Supplemental Screening Based on Breast Density Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in average-risk women with dense breasts. This is not currently widely used in clinical practice. Variant 5: Supplemental breast cancer screening. Intermediate-risk females with dense breasts. Women at intermediate risk for breast cancer are defined as having a 15% to 20% lifetime risk [15]. Although there are clear screening guidelines for women with >20% lifetime risk, the screening guidelines have not been clearly defined for women who are at intermediate risk. Women in this category may include patients who have been diagnosed with lobular neoplasia, atypical ductal hyperplasia, previous history of breast cancer, or have a family history of breast cancer without known genetic mutations such as BRCA1/2. The greatest improvement in the CDR with DBT is seen in women with dense breast tissue [21,22,57,58]. Although the TOMMY trial did not reach statistical significance across all breast densities, in women with >50% breast density, statistical significance was achieved with the sensitivity of 2-D mammography plus DBT reaching 93% versus 86% for 2-D mammography alone [21,22]. In a meta-analysis of 16 studies evaluating women with dense breasts, DBT improved the CDR compared with 2-D mammography alone, in both the diagnostic (RR: 1.16) and the screening (RR: 1.33) settings [58]. In addition to the increase in the CDR, another benefit of adding DBT to 2-D mammography is the reduction in the recall rate [16-19]. In a single-center screening program, Sharpe et al [18] reported a reduction in the recall rate by 18.8%. In the prospective Oslo Tomosynthesis Screening Trial, the recall rate was reduced from 6.7/1,000 to 3.6/1,000 [19]. There is also evidence that the reduction in the recall rate is maintained over consecutive screening episodes [18].
Supplemental Breast Cancer Screening Based on Breast Density. Supplemental Screening Based on Breast Density Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in average-risk women with dense breasts. This is not currently widely used in clinical practice. Variant 5: Supplemental breast cancer screening. Intermediate-risk females with dense breasts. Women at intermediate risk for breast cancer are defined as having a 15% to 20% lifetime risk [15]. Although there are clear screening guidelines for women with >20% lifetime risk, the screening guidelines have not been clearly defined for women who are at intermediate risk. Women in this category may include patients who have been diagnosed with lobular neoplasia, atypical ductal hyperplasia, previous history of breast cancer, or have a family history of breast cancer without known genetic mutations such as BRCA1/2. The greatest improvement in the CDR with DBT is seen in women with dense breast tissue [21,22,57,58]. Although the TOMMY trial did not reach statistical significance across all breast densities, in women with >50% breast density, statistical significance was achieved with the sensitivity of 2-D mammography plus DBT reaching 93% versus 86% for 2-D mammography alone [21,22]. In a meta-analysis of 16 studies evaluating women with dense breasts, DBT improved the CDR compared with 2-D mammography alone, in both the diagnostic (RR: 1.16) and the screening (RR: 1.33) settings [58]. In addition to the increase in the CDR, another benefit of adding DBT to 2-D mammography is the reduction in the recall rate [16-19]. In a single-center screening program, Sharpe et al [18] reported a reduction in the recall rate by 18.8%. In the prospective Oslo Tomosynthesis Screening Trial, the recall rate was reduced from 6.7/1,000 to 3.6/1,000 [19]. There is also evidence that the reduction in the recall rate is maintained over consecutive screening episodes [18].