Screening Modalities for Women at Intermediate and High Risk for Breast Cancer

Abstract

Breast cancer screening is critically important to detect malignancy at an early stage. Annual mammography remains the gold standard as the imaging modality for patients with an average breast cancer risk. However, women with increased breast cancer risk benefit from supplemental screening using additional imaging modalities. This review summarizes the current recommendations within this patient population. Analysis from ACRIN 6666 demonstrated that the cancer detection rate of ultrasound is comparable to mammography with an increased amount of invasive and node-negative cancers detected. Supplemental ultrasound increased the sensitivity and cancer detection rate in the J-START randomized controlled trial. Abbreviated breast MRI and ultrafast breast MRI have demonstrated effective cancer detection performance in the high-risk population. Women with increased breast cancer risk benefit from supplemental screening using digital breast tomosynthesis, ultrasound, and breast MRI. Molecular breast imaging may be considered in some patients.