Breast Density Notification Letters and Websites: Are They Too "Dense"?

Area of Science:

• Health Communication
• Medical Writing
• Patient Education

Background:

• Dense breast notification letters (DBNs) are mandated in many states to inform patients about breast density.
• Assessing the readability of these letters is crucial for effective patient comprehension and informed decision-making.
• Previous assessments indicated potential challenges in DBN readability for the general public.

Purpose of the Study:

• To evaluate the grade-level readability of state-mandated dense breast notification letters (DBNs).
• To assess the readability of popular websites providing information on dense breast tissue.
• To compare the readability of DBNs over time and against online resources.

Main Methods:

• A HIPAA-compliant study evaluated DBNs from states with mandated text using five readability metrics, including Flesch-Kincaid Grade Level.
• Data from 2018 were compared with 2016 for states that had updated their DBNs.
• Readability of common websites about dense breasts was also assessed.

Main Results:

• In 2018, all state-mandated DBNs exceeded a sixth-grade reading level, with a mean score above eighth grade.
• Only one state significantly improved DBN readability between 2016 and 2018.
• Websites ranged from grade 6.0 to 11.3, with the American Cancer Society and ACR websites showing better readability.

Conclusions:

• State-mandated DBNs generally exceed an eighth-grade reading level, posing a barrier to patient understanding.
• Improvements in DBN readability have been minimal, with limited progress observed since 2016.
• Publicly accessible websites related to dense breasts demonstrate relatively better readability compared to DBNs.