This guideline from the USPSTF is based on current evidence on mammography, digital breast tomography, and supplemental screening for breast cancer. The recommendations apply to asymptomatic women ...

/pdf/screening-for-breast-cancer-u-s-preventive-services-task-4hi5mt179k.pdf

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Background: Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. Methods: In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period. Results: The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening. Conclusions: The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. (Funded by the University Medical Center Utrecht and others.

https://www.nejm.org/doi/suppl/10.1056/NEJMoa1903986/suppl_file/nejmoa1903986_appendix.pdf

Supplemental MRI Screening for Women with Extremely Dense Breast Tissue

This guidance statement from the American College of Physicians, based on review of existing guidelines and evidence underpinning those guidelines, provides advice to clinicians on breast cancer sc...

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

Mammography screening: A major issue in medicine

Screening for Breast Cancer

This systematic review, conducted to inform the new recommendation on breast cancer screening from the USPSTF, addresses supplemental breast cancer screening in women with dense breasts.

/pdf/supplemental-screening-for-breast-cancer-in-women-with-dense-3o8cutv63m.pdf

Kunal Shah

Papers

Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force.