• A test only works if you can understand the results.

    From JAMA:

    Along with their screening mammogram results, women in nearly half of US states also receive notifications of breast density, a result of legislation intended to assist in making personalized decisions about further action. Dense breasts can mask cancer on mammography (masking bias), and are an independent cancer risk factor, but evidence does not yet indicate whether or what supplemental screening is appropriate. Rather, risk stratification is proposed to determine who may benefit from supplemental screening (eg, magnetic resonance imaging for women at high risk).

    Yes, it’s law (who cares what patients and doctors might prefer) that women in almost half the states in the US get notifications about their breast density when the get mammograms. Dense breast tissue makes mammograms harder to read. But the women don’t get results through their doctors. They get them in letters, sent to them personally. There’s a problem, though. They’re written at a level that may be hard for many to understand:

    We found wide variation in 23 states’ DBN content, with most having readability at the high school level or above, poor understandability, and discontinuity with states’ average literacy. Such problems may create uncertainty for women attempting to make personalized decisions about supplemental screening and may exacerbate disparities in breast cancer screening related to low health literacy.

    Study after study on health literacy finds that patients don’t understand what their doctors give them to read. Many in the health care arena assume everyone reads proficiently at a very high level. That’s just not the case. Since something like 40% of women have dense breast tissue, they’re getting these notices, probably panicking, and not understanding what’s going on. That’s not good.



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