However, neither study evaluated the CDR by breast density. MRI Breast Without IV Contrast There is no relevant literature regarding the use of MRI breast without IV contrast for supplemental screening in high-risk women with nondense breasts. FDG-PET Breast Dedicated There is limited relevant literature regarding the use of FDG-PET breast dedicated for supplemental screening in high-risk women with nondense breasts. This is not currently widely used in clinical practice. Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in high- risk women with nondense breasts. This is not currently widely used in clinical practice. Variant 4: Supplemental breast cancer screening. Average-risk females with dense breasts. Mammography remains the only validated screening tool for breast cancer screening. Despite widespread mammographic screening, breast cancer represents the leading cause of cancer mortality in women. Although multiple studies have demonstrated improved survival and reduction in breast cancer mortality by up to 30% with regular mammographic screening, there continues to be approximately 40,000 breast cancer deaths annually [10- 13]. Women who have <15% lifetime risk are considered to be at average risk [15]. 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, addition of DBT improved the CDR, compared with 2-D mammography alone, in both diagnostic (relative risk [RR]: 1.16) and the screening (RR: 1.33) settings [58].
Supplemental Breast Cancer Screening Based on Breast Density. However, neither study evaluated the CDR by breast density. MRI Breast Without IV Contrast There is no relevant literature regarding the use of MRI breast without IV contrast for supplemental screening in high-risk women with nondense breasts. FDG-PET Breast Dedicated There is limited relevant literature regarding the use of FDG-PET breast dedicated for supplemental screening in high-risk women with nondense breasts. This is not currently widely used in clinical practice. Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in high- risk women with nondense breasts. This is not currently widely used in clinical practice. Variant 4: Supplemental breast cancer screening. Average-risk females with dense breasts. Mammography remains the only validated screening tool for breast cancer screening. Despite widespread mammographic screening, breast cancer represents the leading cause of cancer mortality in women. Although multiple studies have demonstrated improved survival and reduction in breast cancer mortality by up to 30% with regular mammographic screening, there continues to be approximately 40,000 breast cancer deaths annually [10- 13]. Women who have <15% lifetime risk are considered to be at average risk [15]. 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, addition of DBT improved the CDR, compared with 2-D mammography alone, in both diagnostic (relative risk [RR]: 1.16) and the screening (RR: 1.33) settings [58].