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Breast density implications and supplemental screening

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Abstract

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.

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Abbreviations

ABS:

Three-Dimensional Automated Breast Sonography

ACRIN:

American College of Radiology Imaging Network

ASTOUND:

Adjunct Screening with Tomosynthesis or Ultrasound in women with mammography-Negative Dense breasts trial

BCSC:

Breast Cancer Surveillance Consortium

BI-RADS:

Breast Imaging Reporting and Data System

CESM:

Contrast-enhanced spectral mammography

DBT:

Digital breast tomosynthesis

DCIS:

Ductal carcinoma in situ

EASY:

European Asymptomatic Screening Study

ER:

Estrogen receptor

EUSOBI:

European Society of Breast Imaging

GC-HBOC:

German Consortium for Hereditary Breast and Ovarian Cancer

HHUS:

Hand-held ultrasound

ICDR:

Incremental cancer detection rate

MBI:

Molecular breast imaging

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

PHBC:

Personal history of breast cancer

PPV:

Positive predictive value

STORM:

Screening with Tomosynthesis or Standard Mammography trial

US:

Ultrasound

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Funding

WAB received support from National Institutes of Health grant 1R01CA187593.

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Authors and Affiliations

  1. “Diagnostic Mammography”, Medical Diagnostic Imaging Unit, Founding President of the Hellenic Breast Imaging Society, Kifisias Ave 362, Chalandri, 15233, Athens, Greece

    Athina Vourtsis

  2. Department of Radiology, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Wendie A. Berg

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  1. Athina Vourtsis
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  2. Wendie A. Berg
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Correspondence to Athina Vourtsis.

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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.

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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.

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Vourtsis, A., Berg, W.A. Breast density implications and supplemental screening. Eur Radiol 29, 1762–1777 (2019). https://doi.org/10.1007/s00330-018-5668-8

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