Beyond mammography: new frontiers in breast cancer screening.

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.

[1]  John J Heine,et al.  Full field digital mammography and breast density: comparison of calibrated and noncalibrated measurements. , 2011, Academic radiology.

[2]  T. M. Kolb,et al.  Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. , 2002, Radiology.

[3]  Elisabeth Cardis,et al.  Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK) , 2012, BMJ : British Medical Journal.

[4]  H. Nelson,et al.  Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force , 2009, Annals of Internal Medicine.

[5]  Felix Diekmann,et al.  Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study , 2012, Breast Cancer Research.

[6]  K. Kelly,et al.  Automated whole-breast ultrasound: advancing the performance of breast cancer screening. , 2011, Seminars in ultrasound, CT, and MR.

[7]  N. Boyd,et al.  Mammographic density and the risk and detection of breast cancer. , 2007, The New England journal of medicine.

[8]  Michael R Hamblin,et al.  CA : A Cancer Journal for Clinicians , 2011 .

[9]  M. Gail,et al.  Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. , 1989, Journal of the National Cancer Institute.

[10]  W. Aronow,et al.  Underutilization of Measurement of Serum Low‐Density Lipoprotein Cholesterol Levels and of Lipid‐Lowering Therapy in Older Patients with Manifest Atherosclerotic Disease , 1998, Journal of the American Geriatrics Society.

[11]  P Baldelli,et al.  Comprehensive dose survey of breast screening in Ireland. , 2011, Radiation protection dosimetry.

[12]  Tor D Tosteson,et al.  Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. , 2007, AJR. American journal of roentgenology.

[13]  D. Dershaw.  Mammographic screening of the high-risk woman. , 2000, American journal of surgery.

[14]  D. Miglioretti,et al.  Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography , 2003, Annals of Internal Medicine.

[15]  P. Langenberg,et al.  Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. , 2000, AJR. American journal of roentgenology.

[16]  John M Lewin,et al.  Dual-energy contrast-enhanced digital subtraction mammography: feasibility. , 2003, Radiology.

[17]  Serge Muller,et al.  Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography. , 2006, AJR. American journal of roentgenology.

[18]  Björn Cederström,et al.  Scatter rejection in multislit digital mammography. , 2006, Medical physics.

[19]  R. Hendrick,et al.  Radiation doses and cancer risks from breast imaging studies. , 2010, Radiology.

[20]  J. Otten,et al.  Mammographic breast density and risk of breast cancer: Masking bias or causality? , 1998, European Journal of Epidemiology.

[21]  S. Duffy,et al.  Mammographic parenchymal patterns and mode of detection: implications for the breast screening programme , 1998, Journal of medical screening.

[22]  Martin J Yaffe,et al.  Contrast-enhanced digital mammography: initial clinical experience. , 2003, Radiology.

[23]  Division on Earth.  Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 , 2006 .

[24]  G. Oster,et al.  Cost effectiveness of breast cancer screening with contrast-enhanced MRI in high-risk women. , 2009, Journal of the American College of Radiology : JACR.

[25]  C. Kuhl,et al.  Management of women at high risk for breast cancer: new imaging beyond mammography. , 2005, Breast.

[26]  N. Risch,et al.  Autosomal dominant inheritance of early‐onset breast cancer. Implications for risk prediction , 1994 .

[27]  Ioannis Sechopoulos,et al.  Clinical digital breast tomosynthesis system: dosimetric characterization. , 2012, Radiology.

[28]  V. McCormack,et al.  Breast Density and Parenchymal Patterns as Markers of Breast Cancer Risk: A Meta-analysis , 2006, Cancer Epidemiology Biomarkers & Prevention.

[29]  R E Hendrick,et al.  Radiation risk from screening mammography of women aged 40-49 years. , 1997, Journal of the National Cancer Institute. Monographs.

[30]  Jack Cuzick,et al.  A breast cancer prediction model incorporating familial and personal risk factors , 2012 .

[31]  H. Koning,et al.  Two distinct groups of non-attenders in an organized mammography screening program , 2001, Breast Cancer Research and Treatment.

[32]  K. Kelly,et al.  Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts , 2009, European Radiology.

[33]  Bruce L Daniel,et al.  Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. , 2006, JAMA.

[34]  Stephen W Duffy,et al.  A breast cancer prediction model incorporating familial and personal risk factors , 2004, Hereditary Cancer in Clinical Practice.

[35]  J. Dobbins.  Tomosynthesis imaging: at a translational crossroads. , 2009, Medical physics.

[36]  M. Yaffe,et al.  American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography , 2007 .

[37]  N Risch,et al.  Autosomal dominant inheritance of early‐onset breast cancer. Implications for risk prediction , 1994, Cancer.

[38]  Jennifer A Harvey,et al.  Quantitative assessment of mammographic breast density: relationship with breast cancer risk. , 2004, Radiology.

[39]  Giovanni Parmigiani,et al.  BRCAPRO validation, sensitivity of genetic testing of BRCA1/BRCA2, and prevalence of other breast cancer susceptibility genes. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[40]  P. Porter,et al.  Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. , 2000, Journal of the National Cancer Institute.

[41]  James T Dobbins,et al.  Digital x-ray tomosynthesis: current state of the art and clinical potential. , 2003, Physics in medicine and biology.

[42]  J Whitehead,et al.  Wolfe mammographic parenchymal patterns. A study of the masking hypothesis of Egan and Mosteller , 1985, Cancer.

[43]  Etta D Pisano,et al.  Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. , 2012, JAMA.

[44]  Mats Lundqvist,et al.  Comparison of radiologist performance with photon-counting full-field digital mammography to conventional full-field digital mammography. , 2012, Academic radiology.

[45]  M. Eijkemans,et al.  Mammography: interobserver variability in breast density assessment. , 2007, Breast.

[46]  H. D. de Koning,et al.  Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. , 2004, The New England journal of medicine.