The Challenge of Breast Density– Options for Management and Breast Cancer Screening (invited commentary)

Breast density is now well established as an independent risk factor for breast cancer. Dense breast tissue, as measured on mammography, also has a masking effect, making breast cancer more difficult to detect. It reduces the sensitivity of mammography and increases the likelihood of an interval cancer (malignancy presenting with symptoms between screening rounds). While the risk and the diagnostic challenges associated with dense breast tissue are understood, the way it should be managed remains less clear. There is increasing pressure from consumer groups for women to be notified of their breast density. These community groups, representing women at risk of breast cancer, or with a history of breast cancer, have lobbied strongly, and across most of then United States notification is now mandated by legislation. This means that every woman with dense breasts must be sent a letter by her radiologist informing her of her breast density. However, evidence-based risk management guidelines are lacking, leading to confusion and anxiety. This Commentary will discuss the breast cancer risk associated with breast density and the options for cancer screening. On the basis of this, it will propose recommendations for the assessment and management of women with dense breasts. Options include the use of supplemental screening with to synthesis, ultrasound and/or MRI or varying the screening interval.