Identifying High-Risk Women for Discussion of Supplemental Imaging During Screening

By Karla Kerlikowske, MD on July 05, 2019

In the JAMA Internal Medicine article published July 1, 2019, titled “Strategies to Identify Women at High Risk of Advanced Breast Cancer During Routine Screening for Discussion of Supplemental Imaging,” Dr. Kerlikowske et al present evidence to support discussion of supplemental imaging in women at high risk of advanced breast cancer rather than with all women with dense breasts. The investigators conducted a study that included 638,856 women between the ages of 40 and 74 who underwent 1.7 million screening digital mammograms at Breast Cancer Surveillance Consortium (BCSC) imaging facilities between January 2005 and December 2014. The study found BI-RADS breast density combined with BCSC 5-year risk is the best predictor of advanced breast cancer, more so than breast density alone or breast density and age. Providing information on breast density alone without considering breast cancer risk does not allow for the most informed clinical decisions to be made about appropriate use of supplemental imaging. In discussions of supplemental imaging with women at high risk of advanced disease, these women are also at high risk of a false-positive biopsy. Women at high risk of advanced disease need to decide if the potential of detecting advanced disease early with supplemental imaging is outweighed by the more than 10-fold greater chance of a false-positive biopsy.

Full Text Citation & Link: Kerlikowske K, Sprague BL, Tosteson ANA, Wernli KJ, Rauscher GH, Johnson D, Buist DSM, Onega T, Henderson LM, O'Meara ES, Miglioretti DL. Strategies to Identify Women at High Risk of Advanced Breast Cancer During Routine Screening for Discussion of Supplemental Imaging. JAMA Intern Med. 2019 Jul 1. doi: 10.1001/jamainternmed.2019.1758. [Link to Article]

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