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January 13, 2020
To the CMAJ Editor,
I read the recent article on Breast density disclosure with disbelief and concern. I am a family doctor in BC and in 2015, when 43yrs old, I was diagnosed with breast cancer after palpating a large lump in my left breast. My only risk factors for breast cancer were being female and having dense breasts. However, I did not know my breasts were dense at the time of my diagnosis because this information was never shared with me. If I had known that my breasts were extremely dense, I would not have allowed a normal mammogram to reassure my physician and delay my breast cancer diagnosis by three months.
Women have the right to know their breast density. They have a right to know their breast cancer risks and how sensitive a mammogram is for them. They have the right to make informed decisions about breast cancer screening and their own health. To reason that disclosing ones breast density should be avoided to prevent unnecessary anxiety is unethical and paternalistic.
I was involved in the establishment of a breast health clinic in our community in 2017. We see over 300 patients monthly at the clinic. All patients are informed of their breast density and given information on what it means. Not one patient has ever told me that knowing her breast density has made her more anxious. Instead, we are routinely thanked for taking the time to share and explain this information. Every patient seen at the clinic is also informed on breast cancer risk reduction. This information is readily available on the BC cancer website (FIVE PLUS), Canadian Cancer society website and Dense Breast Canada website. It does not take much time to share this valuable information with women. Does it save lives? I’m not sure. Does it empower women to make informed decisions about their health? Most definitely!
After my diagnosis I was very angry to know that my breast density was never discussed, disclosed or explained me. To think that I wasn’t given this information to save me from unnecessary anxiety is even more disturbing. As a primary care physician and patient who has had breast cancer, I implore health care providers to focusing on patient centered care and informed joint decision making when discussing breast density with their patients rather than the opinions of a policy based researcher and epidemiologist.
Sincerely,
Dr. Elizabeth Ewart MD FCFP