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The Mammography section is a comprehensive resource for diagnostic imaging news and expert insights on Mammography. Read more at Diagnostic Imaging.

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 mammography modality focus page provides information, videos, podcasts, and the latest news about industry product developments, trial results, screening guidelines, and protocol guidance that touch on the use of mammography, including 2D digital mammography, digital breast tomosynthesis, and breast ultrasound.

, Anand Narayan, M.D., and Amy Patel, M.D., offer their perspectives on the challenges faced by radiologists — who are already grappling with increasingly high volume worklists and radiologist shortages — in implementing expanded breast cancer screening as per recently updated recommendations from the 

United States Preventive Services Task Force (USPSTF)

For breast cancer risk assessments, Dr. Patel said another challenge is that not all facilities have access to high-risk breast clinics or genetics programs, limitations that often fall upon the shoulders of breast imaging centers. Dr. Patel noted that artificial intelligence (AI) and possible implementation of a risk-based model with AI may have potential for facilitating appropriate triaging of patients.

In regard to practical steps radiologists can take to help raise awareness of new recommendations to help address disparities in breast cancer screening, Dr. Patel emphasized the importance of an ongoing dialogue with primary care providers.

“Keeping the lines of communication open with your referring providers is paramount. When new recommendations come down the pike, we as a breast imaging community really need to take it upon ourselves to educate our referring providers,” noted Dr. Patel, the medical director of the Liberty Hospital Breast Care Center in Kansas City and an assistant professor at the University of Missouri-Kansas City.

(Editor’s note: For related content, see “

New Research Shows Consequences of Delayed Diagnosis in Mammography Screening

The Reading Room Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 2

The Reading Room Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 1

For more insights from Dr. Narayan and Dr. Patel, listen below or 

In the third episode of a three-part podcast, Anand Narayan, M.D., Ph.D., and Amy Patel, M.D., discuss the challenges of expanded breast cancer screening amid a backdrop of radiologist shortages and ever-increasing volume on radiology worklists. 

The Reading Room Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 3

, Anand Narayan, M.D., and Amy Patel, M.D., offer their perspectives and insights on recently published research that suggested the adoption of a risk-adapted model for breast cancer screening.

multicenter study of over one million women in China

 suggested optimal starting ages for screening mammography at 43 for women of high breast cancer risk and after 55 years of age for those deemed to be at low risk of breast cancer.

Another study, published in April 2023, looked at 

data from breast cancer-specific deaths in over 400,000 women

 and suggested that optimal initiation of breast cancer screening should begin at 42 years of age in Black women with White women starting at 51, Indian women and Hispanic women starting at 57 and Asian and Pacific Islander women starting at 61.

In the podcast, Drs. Narayan and Patel discuss complex issues with adopting a risk-adapted model for breast cancer screening, key challenges with implementation and whether this model would reduce or possibly exacerbate disparities with health equity.

“I think it’s great that these authors are bringing some of this data to light and I think it could help inform some of our clinical practice, but I think we need to have caution in terms of clinical implementation and potentially fostering inequities by using race-based science,” noted Dr. Narayan, the vice-chair of equity in the Department of Radiology at the University of Wisconsin-Madison.

Should Race and Ethnicity Factor into Starting Ages for Mammography Screening?

In the second episode of a three-part podcast, Anand Narayan, M.D., Ph.D., and Amy Patel, M.D., discuss recent studies published by the Journal of the American Medical Association (JAMA) that suggested moving to more of a risk-adapted model for mammography screening. 

, Anand Narayan, M.D., and Amy Patel, M.D., offer their perspectives and insights on the possible impact of recent breast cancer screening recommendations from the 

(Editor's note: For related content, see "

The Reading Room: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 2

In the first episode of a three-part series, Anand Narayan, M.D., Ph.D., and Amy Patel, M.D., discuss recently issued updates to breast cancer screening recommendations from the American College of Radiology and the United States Preventive Services Task Force and potential implications for health equity.

