Supplemental breast cancer screening after negative mammography in U.S. women with dense breasts

Victoria M Foster; Amy Trentham-Dietz; Natasha K Stout; Christoph I Lee; Laura E Ichikawa; Joanna Eavey; Louise Henderson; Diana L Miglioretti; Anna N A Tosteson; Erin A Bowles; Karla Kerlikowske; Brian L Sprague

doi:10.1093/jnci/djae272

Supplemental breast cancer screening after negative mammography in U.S. women with dense breasts

J Natl Cancer Inst. 2024 Oct 30:djae272. doi: 10.1093/jnci/djae272. Online ahead of print.

Authors

Affiliations

¹ Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
² National Cancer Institute, Rockville, MD, USA.
³ Department of Radiology, School of Medicine and Department of Health Systems & Population, Health, School of Public Health, University of Washington, Seattle, WA, USA.
⁴ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.
⁵ Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
⁶ Division of Biostatistics, Department of Public of Health Sciences, University of California Davis, Davis, CA and Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
⁷ The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
⁸ Department of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
⁹ University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.

PMID: 39475439
DOI: 10.1093/jnci/djae272

Abstract

The extent and determinants of supplemental screening among women with dense breasts are unclear. We evaluated a retrospective cohort of 498,855 women aged 40-74 years with heterogeneously or extremely dense breasts who obtained 1,176,251 negative screening mammography examinations during 2011-2019 in the United States. Overall, 2.8% and 0.3% of mammograms had supplemental ultrasound or MRI within one year, respectively. Onsite availability was associated with ultrasound (odds ratio [OR]=4.35; 95%CI : 4.21-4.49) but not MRI (OR = 0.94; 95%CI : 0.85-1.04). Facility academic affiliation and for-profit status were inversely associated with supplemental ultrasound (OR = 0.53; 95%CI : 0.49-0.57 and OR = 0.83; 95%CI : 0.81-0.86, respectively) and positively associated with supplemental MRI (OR = 3.04; 95%CI : 2.86-3.46 and OR = 1.88; 95%CI : 1.66-2.12, respectively). Supplemental screening was more likely to occur after passage of state-specific density notification laws than before passage (OR = 3.56; 95%CI 3.30-3.84 and OR = 1.79; 95%CI 1.60-2.00, respectively). These results show that supplemental breast imaging utilization has been uncommon and was related to facility factors and density legislation.

Keywords: breast density; breast neoplasms; cancer screening; mammography.