For every 1000 women having a 2D screening mammogram, about 100 will be called back (“recalled”) for additional testing, resulting in 2-7 breast cancers found [1, 2].
Breast cancer risk increases with increasing age. For women in their 40s, 2 cancers will be found for every 1000 screening mammograms performed. Those 1000 mammograms also result in 120-140 “false positive” recalls (additional testing for findings that do not prove to be cancer). With increasing age, cancer detection rates increase and false positive recalls decrease, because previous mammograms are available for comparison and also because breasts often become less dense. For women over age 75, cancer detection rates average 6-7 per 1000 screening mammograms and false positive recalls average 55-65 per 1000 .
With any screening method, false positive recalls are almost always lower when previous examinations are available for comparison.
Cancers found as a lump or because of other symptoms in the time period between breast screenings are called “interval cancers.” The time period between screens in the United States is typically one year, in most of Europe it is two years, and in the United Kingdom, three years. Interval cancers tend to grow faster and have worse outcomes than screen detected cancers. They are also more common in women with dense breasts, and occur more often if there is a longer time period between screens. Some supplemental screening methods (used after mammography), such as MRI or ultrasound, have been found to reduce the number of interval cancers.
The Table below shows a summary of the expected additional cancer detection (in women of different breast density), effect on the false positive recall rate, and impact on interval cancer reduction using screening imaging methods after standard 2D mammography.*
|Method||Breast Density||Added Cancer |
|Change in False |
Positive Recall Rate
(from 2D 100-120
|1-2 per 1000 [3-5]||-15 to -44 per 1000c [3-5]||Possiblyd [6, 7]||Widespread|
|Extremely dense||Negligible [3, 8, 9]||No significant reduction |
(3, 8, 9]
|2-3 per 1000 ||+75 to 117 per 1000 [10, 11]||Yes [12-14]||Moderate|
|3-4 per 1000 [11, 12]||+70 to 98 per 1000 [11, 12]||Yes||Moderate|
|Ultrasound after |
|2-3 per 1000 [15, 16]||Increase in false positive |
recalls with USf
|MBI||Heterogenously or |
|7-9 per 1000 [17-19]||+54 to 77 per 1000 [17-19]||Unknown||Limited|
|Heterogeneously or |
|Average 10 per 1000 |
(range 7-13 per 1000)
|+65 per 1000 |
(range +29 to +144 per 1000)
|Average 16 per 1000 |
(range 10 – 20 per 1000)
[12, 24, 26, 27]
|+103 per 1000 |
(range +80 to +215 per 1000)
[12, 24, 26]
|All densities||Average 17 per 1000 |
(range 10 – 25 per 1000)
[12, 24, 26-28]
|+87 per 1000 |
(range +42 to +215 per 1000)
12, 24, 26-28]
|All densities||Average 6 per 1000 |
(range 6 – 7 per 1000)
|+23 per 1000 |
(range +16 to +26 per 1000)
*Ranges provided for added cancer detection and change in false positive recall rate estimates account for the differences in estimates obtained from studies. Differences in estimates may be due to factors including study design, the patient populations studied, and the frequency of screening.
a Relative availability listed is for the United States. For European practice by country, see: https://densebreast-info.org/europe/map-screening-guidelines
b In many centers, a “standard” 2D mammogram can be created from the same projection images used to generate the tomosynthesis (“synthetic” 2D mammogram) so that there is no added radiation or second exposure for the 2D mammogram.
c Tomosynthesis has been shown to reduce the recall rate by an average of 20 per 1000 women screened compared to 2D mammography.
d One study showed a slight reduction in interval cancer rates for tomosynthesis compared to standard mammography overall , which was not specific to density category; however, most studies did not show a reduction in interval cancer rates .
e Performance characteristics of screening ultrasound are similar with handheld ultrasound, automated ultrasound, and semi-automated ultrasound.
f In the Italian multicenter ASTOUND-2 trial, ultrasound increased recalls more than tomosynthesis (1.0% vs. 0.3%) after a negative 2D mammogram, but recall rates are not comparable to those in the United States.
g When comparing CEM added cancer detection to MRI, the following should be considered: No screening studies compared CEM to MRI in the same women; MRI screening intervals differed between studies (one year vs. two); and study populations, risk factors, and study designs differed. In addition, two of the four studies used to estimate the CEM added cancer detection rate included a proportion of women who underwent multiple screens at varying intervals; therefore, it may be most appropriate to compare the CEM added cancer detection rate to the overall rate for first and subsequent MRI rounds combined which would be about 13 per 1000 screens.
