Dense breasts: risk assessment informs need for supplemental imaging

  • Kerlikowske K & al.
  • JAMA Intern Med
  • 1 Jul 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Observational design.