Breast cancer is the second leading cause of cancer death in women. Estimates indicate a nearly 40% breast cancer mortality reduction when screening women annually starting at age 40. Although mammography is well known to be a powerful screening tool in the detection of early breast cancer, it is imperfect, particularly for women with dense breasts. In women with dense breast tissue, the sensitivity of mammography is reduced. Additionally, women with dense breasts have an increased risk of developing breast cancer while mammography has a lower sensitivity. Screening ultrasound, both handheld and automated, is effective in detecting mammographically occult cancer in women with dense tissue. Studies have shown that ultrasound significantly increases detection of clinically important, small, largely invasive, node-negative cancers. The purpose of this review article is to summarize the literature to date regarding screening breast ultrasound, emphasizing differences in cancer detection in high risk and intermediate risk women, and to discuss practical ways to implement screening ultrasound in clinical practice, including automated whole breast ultrasound, as a viable solution to the increasing need for additional screening.

Thank you for your thoughtful comments regarding breast density legislation. We welcome the opportunity for deeper engagement on this important topic. There is great variation in the language used in individual state laws informing women of breast density and we regret that this important discussion was beyond the scope of our manuscript. As discussed in the comment, some states only inform women of the concept of dense breast tissue and do not inform the woman of her individual breast density. This can cause confusion for a woman receiving the letter about her own personal status and what her next steps should be. There is a need for more universal language disclosing the woman's personal density as well as the benefit of additional screening. Many radiologists are familiar with the calls from worried patients who have just received their letter in the mail regarding breast density. This is an opportunity to provide patient-centered, value-added care. Our expertise as radiologists provide us with an opportunity to inform, educate and advise the patient on the issue of breast density. Radiologists are the best equipped to discuss the potential benefits (such as increased cancer detection) and potential disadvantages (such as false positives) that are inherent to adjunct screening modalities, such as MRI and Ultrasound. As the legislative landscape continues to evolve, radiologists should strive to engage with their patients in order to lead the way forward in patient-centered care. Conflicts of Interest: The author declares no conflict of interest.

Objective To compare cancer detection rate (CDR), patient recall, and interpretation time of a full protocol MRI (fpMRI) to an abbreviated MRI protocol (abMRI) in high-risk women. Methods This retrospective study was approved by the IRB. All sequential high-risk screening MRI examinations performed between January 1, 2013, and December 31, 2016, were included. Breast radiologists reviewed patient history, prior images, and abMRI images and recorded their interpretation. Time for interpretation reflected review of the MRI study but not dictation or report generation. Following a minimum 30-day washout period, radiologists interpreted the fpMRI, with interpretation and timing recorded. Data collected included CDR, interpretation time, and patient recall rate. Statistical analyses utilized were Cohen’s kappa coefficient, Student’s t-test, and McNemar’s test. Results Included were 334 MRI examinations of 286 women. Interpretation time was 60.7 seconds for the abMRI compared to 99.4 seconds for the fpMRI, with an average difference of 38.7 ± 5.4 seconds per patient (P < 0.0001). Recall rates were comparable: the abMRI recall rate was 82/334 (24.6%) and the fpMRI 81/334 (24.3%). All five cancers included were detected by both protocols with equal recall rate. However, there were more recommendations for biopsy with the fpMRI, although this difference was not statistically significant. Conclusion The abMRI demonstrated comparable CDR to fpMRI, with shortened interpretation time and similar recall rates. Implementing an abMRI to screen high-risk women reduces imaging and interpretation time, thereby improving cost-effectiveness and the patient experience without reduction in cancer detection.

No abstract

No abstract