title: Dense breast tissue notification: impact on women's perceived risk, anxiety, and intentions for future breast cancer screening.
abstract: OBJECTIVE
  The aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notification, (2) explore individual difference variables (eg, minority status, insurance coverage) that may influence intentions for additional ultrasound screening, and (3) assess whether anxiety mediates the relationship between perceived risk and screening intentions.
  
  
  METHODS
  A total of 184 women aged >40 years in the United States were recruited from Amazon Mechanical Turk to respond to a dense breast tissue notification as if they had personally received it.
  
  
  RESULTS
  After reviewing a notification, women reported greater perceived risk (d = 0.67) and intentions to undergo mammography (d = 0.25) than before. Most women intended to undergo additional ultrasound screening, although to a lesser extent when ultrasound was covered by insurance than when it was not (d = 1.03). All screening intentions were lower in women with ambiguity aversion, a tendency to avoid tests without medical consensus, and those who preferred an active decision-making role. Anxiety mediated the relationship between perceived breast cancer risk and all screening intentions.
  
  
  CONCLUSIONS
  Women who receive dense breast tissue notifications may generally increase their breast cancer screening intentions; however, intention strength varies depending on internal (eg, ambiguity aversion) and external (eg, insurance for ultrasound) factors. Although perceived risk increases after notification, it is anxiety that drives women's intentions for future screening.
authors.affiliation: Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: vivian.yeh@mssm.edu.
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Yeh
authors.affiliation: Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Julie B
authors.initials: JB
authors.lastname: Schnur
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Laurie
authors.initials: L
authors.lastname: Margolies
authors.affiliation: Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Guy H
authors.initials: GH
authors.lastname: Montgomery
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D015897:Comorbidity; D003720:Densitometry / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States; D016387:Women's Health / Q000706:statistics & numerical data
keywords: Dense breast tissue; anxiety; perceived risk; screening intentions