[[{"type":"media","view_mode":"media_crop","fid":"11554","attributes":{"alt":"Stephen Rose","class":"media-image media-image-left","id":"media_crop_8501769795264","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"218","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: left;","title":" ","typeof":"foaf:Image"}}]]In February 2011, the FDA approved the first X-ray mammography system that provides 3-D images for breast cancer screening and diagnosis, 

. The 3-D tomosynthesis is being offered in fewer than two dozen locations in the U.S., and among them is Houston Breast Imaging in Texas.

In this podcast, Stephen Rose, MD, president and CEO of Houston Breast Imaging and a principal investigator of the 3-D tomosynthesis clinical trials in 2010, discusses the benefits of the new technology and what his practice learned when implementing the screening program. .

In this podcast, Stephen Rose, MD, president and CEO of Houston Breast Imaging and a principal investigator of the 3-D tomosynthesis clinical trials in 2010, discusses the benefits of the new technology and what his practice learned when implementing the screening program.

Podcast: Breast Tomosynthesis - One Practice's Experience

In this podcast, Tom Gentile, president and CEO at GE Healthcare Systems, explains that “the whole focus of imaging is moving beyond the quality of the image.” Patient care, physician productivity and reimbursement take on a renewed focus in light of healthcare reform efforts internationally, he says. Such issues will be the focus for GE Healthcare Systems at RSNA 2011.

, CT using Model Based Iterative Reconstruction (MBIR) technology to reduce dose and improve image quality.

Contrast-enhanced spectral mammography will also be a focus at RSNA 2011 for GE. Gentile talks about the speed and specificity of its newly approved product 

as well as newly mobile ultrasound technology,

, that makes ultrasound “the stethescope of the future.”

RSNA

In this podcast, Tom Gentile, president and CEO at GE Healthcare Systems, explains that “the whole focus of imaging is moving beyond the quality of the image.” Patient care, physician productivity and reimbursement take on a renewed focus in light of healthcare reform efforts internationally, he says.

Podcast: GE on MBIR, Spectral Mammography, Ultrasound and Themes for RSNA 2011

[[{"type":"media","view_mode":"media_crop","fid":"1735","attributes":{"alt":"","class":"media-image","id":"media_crop_7567161365917","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"201","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]Imagine a fast, inexpensive method for breast cancer screening. That’s some of the promise behind a new innovation from a doctoral student who has discovered a way to use ultrasound and advanced algorithms to differentiate between benign and malignant tumors.

, a student at the department of mechanical, aerospace, and nuclear engineering at Rensselaer Polytechnic Institute, researched nonlinear elasticity imaging for breast cancer diagnosis. Here Geonezen and his faculty advisor, Assad Oberai, discuss this innovation and what it could mean for breast cancer diagnosis, as well as diagnosis of other diseases.

Imagine a faster, inexpensive method for breast cancer screening. That’s some of the promise behind a new innovation from doctoral student, Sevan Goenezen, who has discovered a way to use ultrasound and advanced algorithms to differentiate between benign and malignant tumors.

Podcast: Student Innovation Holds Promise for Breast Cancer Screening

New research suggests the capability of a mammography-based deep learning model to identify women at high risk of breast cancer led to more than triple the cancer detection rate on breast MRI in comparison to traditional risk assessment tools.

Mammography-Based Deep Learning Model Facilitates Higher Breast Cancer Detection on Screening MRI

In a prospective study of over 55,000 women who had screening mammography, researchers found that double-reading by a radiologist and artificial intelligence (AI) was non-inferior to double-reading by two radiologists in detecting breast cancer.

Large Mammography Study Suggests AI is Equivalent to Radiologists for Double Reading of Exams

In separate test sets that included challenging mammography cases, researchers found that artificial intelligence (AI) demonstrated similar sensitivity and specificity for detecting breast cancer in comparison to assessments from over 500 clinicians.

Can AI Match Radiologist Assessment of Screening Mammography Exams?

The study demonstrated that the combined model yielded improved risk assessment for both interval and long-term breast cancers. 

