Healthcare (Commonwealth Union) – Scientists in Cambridge are urging the inclusion of additional imaging techniques in breast screening for women with extremely dense breast tissue. This recommendation comes in light of a major UK-wide study, which found that using supplementary scans could triple the detection rate of breast cancers in this group—potentially saving as many as 700 lives each year.
Researchers of the study pointed out that approximately 1 in 10 women have very dense breast tissue. Women aged between 50 and 70 in this category are up to four times more likely to develop breast cancer than those with low-density breast tissue.
Each year, more than 2.2 million women undergo breast screening in the UK. However, for those with dense breasts, traditional mammograms (X-ray images of the breast) are less reliable in identifying tumors. This is because dense tissue appears white on a mammogram—the same color as many early-stage cancers—making it harder to distinguish between healthy and abnormal areas.
A study involving over 9,000 women across the UK, published recently in The Lancet, examined participants who had dense breasts and received a negative mammogram (no signs of cancer). Despite the initial clear results, 85 cases of cancer were subsequently identified.
The BRAID trial explored alternative imaging techniques that could complement mammograms in identifying cancers in women with dense breast tissue. Among every 1,000 women screened, two of these techniques uncovered between 17 and 19 cancers that standard mammograms had missed.
These two methods—contrast-enhanced mammography (CEM) and abbreviated magnetic resonance imaging (AB-MRI)—showed the highest detection rates.
According to the researchers leading the study, incorporating either of these scans into the current breast screening programme in the UK could result in the detection of an additional 3,500 cancers annually. Given that early detection through screening is estimated to lower breast cancer death rates by around 20%, this could potentially lead to 700 more lives being saved each year.
The study also examined a third technique, automated whole breast ultrasound (ABUS), which did find cancers missed by mammograms, but was about three times less effective than CEM and AB-MRI.
All three techniques were applied to screen approximately 2,000 women each. For every 1,000 women examined, CEM identified 19 cases of cancer, AB-MRI detected 17, and ABUS discovered 4.
Standard mammograms currently detect about 8 cancers per 1,000 women with dense breast tissue. This suggests that using additional imaging could more than triple cancer detection rates in this population.
The BRAID study is the first to directly evaluate different supplementary imaging approaches and highlight their potential for spotting cancers earlier as part of routine screening. The researchers hope their findings will contribute to improving screening strategies both in the UK and internationally, allowing for earlier diagnosis of more cancers.
However, further research is necessary to determine whether these extra scans actually lower death rates, as not all cancers identified through screening are fatal.
The trial was coordinated from Cambridge and involved participation from 10 sites across the UK. More than 2,000 women were enrolled at Addenbrooke’s Hospital in Cambridge.
The study was overseen by Professor Fiona Gilbert from the Department of Radiology at the University of Cambridge, who also serves as an honorary consultant radiologist at Addenbrooke’s Hospital, which is part of Cambridge University Hospitals NHS Foundation Trust (CUH). The research received funding from Cancer Research UK, with additional backing from the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre (BRC).
Professor Gilbert pointed out that early detection of cancer significantly improves a patient’s treatment options and long-term prognosis and their national screening programme needs reform so that more cancers can be caught sooner, improving survival prospects for many more women.
Professor Stephen Duffy, Emeritus Professor, Queen Mary University, London, trial statistician and screening programme expert added “The NHS Breast Screening Programme has made a huge difference to many lives. Thanks to these results we can see that the technology exists to make screening even better, particularly for the 10% of women with dense breast tissue.”
