Breast Density and Risk Score Best to ID Women for Supplemental Imaging

JoAnn E. Manson, MD, DrPH


June 09, 2015

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Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I would like to talk to you about a recent report[1] in the Annals of Internal Medicine that I think really helps informed clinical decision-making about the identification of women with dense breasts on mammogram who may benefit from supplemental imaging due to having a high risk for an interval diagnosis of a breast cancer within 1 year of mammography.

This report from the Breast Cancer Surveillance Consortium, the BCSC research group, included more than 365,000 women ages 40-74 years who had digital mammograms at BCSC sites around the country. The researchers also calculated a 5-year breast cancer risk score using the BCSC criteria, which included age, race, ethnicity, family history of breast cancer in a first-degree relative, Breast Imaging Reporting and Data System (BI-RADS) score, and a prior history of breast biopsy. If you want to learn more about the score, you can go to It's also downloadable at the app store if you want to be able to access it from a mobile app. The researchers concluded that the combination of having extremely dense breasts plus a 5-year risk score of ≥ 1.67% identified women who are at high risk for interval breast cancer. Having heterogeneously dense breasts and a 5-year breast cancer risk score of ≥ 2.5% also identified high-risk women.

The authors suggested that using a combination of breast density and an elevated 5-year breast cancer risk score would be an efficient way of identifying women who are most likely to benefit from supplemental imaging. Approximately 24% of women with dense breasts would fall into this category. We know that increased breast density is a risk factor for breast cancer and that it can also obscure breast tumors, so it is important to understand which women would benefit the most from supplemental imaging. About 21 US states now have legislation requiring BI-RADS reporting, and they also encourage women to discuss supplemental imaging with their clinicians. Federal legislation for BI-RADS reporting is also under review.

This issue could potentially affect tens of millions of women; therefore, it is important to understand which women are most likely to benefit. About 40% of women will have dense breasts on BI-RAD, which is defined by BI-RADS categories of extremely dense or heterogeneously dense breasts. This report suggests a way to identify women who are most likely to benefit from supplemental imaging. It will also be important to understand which strategies for imaging are most effective. MRI, tomosynthesis, and other methods deserve evaluation. Thank you so much for your attention. This is JoAnn Manson.


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