The Canadian Association of Radiologists (CAR) and the Canadian Society of Breast Imaging (CSBI) recently released a position statement on Breast Density and Supplemental Screening. This position statement was developed in response to increased media attention on mammographic breast density, as well as North American legislative changes. Most American states have adopted breast density legislation and the US Federal law now requires breast density notification in all reports. In Canada, provinces are starting to discuss similar legislation. Additionally, Health Canada recently approved an automated breast ultrasound system.
The following key points were highlighted:
- Dense breast tissue is an independent risk factor for the development of breast cancer and decreases the likelihood of breast cancer being detected on screening mammography.
- Breast density should be reported by the radiologist on all screening and diagnostic mammograms.
- Supplemental screening breast ultrasound may be considered for patients with dense breast tissue (ACR C & D density categories).
- When considering supplemental screening breast ultrasound, breast density should be placed in context with other risk factors and risk reduction strategies.
- Mammography remains the primary modality for screening women of all breast densities.
- Supplemental screening breast ultrasound should not replace breast MRI screening for women who have a high lifetime risk of breast cancer.
- Annual mammography can be considered for all women with dense breast tissue who participate in screening.
The Breast Imaging and Intervention guideline Working Group chaired by Dr. Shiela Appavoo (Alberta) is currently updating the 2016 CAR Breast Imaging and Intervention Guideline to reflect the most recent and relevant scientific literature and to provide guidance for Canadian practitioners on emerging technologies. The working group is a joint effort between the CAR and the CSBI and the guideline will be developed by the fall of 2019.