Breast density implications and supplemental screening
Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast ultrasound detects additional early-stage, invasive breast cancers when combined with mammography; however, its relevant limitations, including the shortage of trained operators, operator dependence and small field of view, have limited its widespread implementation. Automated breast sonography (ABS) is a promising technique but the time to interpret and false-positive rates need to be improved. Supplemental screening with contrast-enhanced magnetic resonance imaging (MRI) in high-risk women reduces late-stage disease; abbreviated MRI protocols may reduce cost and increase accessibility to women of average risk with dense breasts. Contrast-enhanced digital mammography (CEDM) and molecular breast imaging improve cancer detection but require further validation for screening and direct biopsy guidance should be implemented for any screening modality. This article reviews the status of screening women with dense breasts.
• The sensitivity of mammography is reduced in women with dense breasts. Supplemental screening with US detects early-stage, invasive breast cancers.
• Tomosynthesis reduces recall rate and increases cancer detection rate but is less effective in women with extremely dense breasts.
• Screening MRI improves early diagnosis of breast cancer more than ultrasound and is currently recommended for women at high risk. Risk assessment is needed, to include breast density, to ascertain who should start early annual MRI screening.
KeywordsBreast density Screening ultrasound Breast cancer Tomosynthesis Magnetic resonance imaging
Three-Dimensional Automated Breast Sonography
American College of Radiology Imaging Network
Adjunct Screening with Tomosynthesis or Ultrasound in women with mammography-Negative Dense breasts trial
Breast Cancer Surveillance Consortium
Breast Imaging Reporting and Data System
Contrast-enhanced spectral mammography
Digital breast tomosynthesis
Ductal carcinoma in situ
European Asymptomatic Screening Study
European Society of Breast Imaging
German Consortium for Hereditary Breast and Ovarian Cancer
Incremental cancer detection rate
Molecular breast imaging
Magnetic resonance imaging
National Comprehensive Cancer Network
Personal history of breast cancer
Positive predictive value
Screening with Tomosynthesis or Standard Mammography trial
WAB received support from National Institutes of Health grant 1R01CA187593.
Compliance with ethical standards
The scientific guarantor of this publication is: Wendie A. Berg, MD, PhD, Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required for this study because this is a review article.
Institutional Review Board approval was not required because this is a review article.
• Review article
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