Combining AI Lesion Detection, Mammographic Texture Model Improves Breast Cancer Risk Assessment

Primary diagnostic delays in mammography screening led to a greater than 10 percent higher incidence of lymph node metastasis with invasive breast cancer in comparison to women without a primary diagnostic delay, according to new research out of the Netherlands.

Reportedly 365,000 people in the United States had breast augmentation procedures in 2021.

 Emerging research comparing digital breast tomosynthesis (DBT) use in women with and without breast implants found a 22 percent lower cancer detection rate for women with breast implants. Yet there are currently no imaging guidelines specifically geared to breast cancer screening in patients with breast implants.

Society of Breast Imaging (SBI) conference

, Stephen Rose, M.D, pointed out the breast implants may obscure between nine to 44 percent of glandular tissue on imaging. In a recent video interview, Dr. Rose said there are a number of factors, ranging from age of the implant and fibrosis to implant size, implant-related scarring and breast size, that can affect interpretation of breast imaging in patients with breast implants.

In retrospective research presented at the SBI conference, Dr. Rose and colleagues reviewed data from 350,845 DBT exams (including 20,929 DBT exams for women with breast implants) performed at 49 community-based outpatient imaging centers in 2019. In addition to the aforementioned lower cancer detection rate in women with implants, Dr. Rose and colleagues found that women with breast implants had a nearly 5.5 percent increase in ductal carcinoma in situ (DCIS) and a 4.8 percent higher incidence of positive lymph node involvement in detected cancers.

Breast Reconstruction: Current Principles and Emerging Concepts in Imaging

Study Highlights Use of Contrast-Enhanced Mammography in Women with Breast Implants

Has the time come for imaging guidelines that are more specific to the nuances and supplemental imaging needs for women with breast implants?

“Other than the same guidelines we use for women without breast implants, there really hasn’t been any specific guidelines by our societies that suggest doing more (for women with breast implants),” noted Dr. Rose, the founder and president of Rose Imaging Specialists. “It’s all been pretty anecdotal recommendations and it’s not like this is an insignificant number of patients. In some of our populations, 10 to 15 percent have implants.”

For more insights from Dr. Rose, watch the video below.

1. The Aesthetic Society. Aesthetic Plastic Surgery National Databank Statistics 2020-2021. Available at: https://cdn.theaestheticsociety.org/media/statistics/2021-TheAestheticSocietyStatistics.pdf . Accessed June 14, 2023.

In a recent video interview, Stephen Rose, M.D., reviewed a variety of factors that can impact interpretation of breast imaging for women with breast implants and discussed recent research showing a 22 percent reduction in cancer detection rate for this population in comparison to women without breast implants.

Radiology Challenges with Breast Cancer Screening in Women with Breast Implants

Amy Patel, MD has seen the disparities with state laws on breast density notification. In a recent video interview, Dr. Patel, who practices in Missouri, said the neighboring state of Kansas does not currently require breast density notification. While Missouri has had a state law on breast density notification since 2015, Dr. Patel said the state does have high breast cancer mortality rates and a lack of awareness of breast density can contribute to a diagnosis of advanced breast cancer.

“We see it from all geographic locations, urban, rural. They may say ‘I didn’t know that I had dense breasts. My mammogram was negative one year and now you’re telling me that I have metastatic disease.’ It’s really heartbreaking,” noted Dr. Patel, the medical director of the Liberty Hospital Breast Care Center in Kansas City and an Assistant Professor of Radiology at the University of Missouri-Kansas City.

advent of national breast density notification, which will be required as of September 10, 2024, “really levels the playing field

 in terms of education and making the patients aware of their breast density.” However, she maintained that ongoing education for patients as well as primary care providers will be key to improving outcomes.

“We cannot assume that primary care providers have all the knowledge on breast density,” emphasized Dr. Patel, the President of the American Association for Women in Radiology. “As breast imagers, I fervently feel … that we’re going to need to take more of an active approach to ensuring that our primary care providers we work in concert with to serve these patients have the tools and knowledge so they can educate their patients. If they’re not able to at times, we need to step in and take more of an active role to educate our patients.”

