Other Risk Factors Beyond Breast Density Should Be Considered When Recommending Supplemental Ultrasound Screening

New BCSC study examines supplemental ultrasound screening rates in women with dense breasts and in women at high risk of mammography screening failure

Posted by Brian Sprague at 10:00 AM on Jun 20, 2023


Dense breast tissue, which contains a higher proportion of fibrous tissue than fat, is a risk factor for breast cancer and also makes it more difficult to identify cancer on a mammogram. Many states have enacted laws that require women with dense breasts to be notified after a mammogram, so that they can choose to undergo supplemental ultrasound screening to improve cancer detection. Although supplemental ultrasound screening may detect breast cancers missed by mammography, it requires additional imaging and may lead to unnecessary breast biopsies among women who do not have breast cancer. Therefore, it’s important to use supplemental ultrasound only in women at high risk of mammography screening failure—in other words, women who develop breast cancer after a mammogram shows no signs of malignancy.

Brian Sprague, PhD, of the University of Vermont Cancer Center, and his colleagues evaluated 38,166 supplemental ultrasounds and 825,360 screening mammograms without supplemental ultrasounds during 2014–2020 at 32 U.S. imaging facilities within three regional registries of the Breast Cancer Surveillance Consortium. The team found that 95.3% of supplemental ultrasounds were performed in women with dense breasts. In comparison, 41.8% of mammograms without additional screening were performed in women with dense breasts.  Among women with dense breasts, a high risk of interval invasive breast cancer was present in 23.7% of women who underwent ultrasounds, compared with 18.5% of women who had mammograms without additional imaging.  The proportion with intermediate or high risk of advanced cancer was very close between the two groups (32.0% vs. 30.5%).  The findings indicate that ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion of these women were at high risk of mammography screening failure. A similar proportion of women who received only mammograms were at high risk of mammography screening failure. Thus, many women with dense breasts but at low risk of a mammography screening failure underwent ultrasound screening, while many women at high risk of a mammography screening failure underwent mammography alone with no supplemental screening.  Clinicians can consider other breast cancer risk factors beyond breast density to identify women who may be appropriate for supplemental ultrasound screening.

Publicly available risk calculators from the Breast Cancer Surveillance Consortium are available that also consider age, family history, screening frequency, and other factors (https://www.bcsc-research.org/tools).


Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher G, O'Meara ES, Miglioretti DL, Chen S, Lee JM, Stout NK, Mandelblatt JS, Alsheik N, Herschorn SD, Perry H, Weaver DL, Kerlikowske K. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer. 2023 Jun 12. doi: 10.1002/cncr.34768. Epub ahead of print. PMID: 37303202. [Link].


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Posted by: Brian Sprague