Density and tailored breast cancer screening: practice and prediction - an overview

Abstract

Mammography, as the primary screening modality, has facilitated a substantial decrease in breast cancer-related mortality in the general population. However, the sensitivity of mammography for breast cancer detection is decreased in women with higher breast densities, which is an independent risk factor for breast cancer. With increasing public awareness of the implications of a high breast density, there is an increasing demand for supplemental screening in these patients. Yet, improvements in breast cancer detection with supplemental screening methods come at the expense of increased false-positives, recall rates, patient anxiety, and costs. Therefore, breast cancer screening practice must change from a general one-size-fits-all approach to a more personalized, risk-based one that is tailored to the individual woman's risk, personal beliefs, and preferences, while accounting for cost, potential harm, and benefits. This overview will provide an overview of the available breast density assessment modalities, the current breast density screening recommendations for women at average risk of breast cancer, and supplemental methods for breast cancer screening. In addition, we will provide a look at the possibilities for a risk-adapted breast cancer screening.

Keywords: MRI; Screening; breast; breast density; mammography; ultrasound.

Fig. 1.

Image example of the four descriptive breast density categories for mammography defined by the fifth edition of the ACR BI-RADS atlas: ACR-A = the breasts are almost entirely fatty; ACR-B = there are scattered areas of fibroglandular density; ACR-C = the breasts are heterogeneously dense, which may obscure small masses; and ACR-D = the breasts are extremely dense, which lowers the sensitivity of mammography.

Fig. 2.

Model for risk-adapted screening.