From the Guidelines
Heterogeneous dense breast tissue with a BI-RADS 1 assessment indicates normal findings despite dense breast composition, and routine screening can continue as recommended for your age group, typically annual mammograms for women over 40, with consideration of supplemental screening methods such as ultrasound or MRI if additional risk factors are present 1.
Key Points to Consider
- BI-RADS 1 means there is no evidence of cancer, but dense breast tissue can make cancer detection more challenging on mammography alone.
- Women with dense breasts may benefit from supplemental screening methods, especially if they have additional risk factors for breast cancer.
- The heterogeneous density pattern means that the breast contains scattered areas of fibroglandular density throughout the breast, which is a normal variant but can slightly increase breast cancer risk compared to fatty breasts.
- Regular breast self-exams and clinical breast exams by a healthcare provider are also recommended.
Recommendations for Screening
- The American College of Radiology (ACR) recommends annual screening mammography beginning no later than 40 years of age for women at intermediate risk 1.
- For those with a family history of breast cancer, mammography should begin earlier if familial breast cancer occurred at a young age, typically 10 years prior to the youngest age at presentation but generally not before age 30 1.
- Digital breast tomosynthesis (DBT) may be considered as a supplemental screening method, as it has been shown to increase cancer detection rate and decrease recall rate compared to digital mammography alone 1.
Importance of Discussing Risk Profile
- It is essential to discuss your overall risk profile with your healthcare provider to determine the best screening approach for you.
- Factors such as family history, personal history of breast cancer, and breast density should be taken into account when determining the need for supplemental screening methods.
- Your healthcare provider can help you weigh the benefits and risks of different screening options and develop a personalized screening plan.
From the Research
Heterogenous Dense Breast BI-RAD 1
- Heterogenous dense breast tissue is a risk factor for breast cancer and can limit the detection of cancer with mammography 2.
- Women with dense breasts are at a higher risk of breast cancer, and the sensitivity of mammography in this group is reduced due to the masking effect of overlapping tissue 3.
- Supplemental screening methods, such as MRI, digital breast tomosynthesis (DBT), ultrasound (US), and molecular breast imaging, can improve detection in this population 3, 4, 5.
- MRI is the most supported modality, with sensitivity ranging from 81% to 100%, but its use is hindered by high costs, use of contrast, and longer scan times 3, 4.
- Abbreviated MRI protocols aim to overcome these barriers by reducing costs and scan duration 3.
- Ultrasound can approximately double the referral for assessment and increase the detection of breast cancer by supplementary ultrasound screening, but it also results in a higher rate of false positives 5.
- The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography can result in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period 4.