title: Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk.
  
  
  OBJECTIVE
  To perform a systematic review of reproducibility of Breast Imaging Reporting and Data System (BI-RADS) density categorization and test performance and clinical outcomes of supplemental screening with breast ultrasonography, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography results.
  
  
  METHODS
  MEDLINE, PubMed, EMBASE, and Cochrane database from January 2000 to July 2015.
  
  
  METHODS
  Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts.
  
  
  METHODS
  Quality assessment and abstraction of 24 studies from 7 countries; 6 studies were good-quality.
  
  
  RESULTS
  Three good-quality studies reported reproducibility of BI-RADS density; 13% to 19% of women were recategorized between "dense" and "nondense" at subsequent screening. Two good-quality studies reported that sensitivity of ultrasonography for women with negative mammography results ranged from 80% to 83%; specificity, from 86% to 94%; and positive predictive value (PPV), from 3% to 8%. The sensitivity of MRI ranged from 75% to 100%; specificity, from 78% to 94%; and PPV, from 3% to 33% (3 studies). Rates of additional cancer detection with ultrasonography were 4.4 per 1000 examinations (89% to 93% invasive); recall rates were 14%. Use of MRI detected 3.5 to 28.6 additional cancer cases per 1000 examinations (34% to 86% invasive); recall rates were 12% to 24%. Rates of cancer detection with DBT increased by 1.4 to 2.5 per 1000 examinations compared with mammography alone (3 studies). Recall rates ranged from 7% to 11%, compared with 7% to 17% with mammography alone. No studies examined breast cancer outcomes.
  
  
  CONCLUSIONS
  Good-quality evidence was sparse. Studies were small and CIs were wide. Definitions of recall were absent or inconsistent.
  
  
  CONCLUSIONS
  Density ratings may be recategorized on serial screening mammography. Supplemental screening of women with dense breasts finds additional breast cancer but increases false-positive results. Use of DBT may reduce recall rates. Effects of supplemental screening on breast cancer outcomes remain unclear.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Joy
authors.initials: J
authors.lastname: Melnikow
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Meghan S
authors.initials: MS
authors.lastname: Weyrich
authors.forename: Jamie H
authors.initials: JH
authors.lastname: Thompson
authors.forename: Kunal
authors.initials: K
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000033:anatomy & histology*; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D042361:Mammary Glands, Human / Q000002:abnormalities; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012307:Risk Factors; D016217:Ultrasonography, Mammary