FDA Issues Final Rule on National Breast Density Notification for Mammography Reports

Current Insights on National Breast Density Notification for Mammography Reports

Mammography Study Shows 22 Percent Higher Incidence of Dense Breasts in Women with a Family History of Breast Cancer.

For more insights from Dr. Patel, watch the video below.

In a recent video interview, Amy Patel, M.D., shared her perspective on forthcoming national beast density notification in mammography reporting, emphasized the importance of educating primary care providers on breast density risks, and discussed the ongoing need for coverage of supplemental options for breast cancer screening.  

Looking at Next Steps to Reinforce National Breast Density Notification

In a study involving over 2.5 million screening mammograms for over one million women, researchers found a significantly higher cancer detection rate and lower recall rate for digital breast tomosynthesis (DBT) in comparison to digital mammography (DM).

For the retrospective multicenter study, recently published in 

, researchers reviewed 2,528,063 screening mammograms for 1,100,447 women (mean age of 57). According to the study, 597,947 women had a total of 1,693,727 DBT screening exams and 502,500 women had a total of 834,336 DM screening exams.

The study authors found that DBT had a higher cancer detection rate (5.3/1000) in comparison to DM (4.5/1000) and a higher positive predictive value (5.9 percent vs. 4.3 percent). Researchers also noted a lower recall rate for DBT (8.9 percent vs. 10.3 percent for DM).

In a recent interview, Emily Conant, M.D., the lead author of the study, said the findings were similar to those noted in other studies of DBT but seeing the findings in a large, diverse multicenter cohort reaffirmed the advantages of DBT over two-dimensional (2D) mammography. She added that DBT also provides enhanced visualization for cancer detection in women with dense breasts.

“2D mammography, as we know, is very limited in (women with dense breasts) because the breast just appears white. That dense breast tissue obscures finding things,” noted Dr. Conant, the division chief of breast imaging and a professor of radiology at the Hospital of the University of Pennsylvania. “When you can scroll through these slices of reconstructed images of the breast, you can actually find things on (digital breast) tomosynthesis that you didn’t see on 2D mammography because it was just a white blizzard of breast density.”

Mammography Study Shows 22 Percent Higher Incidence of Dense Breasts in Women with a Family History of Breast Cancer

AI Improves Cancer Detection Rate for Digital Mammography and Digital Breast Tomosynthesis

For more insights from Dr. Conant, watch the video below.

In a recent video interview, Emily Conant, M.D., discussed findings from a large multicenter study highlighting the benefits of digital breast tomosynthesis (DBT) in breast cancer screening.

Large Mammography Study Reaffirms Benefits of Digital Breast Tomosynthesis

Noting the prevalence of dense breasts in approximately 40 percent of women in the United States, their increased risk for breast cancer and the inconsistency of state laws on breast density notification, Wendie Berg, M.D., Ph.D., said 

implementation of a national standard for breast density notification (to begin on September 10, 2024)

In a recent video interview, Dr. Berg said the patient breast density notification language in the recently issued final rule updates from the Food and Drug Administration (FDA) to the Mammography Quality Standards ACT (MQSA) emphasizes direct communication as to whether a woman has dense breasts or not, touches upon the limitation of mammography for women with dense breasts and encourages supplemental screening in this patient population. With the FDA requiring this language in all mammography reports as of September 10, 2014, Dr. Berg says there will be a level of consistency with breast density notification that has not been there with varying state laws in 38 states and the District of Columbia.

“What this does is establish a bare minimum of communication that is uniform across all states no matter where a woman lives, which is certainly desirable to reduce confusion,” noted Dr. Berg, a co-founder and chief scientific advisor for 

New Meta-Analysis Says MRI is Best Supplemental Imaging for Dense Breasts

What a New Study Reveals About Breast Density Awareness

As patients become more educated on the elevated breast cancer risks with dense breasts and seek out supplemental imaging options, Dr. Berg said the education of referring providers is paramount to help ensure optimal outcomes.

