Abstract
Breast density, also known as mammographic density, refers to white and bright regions on a mammogram. Breast density can only be assessed by mammogram and is not related to how breasts look or feel. Therefore, women will only know their breast density if they are notified by the radiologist when they have a mammogram. Breast density affects a woman’s breast cancer risk and the sensitivity of a screening mammogram to detect cancer. Currently, the position of BreastScreen Australia and the Royal Australian and New Zealand College of Radiologists is to not notify women if they have dense breasts. However, patient advocacy organisations are lobbying for policy change. Whether or not to notify women of their breast density is a complex issue and can be framed within the context of both public health ethics and clinical ethics. Central ethical themes associated with breast density notification are equitable care, patient autonomy in decision-making, trust in health professionals, duty of care by the physician, and uncertainties around evidence relating to measurement and clinical management pathways for women with dense breasts. Legal guidance on this issue must be gained from broad legal principles found in the law of negligence and the test of materiality. We conclude a rigid legal framework for breast density notification in Australia would not be appropriate. Instead, a policy framework should be developed through engagement with all stakeholders to understand and take account of multiple perspectives and the values at stake.
Highlights
Government-funded breast cancer screening is a population-based program guided by the utilitarian objective of maximising the sum total of welfare
As breast cancer screening is implemented in a clinic-like situation by clinicians, and women attending the program make decisions for their own benefit, issues related to clinical ethics are at play [17]
The central ethical themes associated with breast density notification are equitable care, patient autonomy, trust in the doctor–patient relationship, duty of care by the physician, and uncertainties around evidence relating to measurement and clinical management pathways for women with dense breasts
Summary
Known as mammographic density, refers to white and bright regions on a mammogram. Breast density notification to all women attending the British Columbia Cancer Breast Screening Program became effective on 15 October 2018 [16], with a number of other Canadian provinces following suit. A range of viewpoints were discussed, and it was clear that whether or not to tell women if they have high breast density, when they have a screening mammogram, is a sensitive and contentious issue. The perspectives presented in this manuscript are partially informed by this workshop and through further discussions amongst the inter-disciplinary team of authors In this perspective, we seek to bring together the diverse views held by different stakeholders, rather than take a position on one side of the debate or the other, and we have not sought to either agree or disagree with current Australian breast density notification policy. We identify and discuss the ethical and legal issues associated with breast density notification from an Australian perspective and highlight the key research required to resolve these issues
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