In women with a personal history of breast cancer, the supplemental CDR of screening US has been reported to be 2.88/1,000 [34]. There was no difference in the CDR based on breast density or age. However, the authors reported an interval cancer rate of 1.5/1,000, which was higher in women who were <50 years of age and in those with dense breast tissue, indicating the failure of screening US in the 2 subgroups. Cortesi et al [35] evaluated the efficacy of biannual screening US examination in women who were BRCA mutation carriers, high-risk (non-BRCA1/2), and intermediate-risk patients. Overall, MRI had sensitivity of 93.7%, followed by mammography (55.0%) and US (29.4%). In the nondense breast, the sensitivity of mammography was 82.5% versus 10% for US. In the dense breast, the sensitivity of mammography was 50% versus 42.6% for US. Sensitivity analysis by risk level was also performed. The US sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and 12 Supplemental Screening Based on Breast Density intermediate-risk patients were 22.7%, 24.5%, and 33.6%, respectively. The mammographic sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 25.0%, 66.4%, and 56.6%, respectively. Only the BRCA1/2 mutation carriers underwent MRI screening, which demonstrated a sensitivity of 93.7%. The authors did not analyze the efficacy of US screening based on both density and risk. Although the supplemental screening debate was initiated partly because of the limitations of screening mammography in women with dense breast tissue, there is some evidence to suggest that breast density alone may not be sufficient reason to recommend supplemental screening. One way to assess the failure of mammography is by determining the interval cancer rate in the study population.
Supplemental Breast Cancer Screening Based on Breast Density. In women with a personal history of breast cancer, the supplemental CDR of screening US has been reported to be 2.88/1,000 [34]. There was no difference in the CDR based on breast density or age. However, the authors reported an interval cancer rate of 1.5/1,000, which was higher in women who were <50 years of age and in those with dense breast tissue, indicating the failure of screening US in the 2 subgroups. Cortesi et al [35] evaluated the efficacy of biannual screening US examination in women who were BRCA mutation carriers, high-risk (non-BRCA1/2), and intermediate-risk patients. Overall, MRI had sensitivity of 93.7%, followed by mammography (55.0%) and US (29.4%). In the nondense breast, the sensitivity of mammography was 82.5% versus 10% for US. In the dense breast, the sensitivity of mammography was 50% versus 42.6% for US. Sensitivity analysis by risk level was also performed. The US sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and 12 Supplemental Screening Based on Breast Density intermediate-risk patients were 22.7%, 24.5%, and 33.6%, respectively. The mammographic sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 25.0%, 66.4%, and 56.6%, respectively. Only the BRCA1/2 mutation carriers underwent MRI screening, which demonstrated a sensitivity of 93.7%. The authors did not analyze the efficacy of US screening based on both density and risk. Although the supplemental screening debate was initiated partly because of the limitations of screening mammography in women with dense breast tissue, there is some evidence to suggest that breast density alone may not be sufficient reason to recommend supplemental screening. One way to assess the failure of mammography is by determining the interval cancer rate in the study population.