European Radiology

, Volume 29, Issue 4, pp 1762–1777 | Cite as

Breast density implications and supplemental screening

  • Athina VourtsisEmail author
  • Wendie A. Berg


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.

Key Points

• 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.


Breast 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


Estrogen receptor


European Society of Breast Imaging


German Consortium for Hereditary Breast and Ovarian Cancer


Hand-held ultrasound


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.

Informed consent

Written informed consent was not required for this study because this is a review article.

Ethical approval

Institutional Review Board approval was not required because this is a review article.


• Review article


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.“Diagnostic Mammography”, Medical Diagnostic Imaging Unit, Founding President of the Hellenic Breast Imaging SocietyAthensGreece
  2. 2.Department of Radiology, Magee-Womens Hospital of UPMCUniversity of Pittsburgh School of MedicinePittsburghUSA

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