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General practitioners' responses to dense breast notifications resulting from a screening mammography program
Jacqueline Frayne1, Lucy Gilkes1, Ramya Raman2
1Medical School, Discipline of General Practice, The University of Western Australia, Crawley, Australia.
Women & Health
|March 10, 2026
Summary
General practitioners (GPs) face challenges in referring women with dense breasts for supplemental imaging. Socioeconomic status influences ultrasound referral likelihood, highlighting the need for clearer breast density reporting guidelines.
Area of Science:
- Oncology
- Radiology
- Primary Care Medicine
Background:
- Breast density reporting is increasingly recommended for mammography screening.
- General practitioners (GPs) lack comprehensive guidance on managing dense breasts and supplemental imaging referrals.
- Australia's longest-running state-run Breast Screen program provides a unique setting to study GP practices.
Purpose of the Study:
- To investigate general practitioners' (GPs) beliefs, attitudes, and practices regarding breast density reporting and supplemental imaging.
- To identify factors influencing GPs' decisions to refer women with dense breasts for further investigation.
- To inform the development of optimal care pathways for women with increased breast density from a primary care perspective.
Main Methods:
- A mixed-methods study combining qualitative interviews with GPs and quantitative analysis of de-identified screening mammography data from 692 women.
- Data collected from four multi-GP practices within a state-run Breast Screen program (2019-2022).
- Statistical analyses included descriptive statistics, binomial regression, and qualitative thematic analysis (deductive and inductive).
Main Results:
- Interviews revealed inconsistencies in risk assessment and referral practices for supplemental imaging among GPs.
- 31% of women with dense breasts were referred for supplemental ultrasound.
- Higher socioeconomic status was significantly associated with a 1.35 times greater likelihood of ultrasound referral, after adjusting for other factors.
Conclusions:
- GPs experience significant complexity and uncertainty when managing dense breasts and deciding on supplemental imaging referrals.
- Socioeconomic status appears to be a confounding factor in referral decisions, suggesting potential inequities.
- The findings underscore the need for improved clinical guidelines and support for primary care in addressing breast density concerns.
