- Combining higher breast density with a calculator for high 5-year risk for advanced breast cancer offers a more efficient strategy than using dense breasts alone to target women for discussions of supplemental imaging.
Why this matters
- US legislation proposes an inefficient strategy of targeting all women with dense breasts for supplemental imaging discussions.
- Editorialist Ilana B. Richman, MD, is skeptical of any strategy to legislate such physician-initiated discussions.
- Prospective cohort of 638,856 women undergoing screening mammograms at Breast Cancer Surveillance Consortium (BCSC) imaging facilities, 2005-2014.
- Primary outcomes include advanced breast cancer (≥stage IIb) within 12 months of screening mammography and BCSC calculator for advanced cancer rates of ≥0.61 cases per 1000 mammograms, the top 25th percentile of advanced cancer rates.
- Funding: NIH; Patient-Centered Outcomes Research Institute; others.
- High advanced breast cancer rates occurred in women with:
- Heterogeneously dense breasts and a 5-year risk BCSC calculator of ≥2.5% (6.0% of screened women).
- Extremely dense breasts and a 5-year BCSC risk calculator of ≥1.0% (6.5% of screened women).
- Using a hypothetical cohort of 100,000 women, these 2 categories accounted for 1097 discussions per potential advanced cancer prevented vs 1866 such discussions for all women with dense breasts.
- Observational design.