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

• Published in: JNCI : Journal of the National Cancer Institute 2024-10
• Main Authors: Foster, Victoria M, Trentham-Dietz, Amy, Stout, Natasha K, Lee, Christoph I, Ichikawa, Laura E, Eavey, Joanna, Henderson, Louise, Miglioretti, Diana L, Tosteson, Anna N A, Bowles, Erin A, Kerlikowske, Karla, Sprague, Brian L
• Format: Article
• Language: English
• ISSN: 0027-8874; 1460-2105; 1460-2105
• DOI: 10.1093/jnci/djae272

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.