What are the management and screening options for individuals with dense breasts?

From the Guidelines

Individuals with dense breasts should undergo regular mammography screening as recommended for their age and risk factors, with consideration for supplemental screening methods, such as digital breast tomosynthesis (3D mammography) or ultrasound, to improve cancer detection and reduce the risk of false-negative results. For women with dense breasts, standard digital mammography remains the primary screening tool, but additional imaging may be beneficial due to the limitations of mammography in dense tissue 1. Supplemental screening options, such as digital breast tomosynthesis (3D mammography), which improves cancer detection by about 40% compared to standard mammography, and ultrasound, which can detect small cancers not visible on mammography, may be considered 1. Breast MRI may also be recommended for those at high risk. Management should be personalized based on individual risk factors, including family history, genetic mutations, and prior breast biopsies. Women should be informed about their breast density and its implications for cancer detection and risk. Lifestyle modifications, such as maintaining a healthy weight, limiting alcohol consumption, and regular physical activity, may help reduce breast cancer risk. Regular clinical breast exams by healthcare providers complement imaging studies. Dense breast tissue is common, affecting approximately 40-50% of women, and is itself a modest risk factor for breast cancer, making appropriate screening particularly important for this population.

Some key points to consider:

• The American College of Radiology (ACR) recommends that women with dense breasts be informed about their breast density and its implications for cancer detection and risk 1.
• The US Preventive Services Task Force (USPSTF) recommends that women with dense breasts discuss the benefits and harms of supplemental screening with their healthcare provider 1.
• The American College of Physicians (ACP) recommends that clinicians discuss the potential benefits and harms of screening for breast cancer with mammography before age 50 years with average-risk women aged 40 to 49 years 1.

Overall, the management and screening options for individuals with dense breasts should be personalized and based on individual risk factors, with consideration for supplemental screening methods to improve cancer detection and reduce the risk of false-negative results.

From the Research

Management and Screening Options for Individuals with Dense Breasts

• Individuals with dense breasts face an increased risk of late diagnosis of breast cancer due to the decreased sensitivity of mammography for screening 2.
• The European Society of Breast Imaging (EUSOBI) recommends that women with extremely dense breasts be informed about their breast density and offered screening breast MRI every 2 to 4 years 2.
• Supplemental screening options for women with dense breasts include ultrasound, MRI, digital breast tomosynthesis, and molecular breast imaging 3.
• The U.S. Food and Drug Administration has approved an automated breast ultrasound system for screening whole-breast ultrasound in patients with dense breasts 3.
• Women with extremely dense breasts account for approximately 10% of the screening population and face an increased lifetime risk of developing breast cancer 4.
• Several research initiatives have attempted to address the diagnostic challenge of dense breasts by incorporating supplemental imaging modalities such as ultrasound, MRI, and contrast-enhanced mammography 4.

Recommendations and Guidelines

• The EUSOBI recommends that women aged 50 to 70 years with extremely dense breasts be offered screening breast MRI every 2 to 4 years 2.
• The U.S. Preventive Services Task Force and the American College of Radiology (ACR) have issued guidelines that address breast cancer screening for women with dense breasts, but found insufficient evidence to recommend for or against magnetic resonance screening 5.
• The ACR advises consideration of ultrasonography for supplemental screening for women with dense breasts 5.
• Primary care providers can discuss breast density and recommend supplemental breast cancer screening using the density of the previous mammography, reducing the burden of additional appointments and increasing the number of patients choosing to have supplemental screening 6.

Key Considerations

• Breast density is an independent risk factor for the development of breast cancer, and women with dense breasts face an increased risk of late diagnosis of breast cancer 2, 3.
• The sensitivity of mammography is significantly reduced in women with dense breasts, making supplemental screening options necessary 2, 4.
• Women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method 2.