The evidence

This isn't new information.  A 1995 Canadian study found that ultrasound finds significant numbers of additional cancers missed on mammograms. That study prompted more research, all showing the benefit of ultrasound. In 2022, a study published by Vancouver authors showed they found 7 additional cancers per thousand women using supplemental screening ultrasound exams.  All cancers have been small and node-negative. Significantly, 40% were in women with no family history and 60% were in women with Category C density.

Japan’s J-START randomized control trial in 2016 show that ultrasound in addition to mammogram improves sensitivity and detects more cancers.   A secondary analysis was conducted in 2021 of this same study and confirmed that ultrasound, supplementary to mammogram, is an effective tool in detecting cancer missed by mammogram, and while effective on all density, it was most effective in women with dense breasts.  

There are conversations surrounding "randomized control trials" and "mortality rates" and some medical professionals insist that supplementary screening is not yet proven to reduce mortality rates.  This position is very misleading because it conceals the proven benefits of supplementary screening and the opportunity to catch cancer early.

A randomized control trial compares a group of people who receive the intervention, while the other group, called a control, doesn't receive the intervention.  The J-START trial proved higher detection of cancer with supplementary ultrasound, but there won't be concluded mortality rates because we would have to wait until everyone in this randomized control trial die, to see if those in the intervention group had a reduction in mortality related to breast cancer versus the control group.  It takes decades to find this technical tidbit of information when clearly, supplementary screening catches more cancer, finds it earlier, reduces suffering and obviously will reduce mortality.  

It is unethical for a medical professional to claim there is no evidence to support supplementary screening.  A claim of "it has not been proven to reduce mortality" is deceitful because cancer missed by mammogram may become a later stage diagnosis.  This causes horrific suffering as the woman must endure chemotherapy, radiation, surgery, hair loss, lymphedema, depression, disability, financial burden, loss of the future she planned for and possibly even the loss of her life.   She stands to lose everything.  Witnessing her suffering impacts everyone in her life and if we lose her, it causes catastrophic and lasting loss to all those around her.  The community loses a volunteer, colleague, employee, neighbor.  Friends lose a confidant, companionship, advice and support.  Family loses a mother, daughter, sister, wife, aunt, grandmother, niece.  Everyone close to her becomes vulnerable to isolation, stress, anxiety, depression, mental illness and even physical disease.  To that end, "her people" may be robbed of laughter, future experiences, holidays, joy and memories they could have shared with her.  

Benefits of MRI for women with Dense Breasts

MRI offers significant benefits in detecting cancers in people with dense breasts. It provides a clearer and more detailed image compared to mammograms, making it easier to identify tumors that might be obscured by dense breast tissue. MRI is highly sensitive, capable of detecting small and early-stage cancers that mammograms might miss. This enhanced detection can lead to earlier diagnosis, allowing for less aggressive treatment options and potentially better outcomes. Mammograms typically detect about 5 cancers per thousand women, adding ultrasound finds an additional 2-7 per thousand, while MRI can find an additional 12-16 cancers per thousand.  Read more about the different screening methods here. 

Citations

A 1995 Canadian study - Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer. 1995 Aug 15;76(4):626-30. doi: 10.1002/1097-0142(19950815)76:4<626::aid-cncr2820760413>3.0.co;2-z. PMID: 8625156. 

A secondary analysis - Harada-Shoji N, Suzuki A, Ishida T, Zheng YF, Narikawa-Shiono Y, Sato-Tadano A, Ohta R, Ohuchi N. Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Aug 2;4(8):e2121505. doi: 10.1001/jamanetworkopen.2021.21505. PMID: 34406400; PMCID: PMC8374606. 

7 additional cancers per thousand women - Wu T, Warren LJ. The Added Value of Supplemental Breast Ultrasound Screening for Women With Dense Breasts: A Single Center Canadian Experience. Can Assoc Radiol J. 2022 Feb;73(1):101-106. doi: 10.1177/08465371211011707. Epub 2021 Jun 16. PMID: 34134531. 

The True Cost of Breast Cancer Treatment  - Wilkinson AN, Seely JM, Rushton M, Williams P, Cordeiro E, Allard-Coutu A, Look Hong NJ, Moideen N, Robinson J, Renaud J, Mainprize JG, Yaffe MJ. Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing. Curr Oncol. 2023 Aug 26;30(9):7860-7873. doi: 10.3390/curroncol30090571. PMID: 37754486; PMCID: PMC10527628.