Normalized Comparison of Cancer Detection Rates in Contemporary Breast Imaging Technologies Used in Dense-Breast Supplemental Screening

We present an objective analysis and comparison on a level technological playing field of Cancer Detection Rates (CDRs) by performing a meta-analysis from publications about dense breasts using FDA-approved imaging modalities available for supplemental breast cancer screening in the USA. Awareness is growing about the relatively low overall cancer detection rate of digital mammography (DM), digital breast tomosynthesis (DBT) and breast ultrasound (US), especially for the nearly 25 million screening-eligible women with increased breast density (BIRADS C,D). Since a majority of research papers use comparisons to the screening "gold standard" of DM, analysis using pooled CDRs normalized to DM is presented. Other important factors such as the number of theoretical net lives saved using a benefit-to-risk comparison of ionizing imaging modalities is included. Lingering concerns about ionizing radiation dose of supplemental screening options are also discussed with the comparative perspective of the unavoidable yearly background dose every human being receives. This objective, normalized analysis identifies contrast-enhanced mammography (CEM) and molecular breast imaging (MBI) to have Cancer Detection Rates (CDR) within 90% (and greater) of breast magnetic resonance imaging (MRI). These top-three "vascular imaging modalities" each employ injected contrast agents to enhance visualization and facilitate the detection of early-stage breast cancers. By enabling earlier diagnosis with more appropriate supplemental breast imaging, the use of either CEM, MBI or MRI will: decrease mortality; reduce patient's physical, financial and psychological trauma; and reduce costs per cancer detected earlier, with overall benefit to the patients, the hospitals and the payors, thus providing long-term societal benefits.