# Dense breasts and women's health: which screenings are essential?

## TL;DR

This review explores how dense breast tissue affects cancer screening and recommends additional imaging techniques to improve detection in high-risk women.

## Contribution

The paper provides a comprehensive synthesis of evidence on optimal screening strategies for women with dense breasts, emphasizing context-specific and equitable approaches.

## Key findings

- Dense breast tissue reduces mammographic sensitivity and increases false-negative results.
- Supplementary imaging techniques like MRI and tomosynthesis improve detection in high-risk women.
- Risk stratification models and AI-based analysis can enhance screening effectiveness and personalization.

## Abstract

•Mammographic density impacts the primary screening process, as dense tissue may mask tumors, resulting in false-negative results.•Mammographic density is known to be a risk factor for breast cancer, associated with a 1- to 6-fold increase in the incidence of this disease.•In women at average risk, going to annual screening mammography at age 40 has demonstrated a reduction in breast cancer mortality by roughly 20 %.•For women at intermediate and high-risk, supplementary modalities such as magnetic resonance imaging, ultrasound, tomosynthesis, and molecular breast imaging may be considered for enhanced screening to increase detection rates.

Mammographic density impacts the primary screening process, as dense tissue may mask tumors, resulting in false-negative results.

Mammographic density is known to be a risk factor for breast cancer, associated with a 1- to 6-fold increase in the incidence of this disease.

In women at average risk, going to annual screening mammography at age 40 has demonstrated a reduction in breast cancer mortality by roughly 20 %.

For women at intermediate and high-risk, supplementary modalities such as magnetic resonance imaging, ultrasound, tomosynthesis, and molecular breast imaging may be considered for enhanced screening to increase detection rates.

This review synthesizes current evidence regarding optimal breast cancer screening strategies for women with dense breasts, a population at increased risk due to decreased mammographic sensitivity. A systematic literature review was performed in accordance with PRISMA criteria, covering MEDLINE, EMBASE, CINAHL Plus, Scopus, and Web of Science until May 2025. The analysis examines advanced imaging techniques such as digital breast tomosynthesis (DBT), contrast-enhanced spectral mammography (CESM), ultrasound, and magnetic resonance imaging (MRI), assessing their effectiveness in addressing the shortcomings of traditional mammography in dense breast tissue. The review rigorously evaluates the incorporation of risk stratification models, such as the BCSC, in customizing screening regimens, in conjunction with innovative technologies like liquid biopsy and artificial intelligence-based image analysis for improved risk prediction. A key emphasis is placed on the heterogeneity in international screening guidelines and the challenges in translating research findings to diverse clinical settings, particularly in resource-constrained environments. The discussion includes ethical implications regarding compulsory breast density notification and the possibility of intensifying disparities in health care. The review ultimately encourages the development of evidence-based, context-specific guidelines that facilitate equitable access to effective breast cancer screening for all women with dense breasts.