Improving State-Mandated Breast Density Notifications

Derek L. Nguyen, Emily B. Ambinder, Mary Kate Jones, Lisa A. Mullen, Susan C. Harvey

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Effective written communication directly affects health care outcomes. Since 2016, the complex language of state-mandated breast density notifications (BDNs) has been challenged, because it is perceived to be beyond the comprehension of most patients. The aim of this study was to assess whether a revised BDN written at a lower reading grade level improves understanding compared with the current state-mandated BDN. Methods: A revised notification with similar content to the current state-mandated BDN was developed. Both notifications were presented to patients for direct comparison, using a paper survey asking questions that evaluated patients’ perceptions and convictions associated with breast density. Surveys were distributed at four outpatient imaging centers to screening mammography patients. Results: The current BDN's mean readability metric was 13.4, and that of the revised BDN was 6.6. Five hundred surveys were analyzed. Survey data demonstrated that 56.6% of all women perceived that dense breast tissue results indicated a “high” associated lifetime breast cancer risk from the current state-mandated BDN compared with only 2.2% with the revised notification (P <. 001). Nearly all women were more likely to initiate discussions with their providers regarding their breast tissue density after reading the revised notification (96.0%) as opposed to the current state-mandated BDN (32.8%; P <. 001). Conclusions: A significant portion of women misinterpret the intended messages of the current state-mandated BDN. Thus, a revised notification at a lower reading grade level may improve understanding of breast density, leading to improved individualized breast cancer screening for women with dense breasts.

Original languageEnglish (US)
Pages (from-to)384-390
Number of pages7
JournalJournal of the American College of Radiology
Issue number3
StatePublished - Mar 2020


  • Breast density notification
  • breast imaging
  • readability
  • screening mammography
  • state-mandated

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Improving State-Mandated Breast Density Notifications'. Together they form a unique fingerprint.

Cite this