Breast Cancer Screening in the Setting of Dense Breast Tissue.

A56-year-old African American woman with no family history of breast cancer presents for her annual exam. She asks for a mammography requisition slip because it has been 11 months since her last mammogram and she does not want to be late. She was told last year that she has dense breast tissue, which prompted her to talk to some friends. One told her she should repeat the test, but at a location with a three-dimensional (3D) mammogram. A physician friend suggested she obtain an ultrasound or magnetic resonance imaging (MRI) ‘‘just to be sure.’’ She is Gravida 3 Para 3 (G3P3) with first birth at age 21 years and did not breastfeed any of her children. She reached menarche at age 12 and menopause at age 52 and has needed no medication for menopausal symptoms. She has never had a breast biopsy. The breast examination shows diffuse fine nodularity with no discreet, dominant, or suspicious masses. There are no skin changes or palpable lymph nodes. Her last mammogram was reported as breast imaging-reporting and data system (BIRADS) with more than 50% of tissue determined to be dense.