Imagine a 57-year-old woman, let’s call her Maria, who’s just opened a letter about her mammography results. She’s had several mammograms before, but this time reads new information: “Your breasts are dense”.

While the letter assures her that dense breasts are common, it also indicates it could make it harder to see breast cancer on the mammogram.

Maria is confused about what to do next and wonders if she should be worried. Does she need to see her GP?

Maria may be fictional but she reflects the findings from the first trial of its kind we publish today.

We show women notified they have dense breasts alongside their mammogram result are more confused and anxious, do not feel more informed, and have greater intentions to see their GP for advice.

Remind me, what is breast density?

Dense breast tissue appears white on a mammogram and can hide (or mask) a cancer, which also appears white.

Dense breasts are very common. About 25–40% of women are considered to have dense breasts.

Breast density is one of several independent risk factors for breast cancer. After years of consumer advocacy, more women are being told about their breast density when they get their results from breast cancer screening.

The idea is simple: let women know if they have dense breasts – something that can raise cancer risk and make mammograms harder to read – so they can decide whether to get extra testing, such as an ultrasound or MRI.

Notifying women about their breast density is now legislated in the United States, recommended in Australia, and is being considered in other jurisdictions, such as the United Kingdom.

This is despite the lack of robust evidence on whether the benefits of notifying breast density at screening outweigh potential harms for women, and the impact on health services.

What we did and what we found

Our trial was co-designed with BreastScreen Queensland. From September 2023 to July 2024 we randomised 2,401 women (average age 57) who had a clear mammogram (their mammogram didn’t show cancer), but had dense breasts, into three categories:

1. Control: no notification of dense breasts (standard care)
2. Intervention 1: notification of breast density as part of the screening results letter plus extra written information in a leaflet
3. Intervention 2: notification of breast density as part of the screening results letter plus a link to extra information in an online video.

Eight weeks after screening, we found women notified they had dense breasts felt more anxious and confused about what to do about their breast health compared to the control group.

They also did not feel more informed to make decisions about their breast health, and had greater intentions to discuss this with their GP.

We haven’t followed participants for long enough yet, nor was the trial specifically designed to see if notifying women about their breast density led to extra cancers being detected.

The trial also had some limitations. For example there was a low proportion of women from non-English speaking backgrounds.

However, this is the first randomised trial world-wide to evaluate the immediate impact of breast density notification on women in the context of mammography screening.

It provides evidence for breast screening programs internationally to carefully consider the potential impact of such notification.

What next?

In Australia, where breast density notification is now recommended, it is important we acknowledge that the topic of breast density may be confusing and some women may be worried.

Communicating about breast density, including public messaging, should be focused on density being one of many risk factors for breast cancer and that there are other potentially modifiable ways to reduce a woman’s overall risk.

This includes maintaining a healthy weight, being physically active, reducing alcohol intake, and not smoking. Messaging should also emphasise that mammograms remain the best way to screen for breast cancer in most women even if they have dense breasts.

GPs need to be prepared to have conversations with women about breast density and their overall risk of breast cancer. This includes discussing the benefits and harms of extra screening (via ultrasound, MRI or contrast-enhanced mammograms) that can detect cancers not found on mammograms.

But even that’s not straight forward. For instance, while there is evidence extra screening will detect more cancers, there’s currently no evidence on whether it will reduce advanced-stage breast cancers or death from breast cancer.

Extra screening may lead to adverse effects such as false-positives – apparent abnormalities that, after further evaluation, are found not to be cancer.

Extra screening is also not equitable for all women due to out-of-pocket costs and limited availability through public services.

We need better pathways for evidence-based, equitable care in Australia so the benefits of notifying women about their breast density indeed outweigh any adverse consequences for women and the health system. These pathways need to be evaluated to ensure they are feasible, acceptable, effective and equitable.

Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney and Nehmat Houssami, Professor of Public Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Around half of teenage girls experience moderate to severe period pain. The mechanical force of the uterus contracting and inflammatory chemicals such as prostaglandins contribute to this pain.

Moderate to severe period pain has a significant impact on daily life. Girls with period pain are three to five times more likely than their peers to miss school or university, and two to five times more likely to miss out on social and physical activities.

