1. The Research Question
What is the evidence on diagnostic test performance and clinical outcomes of supplemental screening of women with dense breasts with ultrasound (US), MRI, or digital breast tomosynthesis (DBT)?
CR37 Adjunctive Screening for Breast Cancer in Women with Dense Breasts: A Systematic Review
Joy Melnikow, MD, MPH; Joshua Fenton, MD, MPH; Evelyn Whitlock, MD, MPH; Diana Miglioretti, PhD; Jamie Thompson, MPH; Meghan Weyrich, MPH

2. What the Researchers Did
A systematic review of the published, English-language medical literature on:
Sensitivity, specificity, PPV, cancer detection rates recall rates, and long term outcomes of supplemental screening (after a normal mammogram) with US, MRI or DBT for women with dense breasts (BI-RADS c/d density)

3. What the Researchers Found
No studies of breast cancer morbidity or mortality
Hand-held US
Sensitivity 80-83%; specificity 86-94%; PPV 3-8%.
Additional cancer detection 4.4 per 1,000 exams; recall rates 14% (one study)
MRI
Sensitivity %; specificity 78-89%; PPV 3-33%.
Additional cancer detection 4 to 29 per 1,000 exams; recall rates 12%-24% per 1,000 exams.
DBT
Additional cancer detection: Increased by about 1 cancer per 1000 exams (4/1000 to 5/1000)
Recall rates: 7-11% with DBT + mammography vs 9-17% with mammography alone
2 good quality studies of supplemental handheld breast ultrasound screening and 3 good quality studies of breast MRI provided data on sensitivity, specificity, positive predictive value, recall rates, and cancer detection rates.
No studies of DBT addressed test performance characteristics in women with dense breasts. 3 fair quality studies of DBT examined cancer detection rates and recall rates

4. What This Means for Clinical Practice
No evidence on whether supplemental screening reduces breast cancer mortality or morbidity
Rigorous studies with long term follow-up are needed
Supplemental US and MRI increased cancer detection but had high false positive rates
DBT may reduce recall rates but evidence for women with dense breasts is very preliminary
Melnikow J, Fenton JJ, Whitlock EP, Miglioretti DL, Weyrich MS, Thompson JH, Shah K. Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med Feb 16;164(4): doi: /M Epub 2016 Jan 12. PubMed PMID: