aims
High breast density (BD) is an independent risk factor for breast cancer and decreases the sensitivity of mammography. Notifying women about their BD has been legislated in the United States as a way of providing women with additional information about their breasts to potentially help manage their breast cancer risk. However, there is concern that such notifications may disadvantage culturally and linguistically diverse (CALD) women. The aim of this systematic review is to synthesise existing data to comprehensively understand the impact of BD notification on women from CALD backgrounds.
Methods
A systematic search was performed in March 2023, and the articles were identified using CINHAL, Embase, Medline, and PsychInfo databases. The search strategy combined the terms “breast”, “density” and “notification” and synonyms. Full-text articles were reviewed for analysis by race/ethnicity/primary language. The relevant titles, abstracts and full texts were independently screened for eligibility by two authors using Covidence. When conflicts or discrepancy arose, a third author made the final judgment of the articles. The Joanna Briggs Institute critical appraisal tools were used to assess methodological quality of the studies and studies were synthesised narratively.
Results
Of 1,784 articles, 32 articles were included. Thirty-one studies were conducted in the United States and one in Australia, with 28 quantitative and seven qualitative methodologies. Fourteen of the studies were assessed as high quality, 16 moderate quality and 2 low quality. The overall results in terms of BD awareness, knowledge, attitudes, perceptions, and intentions were heterogenous across studies. However, BD awareness and general knowledge was consistently lower in ethnically diverse women. This was partially accounted for by socio-economic differences, although language barriers, accuracy of translations, and access to reliable information were additional factors. Barriers related to communicating with healthcare professionals and undergoing supplemental screening included socioeconomic factors, health literacy and language barriers, medical mistrust and actual or perceived discrimination.
Conclusions
This systematic review suggests some of the barriers to understanding BD notification, intentions and accessing supplemental screening among CALD women include language and socioeconomic challenges, and health system mistrust and discrimination. While BreastScreen Australia considers the policy on reporting of BD, these results can help inform future research and policy to improve BD notification delivery to CALD women within the program, and to ensure that notification does not potentially disadvantage this population sub-group.