For women with dense breasts, an additional breast screening test after a mammogram may find cancer not seen on the mammogram alone.
Like a mammogram, each type of additional screening has benefits and things to consider. For instance, there is the possibility of being “called back” or “recalled” for more images and sometimes a biopsy. About 1 in every 10 women having a screening mammogram will be called back for extra views or tests to look at an area of the breast more closely. Any additional screening test may also result in a call back. Talk to your health care provider about which one of these tests is right for you.
Out of 1,000 women, about 15 can be diagnosed with breast cancer each year:
- About 5 women will be diagnosed with breast cancer found on their screening mammogram. This means about 10 women will have a cancer missed by their mammogram.
- To identify those 10 women who have breast cancer, an additional breast screening test can be done. Any additional breast screening test may find cancers and also things that look concerning, but that turn out not to be cancer (false alarms).
Cancer Detection by Screening Test
| If 1,000 Women with Dense Breasts are Screened With: | Number of Women Found to Have Cancer is About: |
|---|---|
| Mammogram ONLY | |
| 2D mammogram alone | 5 |
| 3D mammogram (tomosynthesis) | 6 |
| 2D Mammogram PLUS Common Breast Screening Tests | |
| Ultrasound (sonogram) | 8 |
| Contrast-enhanced MRI | 21 |
| 2D Mammogram PLUS Other Breast Screening Tests | |
| Molecular Breast Imaging (MBI) | 13 |
| Contrast-enhanced mammogram (CEM) | 15 © DenseBreast-info.org Rev. August 2022 |
More to Know About Screening Tests After Your Mammogram
Ultrasound is the most common additional test used after a mammogram. Ultrasound uses sound waves and does not involve radiation or an injection into your vein. Gentle pressure is applied to the breasts and rarely causes discomfort. An Ultrasound test takes about 15 to 20 minutes.
If 1,000 women have an Ultrasound:
- 30 women will have something found on their Ultrasound test and will be recommended to have a needle biopsy (where a small sample of your breast tissue is taken and checked for cancer).
- 2-3 cancers will be found that were not seen on the mammogram.
Magnetic resonance imaging (MRI) involves an injection of a gadolinium contrast solution into your vein that may feel a little cold while it is injected. You lie on your stomach and your breasts fit into two openings. The contrast-enhanced MRI is done in the tunnel of a large magnet. The magnet makes loud noises while images are made. Contrast-enhanced MRI does not use radiation and takes from 10 to 25 minutes.
If 1,000 women have an MRI:
- 50 women will be recommended to have a needle biopsy because of something found on the MRI.
- About 10 additional cancers will be found even after ultrasound and mammography.
Molecular Breast Imaging (MBI) involves an injection of a radiotracer into your vein. About 5 minutes after the injection, each breast is placed between two detectors, similar to a mammogram but with less pressure. The test takes at least 40 minutes.
If 1,000 women have MBI:
- About 30 will be recommended to have a needle biopsy because of something found on MBI.
- About 7 cancers will be found that were not seen on the mammogram.
Contrast-enhanced mammogram (CEM) requires an injection of iodine-based contrast into your vein. This is the same contrast used in CT scans. It makes you feel warm all over and you may even feel like you might pee on yourself. After about 2½ minutes, you will have a CEM. The test takes about 10 minutes.
If 1,000 women have CEM:
- 30-50 women will be recommended to have a needle biopsy because of something found on the CEM.
- About 10 additional cancers will be found that were not seen on their mammograms.
Reference:
Berg WA, Rafferty EA, Friedewald SM, Hruska CB, Rahbar H. Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 216:275-294
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Learn More:
- 5 Facts Every Woman Should Know
- Video Series: Let’s Talk About Dense Breasts
- Patient Risk Checklist (print)
- Patient Questions and Answers