近日，澳大利亚悉尼大学教授Nehmat Houssami及其小组的最新研究提出了基于人群的乳腺密度通知的影响：乳腺筛查的多地点平行组随机对照试验。2025年12月3日出版的《英国医学杂志》发表了这项成果。

目的:调查告知妇女致密乳房对其心理社会结局和保健服务使用意愿的影响。

设计:多地点平行随机对照试验。

设置:澳大利亚昆士兰州以人口为基础的乳房筛查项目。

参与者:年龄≥40岁的妇女接受筛查并被分类为乳房x光检查致密性乳房（BI-RADS C-D来自自动密度测量）。妇女被随机分为标准治疗组（不告知乳房密度）、告知乳房密度加书面健康素养敏感信息组（干预1）、告知密度加基于健康素养敏感信息的在线视频链接组（干预2）。

主要结果：测量筛查后8周的心理（感到焦虑、困惑或知情）和保健服务使用意图（与乳腺密度相关的全科医生咨询、补充筛查）。

结果:在2023年9月至2024年7月期间，3107名女性（对照组1030名，干预1组1003名，干预2组1074名）被随机分组，2401名女性（对照组802名，干预1组776名，干预2组823名）被纳入分析，平均基线年龄为57.4岁（标准差9.9）。与对照组相比，被告知乳房致密的女性报告焦虑感明显增加(干预1：优势比1.30,95%可信区间（CI） 1.08至1.57；干预2：优势比1.28,1.07至1.54)和困惑（干预1：优势比1.92,1.58至2.33；干预2：优势比1.76,1.46至2.13），并且与全科医生谈论筛查的意愿明显更高结果:（干预1：相对风险比2.08,95% CI 1.59 - 2.73；干预2：相对风险比1.71,1.31 - 2.25）并依赖全科医生提供补充筛查建议（干预1：相对风险比2.61,1.80 - 3.79；干预2：相对风险比2.29,1.58 - 3.33）。然而，大多数女性不打算进行补充筛查（对照组：91.3%；干预1:78.9%；干预2:81.4%）。被告知的女性并没有感觉自己更了解情况（干预1：优势比0.83,0.68至1.01；干预2：优势比0.80,0.66至0.97）。

研究结果表明，被告知乳房致密的妇女感到焦虑和困惑，在做出有关乳房健康的决定时没有得到更多的信息，她们希望得到全科医生的指导。通报乳腺密度作为基于人群的乳腺筛查的一部分可能会产生不良后果，包括全科医生为妇女提供咨询的额外咨询负担。

附：英文原文

Title: Impact of population based breast density notification: multisite parallel arm randomised controlled trial in BreastScreen

Author: Brooke Nickel, Nick Ormiston-Smith, Erin Cvejic, Jennifer Isautier, Lisa Hammerton, Karen Baker, Paula Legerton, Paul Vardon, Zoe McInally, Sandy Robertson, Kirsten McCaffery, Nehmat Houssami

Issue&Volume: 2025/12/03

Abstract: Objective To investigate the effect of notifying women of their dense breasts on their psychosocial outcomes and health service use intentions.

Design Multisite parallel arm randomised controlled trial.

Setting Population based breast screening programme in Queensland, Australia.

Participants Women aged ≥40 years having screening and classified as having mammographically dense breasts (BI-RADS C-D from automated density measure).

Intervention Women were randomised equally to standard care (no notification of breast density), notification of breast density plus written health literacy sensitive information (intervention 1), or notification of density plus a link to online video based health literacy sensitive information (intervention 2).

Main outcome measures Psychological (feeling anxious, confused, or informed) and health service use intentions (general practitioner consultation related to breast density, supplemental screening) at 8 weeks post-screening.

Results Between September 2023 and July 2024, 3107 women (1030 control, 1003 intervention 1, and 1074 intervention 2) were randomised, and 2401 women (802 control, 776 intervention 1, and 823 intervention 2) with a mean age at baseline of 57.4 (standard deviation 9.9) years were included in the analysis. Compared with the control group, women who were notified of their dense breasts reported feeling significantly more anxious (intervention 1: odds ratio 1.30, 95% confidence interval (CI) 1.08 to 1.57; intervention 2: odds ratio 1.28, 1.07 to 1.54) and confused (intervention 1: odds ratio 1.92, 1.58 to 2.33; intervention 2: odds ratio 1.76, 1.46 to 2.13) and had significantly higher intentions to talk to their general practitioner about their screening results (intervention1: relative risk ratio 2.08, 95% CI 1.59 to 2.73; intervention 2: relative risk ratio 1.71, 1.31 to 2.25) and to rely on their general practitioner for supplemental screening advice (intervention 1: relative risk ratio 2.61, 1.80 to 3.79; intervention 2: relative risk ratio 2.29, 1.58 to 3.33). However, most women did not intend to have supplemental screening (control: 91.3%; intervention 1: 78.9%; intervention 2: 81.4%). Notified women did not feel more informed (intervention 1: odds ratio 0.83, 0.68 to 1.01; intervention 2: odds ratio 0.80, 0.66 to 0.97).

Conclusions Women notified of their dense breasts felt anxious and confused, did not feel more informed to make decisions about their breast health, and wanted to be guided by their general practitioners. Notification of breast density as part of population based breast screening may have adverse outcomes including additional consultation burden on general practitioners to advise women.

DOI: 10.1136/bmj-2024-083649

Source: https://www.bmj.com/content/391/bmj-2024-083649