Follow-Up Recommendations for Heterogeneously Dense Breasts on Mammogram

Understanding Breast Density and Its Implications

Heterogeneously dense breast tissue is common, affecting approximately half of women undergoing screening mammography, according to the American Cancer Society 3, 4
Dense breast tissue presents two significant challenges: reduced mammographic sensitivity (30-48% decrease in extremely dense breasts) and is an independent risk factor for breast cancer development, as stated by the American College of Radiology 1, 2
Women with heterogeneously dense breasts experience both higher risk of developing breast cancer and greater risk of cancer not being detected on standard mammography, as reported by the American College of Radiology 1

The American College of Radiology recommends supplemental screening with breast MRI or abbreviated breast MRI (AB-MRI) to improve cancer detection rates and reduce interval cancers in women with heterogeneously dense breasts 1, 2
AB-MRI demonstrated a cancer detection rate of 15.2 per 1,000 examinations compared to 6.2 per 1,000 with digital breast tomosynthesis (DBT) in women with dense breasts, according to the American College of Radiology 2
Cancers detected by MRI tend to be smaller, lymph node negative, and less biologically aggressive, as stated by the American College of Radiology 1

Digital Breast Tomosynthesis (DBT) improves lesion characterization in non-calcified lesions compared to conventional mammography and shows increased cancer detection rates in both dense and non-dense breast tissue, as reported by the American College of Radiology 1, 5, 6
Whole Breast Ultrasound may be considered as a supplemental screening option for women with dense breasts, but comes with higher false-positive rates and lower positive predictive values for biopsies, according to the American College of Radiology 1, 2

The American College of Radiology now recommends that patients be notified of their breast density and informed that supplemental imaging may be beneficial, with a strength of evidence level of moderate to high 1
Risk assessment should be performed for all women by age 25 to better stratify screening recommendations, as stated by the American College of Radiology 1