Screening Strategies for Women With Increased Breast Density
Posted: Monday, March 19, 2018
Although breast density is widely recognized as an independent risk factor for the development of breast cancer, the significance of this risk remains controversial among experts, according to Shannon Falcon, MD, of Moffitt Cancer Center in Tampa, Florida, and colleagues. In a review of imaging management published in Cancer Control, Dr. Falcon and colleagues urge clinicians to carefully consider a patient’s history when developing a screening plan for women with dense breasts.
Although mammography is considered the most appropriate modality for population-based screening, its sensitivity rate is reduced when noncalcified lesions are masked by tissue superimposition as breast density increases. Approximately half of women have either heterogeneously dense or extremely dense breast tissue, and therefore they require supplemental methods to be properly screened.
The authors suggest that when screening women with dense breasts, clinicians should consider using tomosynthesis for “all levels of risk,” supplemental whole-breast ultrasonography for women at average risk, and supplemental magnetic resonance imaging for women at intermediate and high risk. For women at high risk who have a contraindication to magnetic resonance imaging, whole-breast ultrasonography or molecular breast imaging may be an appropriate option.
Dr. Falcon and colleagues noted that as public awareness of breast density as a risk factor has increased, so have legislation and notification laws regarding the issue. They believe that although additional studies are needed to evaluate optimal supplemental screening strategies, screening will ultimately require a personalized approach based on risk assessment.
