Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women age 40 years or older have dense breast tissue, so supplemental breast cancer screening is essential for these women.

Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.

The lack of available intensive training opportunities is a significant factor, according to Ellen B. Mendelson, MD, professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, and Wendie A. Berg, MD, PhD, professor of radiology at Magee-Women’s Hospital of University of Pittsburgh Medical Center in Pennsylvania.

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Their opinion piece appeared in the American Journal of Roentgenology (2015; 204:265-268). They stated that formal didactic training and hands-on scanning are needed to learn suitable, efficient methods so that a handheld ultrasound examination can be extended to depict the entire breast. Furthermore, “automated options also require intensive training in performance and interpretation,” they explained.

“The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,” said Mendelson and Berg.

“To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.”

Mendelson and Berg explained that MRI, which is the most sensitive, is indicated for women with the highest risk of breast cancer. They suggest ultrasound for women with dense breasts who have average risk for breast cancer.