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Engaging Women With Enhanced Mammography Letters

In recognition of Breast Cancer Awareness Month, Radiology Today presents a discourse featuring a distinguished panel of breast imaging professionals. Topics touched upon during the virtual consultation include engaging women in their breast health care and new ways to communicate mammography and breast density results.

First off, what is a mammography patient letter?
Schroeder: In the US, following her mammogram, a woman will receive a letter with the results of the exam, informing the woman whether the results were normal or if there were any findings, benign or suspicious, that require additional surveillance or testing. Today, most letters will also include a breast density measurement. This letter, written in lay language, is distinct from the official report that is sent to her physicians.

How does the Density Inform movement impact patient letters?
Ellsworth-Beaumont: While laws have been passed to let women know they have dense breasts, the wording in the mammogram report letter is often counterproductive by dismissing it as common. Patient letters provide little or no information about the patient’s risk factors. In addition, most women never see their own mammography images, even though images may help women visualize their breast density and understand why additional imaging may be needed. Patients need personalized correspondence that helps them understand their results and clearly communicates what supplemental screening is recommended for women with their specific risk profile.

How does density information in the letter benefit women? 
Ellsworth-Beaumont: Women need more information than being told they have dense breasts; they need to also know what level of breast density they have and how that translates into screening for their breast type. This then needs to be connected with screening recommendations related to their personal risk factors. Instead of a generic one-size-fits-all message, we need to use tools for precision medicine that customize the letter for each patient.

Yerger: No one I know who has had breast cancer knew beforehand that they had dense breast tissue that could have masked their cancer in a mammogram, and they certainly didn't know it was a risk factor. Knowledge is power, and they certainly could have used the knowledge to possibly help them get diagnosed at an earlier stage. The earlier the diagnosis, the higher the likelihood of survival.

What is the Volpara Density Profile pilot?
Schroeder: Carolina Breast Imaging Specialists is pleased to work with Volpara on a pilot program to include thumbnail images of women’s individual mammograms in patient letters to demystify potentially confusing breast health information. This is a simple visual way of engaging women with their mammography screening results. The premise is that a picture is worth a thousand words, and we expect that the impact of this powerful new tool will improve patient communications and deliver critical information to women to help make decisions about a personalized screening plan. The program includes several enhancements to mammography letters to improve education for patients.

How does including an image engage women?
Schroeder: A mammogram is still the first step for detecting breast cancer and understanding one’s individual long-term risk. But results explained in a text-heavy form letter can never compete with including a personal image that is as individual as your fingerprint. In addition to including the thumbnails of the patients’ actual mammograms, the system includes a QR code that contains a personalized link for those who want more information about their particular density. 

Once a woman is motivated to learn more about her risk levels, with the help of her health care provider, she can make lifestyle changes that help mitigate breast cancer risk and create a personalized screening path that may include additional screening, if necessary.

Yerger: Every woman deserves the right to know all of her health data that may impact her current or future health, such as her blood pressure, cholesterol level, etc. Breast density is a significant risk factor for developing breast cancer; therefore, knowing breast density is equally important to these other measures that are currently much more readily shared and understood.

What action can women take with this information?
Schroeder: The more women know about their mammogram, the better they’ll be able to have productive conversations with their doctors that lead to more informed decisions about their breast health.

Zeamer: Having meaningful and thoughtful conversations with health care providers is most important when women have this information about their breasts. An informative letter about dense breast tissue and subsequent risk factors should be an integral part of discussions with health care providers and patients. Without this information, women are unable to ask appropriate questions about their options to stay healthy.

— A Radiology Today staff report