“I think that has been an area where there has been a relative gap,” maintained Dr. Berg, a professor of radiology at the University of Pittsburgh School of Medicine. “It’s never really clear who is taking the time to explain all these issues to patients. I think radiologists actually can serve a primary role in large part in helping to educate. If they don’t educate the patient directly, they can at least educate their referring physicians about the options and issues with risk assessment and breast density.”

For more insights from Dr. Berg, watch the video below.

In a recent video interview, Wendie Berg, M.D., Ph.D., discussed the newly issued final rule from the Food and Drug Administration (FDA) requiring a national standard for breast density notification (starting on September 10, 2024) as well as its potential impact in mammography reporting and facilitating supplemental screening for patients with dense breasts.



Over 40 percent of women in the United States between the ages of 40 and 74 have dense breasts and a 

 showed that women with extremely dense breasts have more than double the risk for developing breast cancer in comparison to women with average breast density.

Yet a new study, based on a survey of over 8,000 women revealed a prevailing lack of breast density awareness. According to the study findings, which were presented at the recent 

Radiological Society of North America (RSNA)

 conference, approximately two-thirds of women between the ages of 40 and 59 were not aware of breast density. For women under 40 years of age, only 2.3 percent were aware of breast density, according to the study.

In an interview at the RSNA conference, study co-author Mary Yamashita, MD said the study found significant differences in breast density awareness based on education level as well as disparities in awareness between Hispanic women and non-Hispanic White women. Differences in the content required for the 38 states that currently have breast density notification laws and challenges with understanding the notification language may have exacerbated the lack of breast density awareness, according to Dr. Yamashita, a Clinical Associate Professor of Radiology at the Keck School of Medicine of the University of Southern California (USC).

(Editor’s note: For related video content, see “

Current Insights on Breast Density, Contrast-Enhanced Mammography and Supplemental Breast Cancer Screening

Can AI Improve the Consistency of Breast Density Assessment by Radiologists?

pending national standard for breast density notification

 in early 2023 will be a welcome development, she emphasized that the breast imaging community needs to develop standard consensus recommendations for the use of supplemental screening (via whole breast ultrasound, breast MRI or contrast-enhanced mammography) based on risk stratification in women with dense breasts.

For more insights from Dr. Yamashita, watch the video below.

1. Yamashita MW, Larsen LH, Sharek D, Bohm-Velez M, Mahoney T, Walker P. Density awareness: do patients know about breast density? Presented at the Radiological Society of North America (RSNA) Annual Meeting. November 27-December 1, 2022. Presentation available at: 

https://dps2022.rsna.org/exhibit/?exhibit=M5A-SPBR-5

2. Hall J. What a new meta-analysis reveals about breast density, mammography and MRI screening. 

https://www.diagnosticimaging.com/view/what-a-new-meta-analysis-reveals-about-breast-density-mammography-and-mri-screening

 . Published September 28, 2022. Accessed January 5, 2023.

3. Hall J. Mammography news: FDA says national breast density notification rule may be published in late 2022 or early 2023. 

https://www.diagnosticimaging.com/view/mammography-news-fda-says-national-breast-density-notification-rule-may-be-published-in-late-2022-or-early-2023

 . Published October 18, 2022. Accessed January 5, 2023.

In a recent interview from the Radiological Society of North America (RSNA) conference, Mary Yamashita, M.D. discussed a variety of findings from a survey of over 8,000 women about breast density awareness, challenges with current breast density notification after mammography exams, and the ongoing need to educate patients as well as referring providers on breast density awareness.

Artificial intelligence (AI) could play a key role in improving the consistency of breast density assessment, according to new research presented at the recent Radiological Society of North America (RSNA) conference.

In a retrospective, longitudinal study that examined the effectiveness of an emerging artificial intelligence (AI) model (WRDensity, Whiterabbit.ai ) for assessing breast density, researchers reviewed mammography data from over 61,000 patients who had three or more mammograms over a five-year period. They found the AI model was over 24 percent more consistent than radiologist assessment in assessing breast density via the Breast Imaging Reporting and Data System (BI-RADS).