Our new research found girls with period pain reported higher levels of psychological distress as young adults, even after accounting for earlier mental health issues and socioeconomic factors.

What comes first?

Menstrual pain has been dismissed and under-treated. Women report there is a perception among some health-care providers that stress, anxiety, or depression cause their pain.

However, participants in our lived experience research have told us that period pain leads to psychological distress. As one woman explained:

mental health [is] used frequently by health professionals to diminish my symptoms and make me feel as though I have untreated mental health conditions that are the cause of my issues instead of my physical pain.

Prior research suggests a bi-directional link between pain and mental health. A study of almost 15,00 adolescents with chronic pain found an increased risk of lifetime anxiety and depression. While our prior research on pelvic pain in adults showed psychological distress can worsen functional pain over time.

Research exploring the relationship between mental health and pain in teens with period pain is limited, with the direction of the relationship still unclear.

Take the example of Ruby, who represents a composite of clinical cases:

Ruby was netball captain in Year 6 but painful periods led to her dropping out of the team in Year 8. By Year 10, she was socialising less with her friends. At 17, she felt like her mental health was deteriorating and was locked in a struggle with her own body. Ruby saw her GP and was told to take Nurofen and keep moving because anxiety and depression had caused chronic pain.

While research has linked mental health and pain perception, we set out to determine the direction of this link: do mental health difficulties lead to period pain? Or does period pain contribute to mental health issues?

Our new study

We used data from the Longitudinal Study of Australian Children, also known as Growing Up in Australia, which has tracked the lives of 10,000 children and their families since 2004. We used data that tracked 1,600 girls who reported on their periods from age 14, 16 and 18.

Parents reported symptoms of anxiety and depression when the girls were 14–16 years old. The young women self-reported these symptoms at age 18, and levels of psychological distress at age 20–21.

This multi-stage study allowed us to look at how menstrual pain and mental health show up together and change over time during an important stage in young women’s lives.

While conditions such as endometriosis (which causes tissue similar to that which lines the uterus to grow outside the uterus) can be associated with pelvic pain, including period pain, the survey didn’t ask participants about endometriosis or pain-related diagnoses. So this didn’t form part of our study.

Around half of the participants experienced moderate to severe period pain.

We found girls who had painful periods were much more likely to also have symptoms of anxiety and depression at ages 14, 16 and 18 compared to those who did not have painful periods.

At age 14, adolescents who experienced painful periods were around twice as likely to have symptoms of anxiety and depression, compared to their peers who said their periods were not painful, or only a little painful.

These adolescents also reported higher levels of psychological distress as young adults, even after accounting for earlier mental health issues and socioeconomic factors.

Adolescents who reported period pain throughout their teens were more likely to experience “moderate” psychological distress in early adulthood. In contrast, adolescents who did not have period pain were more likely to experience “mild” psychological distress in early adulthood.

Importantly, we showed that period pain often comes before mental health issues develop – not the other way around. This suggests period pain could be a risk factor for future mental health problems.

The findings underscore the importance of identifying adolescents who are experiencing period pain. Many adolescents believe period pain is something they just have to put up with, and don’t seek help.

What can be done about period pain?

We recommend treating period pain early with a variety of options.

First-line period pain management includes:

• anti-inflammatories such as ibuprofen, which are available over the counter
• seeing your GP to discuss hormonal therapies, such as the oral contraceptive pill.

Additional strategies to manage period pain can include:

• heat (such as heat pads)
• physiotherapy
• regular exercise – even gentle activities such as yoga.

Improved menstrual education is needed to ensure teens can recognise when their menstrual experience is unusual, and know where they can access support.

Some programs provide menstrual education across schools and community groups. This education should be extended to families and school health and wellbeing support staff to facilitate early recognition and intervention.

Finally, further research is needed to confirm whether addressing period pain promptly reduces the risk of longer-term mental health symptoms.

Subhadra Evans, Associate Professor, Psychology, Deakin University; Antonina Mikocka-Walus, Professor in Health Psychology, Deakin University, and Marilla L. Druitt, Affiliate Senior Lecturer, Faculty of Health, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.