No Evidence for Alternative Screening of Dense Breast Tissue

Although numerous states have adopted laws requiring caregivers to inform women with dense breast tissue of an increased risk for breast cancer and to discuss alternative breast screening methods with those patients, the American College of Obstetricians and Gynecologists (ACOG) says there is no evidence to support alternative screening for asymptomatic women with no additional risk factors.

Women with dense breasts have a "modestly increased risk" for breast cancer and reduced sensitivity to mammography, the ACOG Committee on Gynecologic Practice of acknowledged in an opinion published in the April issue of Obstetrics & Gynecology. However, the committee said there is no evidence that alternative screening techniques, such as tomosynthesis or thermography, or adjunctive screening methods, such as ultrasound or magnetic resonance imaging, improve breast cancer mortality in asymptomatic women with no other risk factors. "[E]vidence is lacking to advocate for additional testing until there are clinically validated data that indicate improved screening outcomes," the authors write.

The committee notes that digital mammography has been shown to be more effective than film mammography in women with extremely dense tissue.

The report indicates that women with extremely dense breasts, who make up about 8% of the population, have a relative breast cancer risk of 1.4 compared with the risk for women with average breast density. Women with heterogeneously dense tissue (39% of the population) had a relative risk of 1.2. Screening sensitivity fell from 88% in breasts composed almost entirely of fat to 62% in extremely dense tissue, the report showed. Sensitivity of screening heterogeneously dense tissue was 69%.

In states with laws that require caregivers to inform women with dense breast tissue of an increased risk for breast cancer, ACOG recommends that healthcare providers comply with the laws despite the lack of proven benefit from alternative screening methods.

Obstet Gynecol. 2014;123:910-911.

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