For every 1000 women having a 2D screening mammogram:
- About 100 (10%) will be recommended to return (“recalled”) for additional testing.
- About 95 (95%) of those recalled will have findings that turn out not to be cancer (“false positives”).
- About 2-7 breast cancers will be found (depending on age)[1, 2].
Tomosynthesis (3D mammography) is often used for screening in the U.S. and increases cancer detection across all breast densities by 1 to 2 cancers per 1000 women screened [3-7] and reduces recalls to about 84 per 1000 [3-6].
Breast cancer incidence increases with age and false positives decrease with age.
Cancers found because of a lump or other symptoms after a normal screening mammogram and before the next routine screening are called “interval cancers.” Interval cancers tend to grow faster and have worse outcomes than screen-detected cancers. Interval cancers are much more common in women with dense breasts. Interval cancers occur more often if there is a longer time period between screens. Supplemental screening methods (used after mammography), such as MRI or ultrasound, are proven to improve detection of cancers not seen on mammography and to reduce the number of interval cancers.
Results from supplemental screening in dense breasts after mammography are summarized in the table.
| Method | Added Cancer Detection per 1000 Women Screeneda | Change in False Positive Recall Rate per 1000 Womena | Availabilityb |
|---|---|---|---|
| Ultrasound | |||
| After 2D mammography (first round)c | 2-3 [9] | +75 to 117 [9, 10] | Moderate |
| After 2D mammography (subsequent rounds) | 3-4 [10, 11] | +70 to 98 [10, 11] | Moderate |
| After tomosynthesis (first round) | 1-3 [12-15] | +45 [14]d | Moderate |
| After tomosynthesis (subsequent rounds) | 1 [14] | 37 [14] | Moderate |
| Molecular Breast Imaging | |||
| After 2D mammography | 7-9 [16-18] | +56 to 77 [16-18] | Limited |
| After tomosynthesis (first round) | 6 [19] | +89 [19] | Limited |
| After tomosynthesis (subsequent rounds) | 4 [19] | +42 [19] | Limited |
| Contrast-Enhanced Mammography | |||
| Added to 2D mammography (first round) | 7-13 [20-22]e | +29 to +144 [20-22] | Limited |
| Added to tomosynthesis (first round) | 7-10 [23, 24] | +52 to 132 [23, 24] | Limited |
| Added to tomosynthesis (subsequent rounds) | 4 [24] | +46 [24] | Limited |
| MRI/Abbreviated MRI | |||
| After 2D mammography (first round) | 14 – 20 [11, 25, 26] | +80 to +215 [11, 25, 26] | Moderate for high-risk women |
| After 2D mammography (subsequent rounds) | 6 [27] | +26 [27] | Moderate for high-risk women |
| After tomosynthesis (first round) | 10 [28] | +107 [28] | Moderate for high-risk women |
| After tomosynthesis (subsequent rounds) | 3 [29] | +33 [29] | Moderate for high-risk women © DenseBreast-info.org, Dr. Wendie Berg, Dr. Robin Seitzman |
a Ranges provided for added cancer detection and change in false positive recall rate estimates account for differences in estimates from studies. Differences in estimates are due to differences in study design, methods, patient populations studied, and frequency of screening.
b Relative availability listed is for the United States. For European practice by country, see: https://densebreast-info.org/europe/map-screening-guidelines
c Performance characteristics of screening ultrasound are similar with handheld ultrasound, automated ultrasound, and semi-automated ultrasound [8].
d In the Italian multicenter ASTOUND-2 trial, ultrasound increased recalls more than tomosynthesis (1.0% vs. 0.3%) after a negative 2D mammogram, but absolute recall rates are not comparable to those in the United States.
e When comparing added cancer detection from CEM to that from 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 10 per 1000 screens.
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