Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort vary by educational attainment and dominant language

Abstract Introduction: Socioeconomic, racial and ethnic disparities in the awareness and knowledge of dense breast notification (DBN) legislation have been documented, but its effect on women’s cognitive and emotional appraisal of the notification information which affect screening behavior remains unknown. Ambiguous screening and follow-up care for women with dense breasts may allow DBN to increase women’s anxiety, perceptions of risk, and worry, with unclear consequences for future screening decisions. We examined short- and long-term psychological responses to DBN and awareness of breast density (BD) by education, health literacy, nativity and dominant language. Methods: In a predominantly Latina and foreign-born New York City screening cohort (63% Spanish-speaking), ages 40-60, we assessed breast cancer worry, perceived absolute and comparative breast cancer risk, and uncertainties about breast cancer risk and screening choices, in short (approximately 1-3 months) and long-term (approximately 9-18 months) surveys following the enrollment screening mammogram (between 2016-2018). We compared psychological responses by women’s dense breast status (as proxy for DBN receipt) and BD awareness using cumulative, binary, and multinomial logistic regression. We examined multiplicative interaction by education, health literacy, nativity, and interview language. Results: In multivariable models using short-term surveys, BD awareness was associated with increased absolute perceived risk (Odds Ratio (OR): 2.27, 95% Confidence Interval (CI): 0.99, 5.20 for high, OR: 2.19, 95% CI: 1.34, 3.58 for moderate, vs. low risk) in the overall sample, and with increased uncertainty about risk (OR: 1.97 per 1-unit increase, 95% CI: 1.15, 3.39) and uncertainty about screening choices (OR: 1.73 per 1-unit increase, 95% CI: 1.01, 2.9) in women who are Spanish-dominant. DBN was associated with decreased perceived risk among women with at least some college education (OR: 0.32, 95% CI: 0.11, 0.89, for high, OR: 0.50, 95% CI 0.29, 0.89, for moderate vs. low risk) while those with a high school education or less experienced an increase (OR: 3.01, 95% CI: 1.05, 8.67 high vs. low risk). There were no associations observed between DBN or BD awareness and short-term breast cancer worry, nor with any psychological outcomes at long-term surveys. Conclusions: Associations of BD awareness and notification with breast cancer related psychological outcomes differed by education and language and were limited to short term increases in perceived absolute breast cancer risk and uncertainty around breast cancer risk and screening choices. Women with lower educational attainment or language barriers could specifically benefit from outreach to clarify the implications of breast density and reduce uncertainty around risk and screening choices. Citation Format: Erica J. Lee Argov, Carmen B. Rodriguez, Mariangela Agovino, Ying Wei, Rachel C. Shelton, Rita Kukafka, Karen M. Schmitt, Elise Desperito, Mary Beth Terry, Parisa Tehranifar. Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort vary by educational attainment and dominant language [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B011.