The Research Question

1. The Research Question • What is the evidence on diagnostic test performance and clinical outcomes of supplemental screening of women with dense breasts with ultrasound (US), MRI, or digital breast tomosynthesis (DBT)?

2. What the Researchers Did • A systematic review of the published, English-language medical literature on: • Sensitivity, specificity, PPV, cancer detection rates recall rates, and long term outcomes of supplemental screening (after a normal mammogram) with US, MRI or DBT for women with dense breasts (BI-RADS c/d density)

3. What the Researchers Found • No studies of breast cancer morbidity or mortality • Hand-held US • Sensitivity 80-83%; specificity 86-94%; PPV 3-8%. • Additional cancer detection 4.4 per 1,000 exams; recall rates 14% (one study) • MRI • Sensitivity 75-100%; specificity 78-89%; PPV 3-33%. • Additional cancer detection 4 to 29 per 1,000 exams; recall rates 12%-24% per 1,000 exams. • DBT • Additional cancer detection: Increased by about 1 cancer per 1000 exams (4/1000 to 5/1000) • Recall rates: 7-11% with DBT + mammography vs 9-17% with mammography alone

4. What This Means for Clinical Practice • No evidence on whether supplemental screening reduces breast cancer mortality or morbidity • Rigorous studies with long term follow-up are needed • Supplemental US and MRI increased cancer detection but had high false positive rates • DBT may reduce recall rates but evidence for women with dense breasts is very preliminary