In a recent video interview, Susan Holley, MD, a co-author of the study who presented the findings at the RSNA conference, said the AI model can help address the “innate variability” that can occur with radiologist assessment of breast density. As Dr. Holley pointed out, adjunctive AI assessment could be beneficial in risk stratification, determining the potential need for supplemental screening and documenting breast density assessment in radiology reports.

“With breast density being so important for risk assessment, supplemental screening and also now with a national breast density notification law that is looking like it’s going to actually happen in 2023, looking at variability and how we can get better at density assessment is even more timely and more critical,” noted Dr. Holley, a radiologist who is affiliated with UNC Health Care in Raleigh, N.C.

For more insights from Dr. Holley, watch the video below.

In a recent video interview, Susan Holley, MD discussed key findings from a large retrospective longitudinal study, presented at the recent Radiological Society of North America (RSNA) conference, which found that an emerging artificial intelligence (AI) model was over 24 percent more consistent than radiologist assessment of breast density. 

For Wendie Berg, MD, PhD, FACR, FSBI, conducting and disseminating research and education on breast cancer screening has been a driving force in her career and a personal mission as well. Her mother had breast cancer, her aunt had breast cancer and Dr. Berg is a breast cancer survivor. In a recent interview, Dr. Berg emphasized the importance of timely supplemental breast imaging in women with dense breasts.

“It’s very hard when you see a patient who has a cancer that is larger than it needed to be that wasn’t seen on a recent mammogram, and she didn’t know she had dense breasts and didn’t know she could have had additional screening that could have found the cancer earlier,” noted Dr. Berg, a professor of radiology at the University of Pittsburgh. “I’m trying to reduce that from happening to other women.”

, which provides patient-oriented and provider-focused resources on dense breasts, a key risk factor for the development of breast cancer. On the recent World Dense Breast Day (September 28, 2022), Dr. Berg said the website had a reach of over 8 million people on social media platforms with visits from 37 countries and over 17,000 content engagements.

One of the leading researchers on breast imaging, Dr. Berg said contrast-enhanced mammography is a promising advance that can help detect breast cancer that may not be apparent on digital mammography. She also noted that contrast-enhanced mammography has practical advantages as it can be performed with existing equipment, minimal software upgrades and contrast that is inexpensive.

In a wide-ranging video interview, Wendie Berg, MD, PhD, discussed her family history with breast cancer, the founding of DenseBreast-info.org, emerging research with contrast-enhanced mammography and the need for a national standard on breast density notifications. 

In a recently reported survey, published by the journal 

, researchers found that out of nearly 2,000 women between the ages of 40 and 49, over 53 percent said they did not have a screening mammogram in the past year. According to the 

, over 38 percent of those who did not have a mammogram said they had no reason to get one or had never thought about it.

In a recent video interview, Amy K. Patel, M.D., discussed patient education on mammography screening and the potential impact of new patient-oriented breast cancer screening guidelines from the National Comprehensive Cancer Network (NCCN).

The NCCN guidelines on ductal carcinoma in situ, invasive breast cancer and metastatic breast cancer are in alignment with guidelines and recommendations from the American College of Radiology and the Society for Breast Imaging, according to Dr. Patel, the medical director of the Breast Care Center at Liberty Hospital in Kansas City, and an assistant professor of radiology at the University of Missouri-Kansas City.

“I was very pleased to see that the NCCN is recommending annual screening mammography in average risk women beginning at the age of 40,” noted Dr. Patel, the president-elect of the American Association for Women in Radiology.

 for the recommendation of supplemental breast MRI for women who have an above average risk for breast cancer and the inclusion of screening considerations for pregnant and lactating women.

With ongoing gaps in mammography screening and patient anxiety that often accompanies screening exams and a possible diagnosis of breast cancer, patient education is critical. Accordingly, in a recent video interview, Amy K. Patel, M.D., discussed the potential impact of new patient-oriented breast cancer screening guidelines from the National Comprehensive Cancer Network. 

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