Table 4.

Current National Group Positions on Screening Women with Dense Breasts

National Group	Year	Recommendation Statement on Primary Screening	Recommendation Statement on Supplemental Screening
U.S. Preventive Services Task Force (USPSTF)	2009/2016	“For younger women and women with dense breast tissue, overall detection is somewhat better with digital mammography (2009).”	“[T]he current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (2016).”
American Cancer Society (ACS)	2015	“Although overall the sensitivity of digital and screen-film mammography is similar, digital mammography is more sensitive in younger women and women with mammographically dense breasts.”	“Accumulating data on digital breast tomosynthesis (DBT) appear to demonstrate further improvements in accuracy (both sensitivity and specificity), and DBT is steadily increasing in prevalence in mammography facilities.” “The [guideline development group (GDG)] also did not include in this review evidence on the effectiveness of supplemental breast imaging for women with mammographically dense breasts.”
American College of Radiology (ACR)	2013	Annual screening mammography is indicated for high-risk and intermediate-risk women. Additionally, for high-risk women, contrast-enhanced MRI is indicated as well. Ultrasound can be considered as an alternative for those with contraindications to MRI.	“[M]ammography alone does not perform as well as mammography plus supplemental screening in certain subsets of women, particularly those with genetic predispositions to the disease and those with dense breasts.” “Supplemental screening with ultrasound for women with intermediate risk and dense breasts is an option to increase cancer detection.”
National Comprehensive Cancer Network (NCCN)	2016	“Digital mammography appears to benefit young women and women with dense breasts.”	“Although there are some studies supporting the use of ultrasound for breast cancer screening as an adjunct to mammography for high risk women with dense breast tissue, the NCCN Panel however cautions that there is insufficient evidence to support routine supplemental screening in women with dense breasts and no other risk factors.”