General practitioners’ responses to dense breast notifications resulting from a screening mammography program

Breast density reporting is recommended; however, guidance for general practitioners (GPs) is limited. This study investigates GPs' beliefs, attitudes, and practices within the only state-run Breast Screen program in Australia that has been notifying women if they have dense breasts for over a decade. A mixed-methods study was undertaken from four multi-GP practices. Qualitative interviews from GPs and de-identified data from a randomized sample of 692 women who attended screening mammography (2019-2022) were collated. Descriptive statistics, binomial regression for quantitative data, and both deductive and inductive analyses of qualitative data are reported. Interviews highlighted inconsistencies in practice regarding risk assessment and appropriateness of referrals for supplemental imaging. Three themes were identified: the professional role and responsibility, handling uncertainty and patients and the system. Quantitative data reported 31 percent of those with dense breasts were referred for supplemental ultrasound. Adjusting for age, family history, hormone replacement therapy, and socioeconomic status, only higher socioeconomic status was associated with a 1.35 times greater likelihood of ultrasound referral. This study emphasizes the complexities and uncertainty GPs face when consulting women with dense breasts and who and when to refer for supplemental imaging. Results inform optimum care pathways from a primary care perspective for those with increased breast density.