- Lee CS, Sengupta D, Bhargavan-Chatfield M, Sickles EA, Burnside ES, Zuley ML. Association of Patient Age With Outcomes of Current-Era, Large-Scale Screening Mammography: Analysis of Data From the National Mammography Database. JAMA Oncol. 2017; 3(8):1134-1136.
- Lehman CD, Arao RF, Sprague BL, et al. National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium. Radiology. 2017; 283(1):49-58.
- Rafferty EA, Durand MA, Conant EF, et al. Breast Cancer Screening Using Tomosynthesis and Digital Mammography in Dense and Nondense Breasts. JAMA. 2016; 315(16):1784-1786.
- Skaane P, Bandos AI, Niklason LT, et al. Digital Mammography versus Digital Mammography Plus Tomosynthesis in Breast Cancer Screening: The Oslo Tomosynthesis Screening Trial. Radiology. 2019; 291(1):23-30.
- Conant EF, Zuckerman SP, McDonald ES, et al. Five Consecutive Years of Screening with Digital Breast Tomosynthesis: Outcomes by Screening Year and Round. Radiology. 2020; 295(2):285-293.
- Johnson K, Lang K, Ikeda DM, Akesson A, Andersson I, Zackrisson S. Interval Breast Cancer Rates and Tumor Characteristics in the Prospective Population-based Malmo Breast Tomosynthesis Screening Trial. Radiology. 2021; 299(3):559-567.
- Houssami N, Hofvind S, Soerensen AL, et al. Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: An individual participant data meta-analysis. EClinicalMedicine. 2021; 34:100804.
- Yi A, Chang JM, Shin SU, et al. Detection of noncalcified breast cancer in patients with extremely dense breasts using digital breast tomosynthesis compared with full-field digital mammography. Br J Radiol. 2019; 92(1093):20180101.
- Osteras BH, Martinsen ACT, Gullien R, Skaane P. Digital Mammography versus Breast Tomosynthesis: Impact of Breast Density on Diagnostic Performance in Population-based Screening. Radiology. 2019; 293(1):60-68.
- Berg WA, Vourtsis A. Screening breast ultrasound using hand-held or automated technique in women with dense breasts. J Breast Imaging. 2019; 1:283-296.
- Weigert JM. The Connecticut Experiment; The Third Installment: 4 Years of Screening Women with Dense Breasts with Bilateral Ultrasound. Breast J. 2017; 23(1):34-39.
- Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012; 307(13):1394-1404.
- Corsetti V, Houssami N, Ghirardi M, et al. Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: interval breast cancers at 1 year follow-up. Eur J Cancer.2011; 47(7):1021-1026.
- Harada-Shoji N, Suzuki A, Ishida T, et al. Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open.2021; 4(8):e2121505.
- Tagliafico AS, Calabrese M, Mariscotti G, et al. Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial. J Clin Oncol. 2016; 34(16):1882-1888.
- Tagliafico AS, Mariscotti G, Valdora F, et al. A prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2). Eur J Cancer. 2018; 104:39-46.
- Rhodes DJ, Hruska CB, Conners AL, et al. Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts. AJR Am J Roentgenol. 2015; 204(2):241–251.
- Shermis RB, Wilson KD, Doyle MT, et al. Supplemental breast cancer screening with molecular breast imaging for women with dense breast tissue. AJR Am J Roentgenol. 2016; 207(2):450–457.
- Rhodes DJ, Hruska CB, Phillips SW, Whaley DH, O’Connor MK. Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts. Radiology. 2011; 258(1):106–118.
- Sung JS, Lebron L, Keating D, et al. Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer. Radiology. 2019; 293(1):81–88.
- Sorin V, Yagil Y, Yosepovich A, et al. Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol. 2018; 211(5):W267–W274.
- Gluskin J, Rossi Saccarelli C, Avendano D, et al. Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery. Cancers (Basel). 2020;12(12):3495.
- Hogan MP, Amir T, Sevilimedu V, Sung J, Morris EA, Jochelson MS. Contrast-Enhanced Digital Mammography Screening for Intermediate-Risk Women With a History of Lobular Neoplasia. AJR Am J Roentgenol. 2021; 216(6):1486-1491.
- Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019; 381(22):2091-2102.
- Veenhuizen SGA, de Lange SV, Bakker MF, et al. Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial. Radiology. 2021; 299(2):278-286.
- Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 2020; 323(12):746-756.
- Kuhl CK, Strobel K, Bieling H, Leutner C, Schild HH, Schrading S. Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer. Radiology. 2017; 283(2):361-370.
- Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014; 32(22):2304-2310.