The Role of Ultrasound in Screening Dense Breasts—A Review of the Literature and Practical Solutions for Implementation

Abstract

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.

Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography

“… 20 However, results according to breast density were not described in detail, 21 , 22 and further studies investigating specific breast density groups have been solicited. 21 , 23 This secondary analysis of the J-START RCT aimed to address issues related to performance of each modality according to differences in breast density.…”

Ultrasound for Breast Cancer Screening in High-Risk Women: Results From a Population-Based Cancer Screening Program in China

“…Therefore, such limitation of mammography may limit the its screening efficacy in population having a high proportion of dense breast. Ultrasound has the potential of detecting small nodules and is also widely accessible and affordable in countries having limited and unbalanced health resources (8–10). The current breast cancer screening guidelines recommended that ultrasound could be served as an auxiliary screening method to mammography (5, 11).…”

Characterization of breast masses: a comparative study between automated breast ultrasound (ABUS) and digital breast tomosynthesis (DBT)

“…Ultrasound is essential for the characterization of breast masses. It is commonly employed as an adjunct to diagnostic clinical mammography and as an aid to screening mammography in dense breasts [5].…”