title: Beyond mammography: new frontiers in breast cancer screening.
abstract: Breast cancer screening remains a subject of intense and, at times, passionate debate. Mammography has long been the mainstay of breast cancer detection and is the only screening test proven to reduce mortality. Although it remains the gold standard of breast cancer screening, there is increasing awareness of subpopulations of women for whom mammography has reduced sensitivity. Mammography also has undergone increased scrutiny for false positives and excessive biopsies, which increase radiation dose, cost, and patient anxiety. In response to these challenges, new technologies for breast cancer screening have been developed, including low-dose mammography, contrast-enhanced mammography, tomosynthesis, automated whole breast ultrasound, molecular imaging, and magnetic resonance imaging. Here we examine some of the current controversies and promising new technologies that may improve detection of breast cancer both in the general population and in high-risk groups, such as women with dense breasts. We propose that optimal breast cancer screening will ultimately require a personalized approach based on metrics of cancer risk with selective application of specific screening technologies best suited to the individual's age, risk, and breast density.
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. jennifer.drukteinis@moffitt.org
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Drukteinis
authors.forename: Blaise P
authors.initials: BP
authors.lastname: Mooney
authors.forename: Chris I
authors.initials: CI
authors.lastname: Flowers
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gatenby
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000639:trends*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D057054:Molecular Imaging; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media
references.citation: Eur J Epidemiol. 1998 Jun;14(4):315-20
references.pmid: 9690746
references.citation: J Natl Cancer Inst Monogr. 1997;(22):119-24
references.pmid: 9709287
references.citation: AJR Am J Roentgenol. 2000 Jun;174(6):1769-77
references.pmid: 10845521
references.citation: JAMA. 2006 May 24;295(20):2374-84
references.pmid: 16720823
references.citation: Breast Cancer Res. 2012 Jun 14;14(3):R94
references.pmid: 22697607
references.citation: J Clin Oncol. 2002 Jun 1;20(11):2701-12
references.pmid: 12039933
references.citation: J Am Geriatr Soc. 1998 Sep;46(9):1128-31
references.pmid: 9736107
references.citation: JAMA. 2012 Apr 4;307(13):1394-404
references.pmid: 22474203
references.citation: Med Phys. 2006 Apr;33(4):933-40
references.pmid: 16696469
references.citation: Radiology. 2003 Sep;228(3):842-50
references.pmid: 12881585
references.citation: Med Phys. 2009 Jun;36(6):1956-67
references.pmid: 19610284
references.citation: Radiology. 2004 Jan;230(1):29-41
references.pmid: 14617762
references.citation: Breast. 2007 Dec;16(6):568-76
references.pmid: 18035541
references.citation: Am J Surg. 2000 Oct;180(4):288-9
references.pmid: 11113437
references.citation: Phys Med Biol. 2003 Oct 7;48(19):R65-106
references.pmid: 14579853
references.citation: J Natl Cancer Inst. 1989 Dec 20;81(24):1879-86
references.pmid: 2593165
references.citation: Cancer. 1994 Feb 1;73(3):643-51
references.pmid: 8299086
references.citation: Breast. 2005 Dec;14(6):480-6
references.pmid: 16185869
references.citation: N Engl J Med. 2004 Jul 29;351(5):427-37
references.pmid: 15282350
references.citation: Radiology. 2012 Apr;263(1):35-42
references.pmid: 22332070
references.citation: Stat Med. 2004 Apr 15;23(7):1111-30
references.pmid: 15057881
references.citation: Breast Cancer Res Treat. 2001 Nov;70(2):145-53
references.pmid: 11768605
references.citation: J Med Screen. 1998;5(4):207-12
references.pmid: 9934652
references.citation: AJR Am J Roentgenol. 2007 Sep;189(3):616-23
references.pmid: 17715109
references.citation: Acad Radiol. 2012 Aug;19(8):916-22
references.pmid: 22537503
references.citation: BMJ. 2012 Sep 06;345:e5660
references.pmid: 22956590
references.citation: CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89
references.pmid: 17392385
references.citation: Acad Radiol. 2011 Nov;18(11):1430-6
references.pmid: 21971260
references.citation: J Am Coll Radiol. 2009 Mar;6(3):171-9
references.pmid: 19248993
references.citation: Eur Radiol. 2010 Mar;20(3):734-42
references.pmid: 19727744
references.citation: N Engl J Med. 2007 Jan 18;356(3):227-36
references.pmid: 17229950
references.citation: Radiat Prot Dosimetry. 2011 Apr;145(1):52-60
references.pmid: 21097483
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1159-69
references.pmid: 16775176
references.citation: Radiology. 2010 Oct;257(1):246-53
references.pmid: 20736332
references.citation: Ann Intern Med. 2009 Nov 17;151(10):727-37, W237-42
references.pmid: 19920273
references.citation: Ann Intern Med. 2003 Feb 4;138(3):168-75
references.pmid: 12558355
references.citation: AJR Am J Roentgenol. 2006 Nov;187(5):W528-37
references.pmid: 17056886
references.citation: Semin Ultrasound CT MR. 2011 Aug;32(4):273-80
references.pmid: 21782117
references.citation: Cancer. 1985 Sep 15;56(6):1280-6
references.pmid: 4027868
references.citation: Radiology. 2003 Oct;229(1):261-8
references.pmid: 12888621
references.citation: Radiology. 2002 Oct;225(1):165-75
references.pmid: 12355001