Screening breast US in women with mammographically dense breasts, including those with risk factors placing them at increased breast cancer risk, identifies mammographically occult, small, node-negative invasive tumors with an increased CDR of 1.8 to 4.6 cancers per 1,000 women screened [40,49]. Although supplemental screening US in women with dense breasts results in an increased CDR, US also increases recall rate, false-positive examinations, and false-positive biopsies [26,49-55]. Data regarding supplemental screening US in average-risk women with nondense breasts is less compelling. In a study of 1,526 average-risk women without mammographic abnormalities, screening with US demonstrated an overall incremental CDR of 3.3 per 1,000, with 5.1 per 1,000 examinations in dense breasts and 0 per 1,000 in nondense breasts compared to digital mammography [56]. In another study of 1,003 average-risk women, US yielded an overall incremental CDR of 3.2 per 1,000 examinations, with 0 per 1,000 in nondense breasts, compared to DBT with or without digital mammography [53]. Digital Breast Tomosynthesis Screening DBT displays reconstructed stacked images of the breast in combination with digital mammographic views, which may be synthetic mammograms reconstructed from the acquired tomosynthesis dataset or FFDM. Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases CDR and decreases recall rate [14-22]; although, some studies have not reached statistical significance [23] or have found less compelling results in subsets of women, such as those with extremely dense breasts [24,25]. Dense breast tissue decreases the sensitivity of mammography [26] and is an independent risk factor for developing breast cancer [27].
Female Breast Cancer Screening. Screening breast US in women with mammographically dense breasts, including those with risk factors placing them at increased breast cancer risk, identifies mammographically occult, small, node-negative invasive tumors with an increased CDR of 1.8 to 4.6 cancers per 1,000 women screened [40,49]. Although supplemental screening US in women with dense breasts results in an increased CDR, US also increases recall rate, false-positive examinations, and false-positive biopsies [26,49-55]. Data regarding supplemental screening US in average-risk women with nondense breasts is less compelling. In a study of 1,526 average-risk women without mammographic abnormalities, screening with US demonstrated an overall incremental CDR of 3.3 per 1,000, with 5.1 per 1,000 examinations in dense breasts and 0 per 1,000 in nondense breasts compared to digital mammography [56]. In another study of 1,003 average-risk women, US yielded an overall incremental CDR of 3.2 per 1,000 examinations, with 0 per 1,000 in nondense breasts, compared to DBT with or without digital mammography [53]. Digital Breast Tomosynthesis Screening DBT displays reconstructed stacked images of the breast in combination with digital mammographic views, which may be synthetic mammograms reconstructed from the acquired tomosynthesis dataset or FFDM. Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases CDR and decreases recall rate [14-22]; although, some studies have not reached statistical significance [23] or have found less compelling results in subsets of women, such as those with extremely dense breasts [24,25]. Dense breast tissue decreases the sensitivity of mammography [26] and is an independent risk factor for developing breast cancer [27].