Response to Comment on Thigpen D. et al. The Role of Ultrasound in Screening Dense Breasts—A Review of the Literature and Practical Solutions for Implementation. Diagnostics 2018, 8, 20

Abstract

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.

Mobile Screening Units for the Early Detection of Breast Cancer and Cardiovascular Disease: A Pilot Telemedicine Study in Southern Italy

“…42 In Italy, telemedicine services show different development levels and they are widespread in few regions. 32,[43][44][45][46] This study is the first telemedicine pilot screening developed in Southern Italy. The use of mobile units is the first approach that reaches any area of the Caserta Province, with particular attention to the rural areas bringing assistance and diagnostic equipment.…”

“…The adding of ultrasound to the screening for breast cancer is an approach to reduce the false negative rates of the screening process, especially in the presence of young women. 31,32 Digital mammograms and ultrasound obtained were sent in real time to the operative center in the ''Sant'Anna and San Sebastiano'' hospital, where specialists analyzed images and referred in real time to mobile units.…”

Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma

“…Women with dense breasts encounter two major problems as increased breast density decreases the sensitivity and specificity of mammography and the dense breast itself is a risk factor for developing breast cancer [3].…”

Multi-energy computed tomography breast imaging with Monte Carlo simulations: Contrast-to-noise-based image weighting

“…[ 1 2 3 4 ] The sensitivity for this technique is about 85% and it reduces to 47.8-64.4% for dense breasts. [ 5 ] Breast computed tomography (CT) has been an active area of research with promising outcomes that can reduce the structural overlap of mammography. [ 6 7 8 9 10 ] Boone et al .…”