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%), then 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 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. The addition of WBUS to mammography increases the CDR in high-risk women. In a surveillance cohort study of 529 women with elevated lifetime risk, the sensitivity of mammography, WBUS, and the 2 modalities combined was 33%, 40%, and 49%, respectively [44]. However, subgroup analysis was not performed by breast density. In Supplemental Screening Based on Breast Density the same population, MRI had a sensitivity of 91% [44]. In the ACRIN 6666 trial, after 3 rounds of screening mammography and screening WBUS in women with dense breast tissue at intermediate to elevated lifetime risk, the sensitivity, specificity, and PPV3 of mammography was 0.52, 0.91, and 0.38, respectively. The addition of US to mammography increased the sensitivity (0.76) but decreased the specificity (0.84) and PPV3 (0.38) [45]. In a prospective cohort trial of 687 high-risk women, the cancer yield of mammography alone was 5.4/1,000 and increased to 7.7/1,000 with the addition of US [46].
Supplemental Breast Cancer Screening Based on Breast Density. 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%), then 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 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. The addition of WBUS to mammography increases the CDR in high-risk women. In a surveillance cohort study of 529 women with elevated lifetime risk, the sensitivity of mammography, WBUS, and the 2 modalities combined was 33%, 40%, and 49%, respectively [44]. However, subgroup analysis was not performed by breast density. In Supplemental Screening Based on Breast Density the same population, MRI had a sensitivity of 91% [44]. In the ACRIN 6666 trial, after 3 rounds of screening mammography and screening WBUS in women with dense breast tissue at intermediate to elevated lifetime risk, the sensitivity, specificity, and PPV3 of mammography was 0.52, 0.91, and 0.38, respectively. The addition of US to mammography increased the sensitivity (0.76) but decreased the specificity (0.84) and PPV3 (0.38) [45]. In a prospective cohort trial of 687 high-risk women, the cancer yield of mammography alone was 5.4/1,000 and increased to 7.7/1,000 with the addition of US [46].