Supplemental Screening for Breast Cancer

Increased breast density, among other calculated risk factors, decreases the sensitivity of screening mammography. Several supplementary imaging modalities including breast ultrasound, breast MRI, contrast-enhanced mammography (CEM), and molecular breast imaging (MBI) can be used in addition to screening mammograms to increase the sensitivity of cancer detection in above-average-risk women and will be discussed here. Ultrasound is the most widely used and accessible supplementary screening method that improves the cancer detection rate. MRI, the most sensitive supplemental breast imaging modality, is used to detect and visualize additional cancers in those with a lifetime risk of breast cancer at or greater than 20%. Small studies indicate that CEM has cancer detection rates equivalent to MRI; nevertheless, more evidence is needed to demonstrate its use. MBI has shown promise to be an adjunct to mammography for patients with dense breasts and for situations in which breast MRI is contraindicated. Despite this promising research, the American College of Radiology currently does not recommend the use of MBI for screening. In women who have a higher-than-average risk of developing breast cancer, additional imaging modalities, such as breast ultrasound, breast magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging, can be used in conjunction with screening mammograms to increase the sensitivity of cancer detection.