A risk stratified protocol for breast screening for women with dense breasts.

Background and Purpose: In Australia, breast cancer is the most common cancer in women and the second most common cancer, overall. Screening mammography is offered to all eligible women; however, its sensitivity decreases with breast density, although women with dense breasts are at four- to sixfold increased risk of breast cancer compared to women with little or no dense tissue1. This raises significant concern for sensitivity and safety of screening mammograms for women with dense breasts. This article reviews the current evidence regarding the impact of breast density using screening mammography, and the evidence for supplemental screening using tomosynthesis (3-dimensional mammography), ultrasonography (US) and abbreviated magnetic resonance imaging (MRI) in women with dense breasts, defined as BI-RADS (Breast Imaging-Reporting and Data System) C or D. This review is to assist general practitioners and breast surgeons in screening and management of women with BI-RAD C and D breasts. Methods: An online search using MeSH keywords, 'breast density' and 'screening' was performed on National Library of Medicine, National Centre for Biotechnology Information. 10 cohort studies relating to breast density and breast cancer screening were found in the last 10 years. Results: Breast cancer screening via 2-dimentional mammography for women with dense breasts had significantly lower sensitivity compared to women with fatty breasts. Sensitivity for cancer detection was increased, and frequency of interval cancer was decreased by additional screening with 3-dimentional mammography, US, and abbreviated MRI in women with dense breasts. Conclusions: Supplemental screening with 3-dimentional mammography, US and/or abbreviated MRI must be considered in women with dense breasts. We suggest abbreviated MRI and/or US to be used in conjunction with mammogram for average-risk women with BI-RAD C or D breasts. References: 1. Wanders JOP, van Gils CH, Karssemeijer N et al (2018) The combined effect of mammographic texture and density on breast cancer risk: a cohort study. Breast Cancer Res. 20(1):36