Breast Cancer in Women: Screening (Supplemental Screening)

The USPSTF summarizes the gaps in the evidence for screening for breast cancer and emphasizes health equity gaps that need to be addressed to advance the health of the nation. Although the health equity gaps focus on Black women because they have the poorest health outcomes from breast cancer, it is important to note that all studies should actively recruit enough women of all racial and ethnic groups, including Asian, Black, Hispanic, Native American/Alaska Native, and Native Hawaiian/Pacific Islander participants, to investigate whether the effectiveness of screening, diagnosis, and treatment vary by group.

1. Research is needed to help clinicians and patients understand the best strategy for breast cancer screening in women found to have dense breasts on a screening mammogram, which occurs in more than 40% of women screened.
   • Research is needed to determine the benefits and harms of supplemental screening (e.g., ultrasonography, MRI, or contrast-enhanced mammography) compared with usual care (DBT or digital mammography alone) for women with dense breasts. Studies are needed that report outcomes such as the rates of advanced breast cancers diagnosed across consecutive screening rounds in addition to the rates of diagnosis of breast cancer, and health outcomes such as quality of life and breast cancer–associated morbidity and mortality.
2. Research is needed to understand why Black women are more likely to be diagnosed with breast cancers that have biomarker patterns that confer greater risk for poor health outcomes.
   • Research is needed to understand and address the higher breast cancer mortality among Black women.
   • Research is needed to understand how variations in care (including diagnosis and treatment) leads to increased risk of breast cancer morbidity and mortality in Black women, across the spectrum of stages and biomarker patterns, and on effective strategies to reduce this disparity.
   • Research is needed to determine whether the benefits differ for annual vs biennial breast cancer screening among women overall and whether there is a different balance of benefits and harms among Black women compared with all women.
3. Research is needed to identify approaches to reduce the risk of overdiagnosis leading to overtreatment of breast lesions identified through screening that may not be destined to cause morbidity and mortality, including DCIS.
   • Research is needed on the natural history of DCIS and to identify prognostic indicators to distinguish DCIS that is unlikely to progress to invasive breast cancer.

Research Taxonomy:For additional information on research needed to address these evidence gaps, see the Research Gaps Taxonomy table on the USPSTF website .

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or magnetic resonance imaging (MRI) in women identified to have dense breasts on an otherwise negative screening mammogram.

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