For every 1000 women screened with 2D mammography, approximately 100 women will be recalled for additional testing and 2-7 women (depending on the age and risk factors of the woman) will be found to have breast cancer [1].
Breast cancer incidence increases as women get older: for women in their 40s, cancer detection rates on mammography are closer to 2 per 1000 and “false positive” recalls are 120-140 per 1000. With increasing age, cancer detection rates increase and false positive recalls decrease (in part because prior mammograms are available for comparison and in part because breasts are less “busy” as women get older). For women over age 75, cancer detection rates average 6-7 per 1000 and false positive recalls average 55-65 per 1000 [1].
With any screening method, false positive recalls (for additional testing for findings that do not prove to be cancer) are almost always reduced when prior examinations are available for comparison, i.e. in subsequent or “incident” screening rounds.
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 type of cancers seen using screening imaging methods after standard 2D mammography.
| Method | Breast Density | Added Cancer Detection | Projected Impact on False Positive Rate | Types of Cancers Seen |
|---|---|---|---|---|
| Tomosynthesis (3D mammography)a | Scattered fibroglandular density or Heterogeneously dense | 1-2 per 1000 [1-3] | Overall decrease in false positive recalls to 80 to 90 per 1000; May drop to 60 to 70 per 1000 after multiple screening rounds (based on a single-center study) [5] | The cancers seen only on tomosynthesis are nearly all invasive; greatest detection benefit and shift to smaller, better prognosis cancers seen in women 40-49 years old [6] |
| Tomosynthesis (3D mammography)a | Extremely dense | Negligible [2, 7, 8] | No significant reduction in false positive recall rate | Not applicable |
| Ultrasound (US) (first round) | Heterogeneously dense or Extremely dense | 2-3 per 1000 [9] | Increase in false positive recalls to 170 to 200 per 1000 | More than 85% of cancers seen only on US are invasive; 82-90% are node negative [9] (still contained within the breast) |
| Ultrasound (US) (subsequent rounds) | Heterogeneously dense or Extremely dense | 2-3 per 1000 | Increase in false positive recalls to 150 to 170 per 1000 [10, 11] | More than 85% of cancers seen only on US are invasive; 82-90% are node negative [9] (still contained within the breast) |
| Ultrasound vs. tomosynthesis | Heterogeneously dense or Extremely dense | 2-3 per 1000 more with US [12, 13] | Increase in false positive recalls with USb | |
| MRI (first round) | Extremely dense | 16 per 1000 [14] | Increase in false positive recalls to 178 per 1000 | 13 per 1000 invasive cancer yield (3 per 1000 are non-invasive, i.e. DCIS) seen only on MRI |
| MRI (subsequent rounds) | Extremely dense | 6 per 1000 [15] | Increase in false positive recalls to 127 per 1000 | 4 per 1000 invasive cancer yield (2 per 1000 are non-invasive, i.e. DCIS) seen only on MRI |
| Abbreviated (“fast” or “mini”) MRI after tomosynthesisc | Heterogeneously dense or Extremely dense | 10 per 1000 [16] | Increase in false positive recalls: 133 per 1000 for MRI vs. 26 per 1000 for tomosynthesis | 7 per 1000 invasive cancer yield (3 per 1000 are non-invasive) seen only on MRI in first round of screening © DenseBreast-info.org and Dr. Wendie Berg |
a 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.
b 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.
c In this prospective trial across 48 centers in the United States and Germany, abbreviated MRI was compared to tomosynthesis (3D mammography).
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