A systematic assessment of online international breast density information

Brooke Nickel¹, Tessa Copp², Tong Li³, Hankiz Dolan⁴, Meagan Brennan⁵, Angela Verde⁶, Lisa Vaccaro⁷, Kirsten McCaffery², Nehmat Houssami⁸

Affiliations

¹ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: brooke.nickel@sydney.edu.au.
² Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
³ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.
⁴ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁵ The University of Notre Dame Australia, School of Medicine Sydney, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.
⁶ Breast Cancer Network Australia, Melbourne, Australia.
⁷ Health Consumers New South Wales, Sydney, Australia; Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁸ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.

PMID: 35763979
PMCID: PMC9240362
DOI: 10.1016/j.breast.2022.06.006

A systematic assessment of online international breast density information

Brooke Nickel et al. Breast. 2022 Oct.

. 2022 Oct:65:23-31.

doi: 10.1016/j.breast.2022.06.006. Epub 2022 Jun 22.

Authors

Brooke Nickel¹, Tessa Copp², Tong Li³, Hankiz Dolan⁴, Meagan Brennan⁵, Angela Verde⁶, Lisa Vaccaro⁷, Kirsten McCaffery², Nehmat Houssami⁸

Affiliations

¹ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: brooke.nickel@sydney.edu.au.
² Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
³ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.
⁴ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁵ The University of Notre Dame Australia, School of Medicine Sydney, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.
⁶ Breast Cancer Network Australia, Melbourne, Australia.
⁷ Health Consumers New South Wales, Sydney, Australia; Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁸ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.

PMID: 35763979
PMCID: PMC9240362
DOI: 10.1016/j.breast.2022.06.006

Abstract

Background: Breast density has become a topic of international discussion due to its associated risk of breast cancer. As online is often a primary source of women's health information it is therefore essential that breast density information it is understandable, accurate and reflects the best available evidence. This study aimed to systematically assess online international breast density information including recommendations to women.

Methods: Searches were conducted from five different English-speaking country-specific Google locations. Relevant breast density information was extracted from the identified websites. Readability was assessed using the SHeLL Editor, and understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). A content analysis of specific recommendations to women was also conducted.

Results: Forty-two eligible websites were identified and systematically assessed. The included informational content varied across websites. The average grade reading level across all websites was 12.4 (range 8.9-15.4). The mean understandability was 69.9% and the mean actionability was 40.1%, with 18/42 and 39/42 websites respectively scoring lower than adequate (70%). Thirty-six (85.7%) of the websites had breast density-related recommendation to women, with 'talk to your doctor' (n = 33, 78.6%) the most common.

Conclusions: Online information about breast density varies widely and is not generally presented in a way that women can easily understand and act on, therefore greatly reducing the ability for informed decision-making. International organisations and groups disseminating breast density information need to ensure that women are presented with health literacy-sensitive and balanced information, and be aware of the impact that recommendations may have on practice.

Keywords: Breast density; Health literacy; Information; International; Online; Women's health.

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Conflict of interest statement

Declaration of competing interest None declared.

References

1. Boyd N.F., Guo H., Martin L.J., et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. Jan 18 2007;356(3):227–236. doi: 10.1056/NEJMoa062790. - DOI - PubMed
1. Sprague B.L., Gangnon R.E., Burt V., et al. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst. Oct 2014;106(10) doi: 10.1093/jnci/dju255. - DOI - PMC - PubMed
1. Noguchi N., Marinovich M.L., Wylie E.J., Lund H.G., Houssami N. Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening. Med J Aust. Oct 18 2021;215(8):359–365. doi: 10.5694/mja2.51216. - DOI - PMC - PubMed
1. Houssami N., Hunter K. The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer. 2017;3:12. doi: 10.1038/s41523-017-0014-x. - DOI - PMC - PubMed
1. Carney P.A., Miglioretti D.L., Yankaskas B.C., et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. Feb 4 2003;138(3):168–175. doi: 10.7326/0003-4819-138-3-200302040-00008. - DOI - PubMed

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A systematic assessment of online international breast density information

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A systematic assessment of online international breast density information

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials