Flow Chart: Who Needs More Screening?

Footnotes

MRI = magnetic resonance imaging; DBT = digital breast tomosynthesis; PHBC = personal history of breast cancer; dx = diagnosed; LCIS = lobular carcinoma in situ; ADH = atypical ductal hyperplasia; XRT = radiation therapy; US = ultrasound.

^A Modified from Berg WA et al Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review. AJR 2020, epub 09/10/2020. doi 10.2214/AJR.20.24436

^B While breast self examination and clinical breast examination have not been proven to reduce deaths from breast cancer, women should be familiar with their breasts and promptly report changes to their health provider. For information about cancer detection by modality, see DenseBreast-info.org (Technology Tab/Table: Summary of Cancer Detection Rates for Commonly Available Breast Screening Tests).

^C Using risk models largely dependent on family history; see DenseBreast-lnfo.org (Health Provider Tab/Risk Models).

^D For those who qualify for, but cannot undergo, MRI, consider US or, for women over age 30, contrast-enhanced mammography. Insurance coverage for supplemental screening can vary by state and insurer/payer.

NOTE: This flow chart was developed as an educational tool and reflects the consensus opinion of our medical reviewers based on the best available evidence. The proposed strategy is relatively aggressive, designed to optimize cancer detection. Every technology may not be available at every site. Other guidelines may recommend a later start or different screening frequency. This is not intended to be a substitute for medical advice from a physician or to create a standard of care for health care providers.