Supplemental Screening for Patients at Intermediate and High Risk for Breast Cancer

What’s Hot in Breast MRI

“…More recently, MRI has been recommended for higher than average risk women, including women with dense breasts (Figure 6), which is an independent risk factor for breast cancer. 66 In the high-risk male population screening with breast MRI is not frequently used. 67 No RCT studies are available to prove the efficacy of screening breast MRI in the general population, however based on that 1 in 8 Canadian women will develop breast cancer during their lifetime and 1 in 33 will die from it, 68 together with the scientific knowledge that of 9 cancers in 9 asymptomatic women will be all detected by MRI and 3 of the 9 cancers will be detected by mammography or sonography, it makes sense to develop strategies to make available for breast MRI to the general population.…”

“…More recently, MRI has been recommended for higher than average risk women, including women with dense breasts (Figure 6), which is an independent risk factor for breast cancer. 66 In the high-risk male population screening with breast MRI is not frequently used. 67…”

A scoping review of programme specific mammographic breast density related guidelines and practices within breast screening programmes

“… MBD assessment – Yes MBD notification - No “Premature to uniformly notify. But if making the notification, municipalities are required to provide explanations and guidance.” Instance Nationale de l’Evaluation et de l’Accréditation en Santé (INEAS) and the Tunisian Society of Oncology [105] Conditional for either 2021 Guiding supplemental screening “Recommendation addressing SS with US modified from ‘conditional against’ to ‘conditional for either’ due to more favourable ratings by the adoloping panel in terms of equity and feasibility.” American College of Radiology [76] *Usually appropriate – “The imaging procedure is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients” #, %, € May be appropriate – “The imaging procedure may be indicated in the specified clinical scenarios as an alternative to imaging procedures with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal” $ May be appropriate (Disagreement) 2021 Guiding supplemental screening - Yes *DBT screening Guiding supplemental screening $ Insufficient evidence for or against US breast for average risk females with dense breasts but may be appropriate Guiding supplemental screening Limited or no relevant literature regarding the use of # Mammography with IV contrast % MRI breast without and with IV contrast € MRI breast without and with IV contrast abbreviated as a supplemental screening modality for average risk females with dense breasts The American Academy of Family Physicians [77] 2021 Guiding supplemental screening Supports USPSTF recommendation American College of Obstetricians and Gynecologists [106] 2020 MBD notification “Compliance with state laws that may require disclosure to women of their MBD as recorded in a mammogram report.” Guiding supplemental screening - No For asymptomatic women with dense breasts and no other risk factors American Cancer Society [49] , [78] 2007 Guiding supplemental screening “ Insufficient evidence to recommend for or against breast MRI screening for women with heterogeneously or extremely dense breasts.” The National Comprehensive Cancer Network [77] , [107] 2019 Guiding supplemental screening For women with dense breasts, there is insufficent evidence to recommend MRI. “US can increase cancer detection rate but can also result in an increase in recall rates and benign biopsies....…”

“… Key factors Examples of considerations Evidence base Additional evidence is needed relating to: Impact of SS on long term breast cancer outcomes e.g. mortality, survival, and over diagnosis [59] , [74] Impact of MBD notification without offering further specific care for those with dense breasts [30] Clinical and cost-effectiveness of MBD related guidelines within a PB screening programme [54] Resources Resources to be considered in the context of a screening programme include: Skilled expertise [62] , [107] Screening capacity in terms of workforce, equipment, and software [49] , [59] , [109] Workforce planning [62] , [79] , [109] Cost to the healthcare system [20] , [49] , [59] , [71] , [73] , [107] Impact of MBD related guidelines on the HCPs delivering the population-based screening programme in terms of: Their roles and responsibilities The demand on their time [73] , [107] The need for additional education and training to provide such a service and to inform and support screening programme participants [30] , [62] , [63] , [64] MBD classification & measurement Lack of a recommended standardised density measurement tool and criteria for use in a PB screening programme [53] , [54] , [74] , [94] Considerations regarding: The optimal stage to start measuring breast cancer risk as MBD declines with age and menopause The optimal screening interval for screening programme participants with dense breasts and with non-...…”

Predictors of nonadherence to breast cancer screening guidelines in a United States urban comprehensive cancer center

“…[17][18][19][20][21][22][23] Lower rates of guidelinecongruent screening have been reported among average-risk Black women compared with their White counterparts. 22 Whereas prior studies have evaluated potential predictors of supplemental breast cancer screening among high-risk women recruited either from a high-risk screening clinic, [24][25][26] a research study sample, 5 or a sample of women enlisted in the military, 27 to our knowledge, only one other study has examined the use of supplemental breast cancer screening among high-risk women from a general screening population. 10 In this study, we report the rate of guideline-congruent and -incongruent breast cancer screening behaviors among a sample of Black and White women who were part of a general screening population at a large comprehensive cancer center in Detroit, Michigan and report on predictors of congruent and incongruent screening.…”