Where breast cancer screening is headed: 20 notes

Research and innovation have steadily driven advancements in breast cancer screening since Congress enacted the Mammography Quality Standards Act in 1992. 

Here are 20 things to know about where breast cancer screening is headed: 

Incidence and death rates

1. In the U.S., American Indian and Alaska Native women have a 10% lower incidence rate and a 6% higher mortality rate compared to white women. Also compared to white women, Black women are 38% more likely to die from breast cancer despite a 5% lower incidence. Between 2012 and 2021, the breast cancer incidence rate rose 2.5% among Asian American women and 2.7% among Pacific Islander women. 
   
   
2. Due to the pandemic, the U.S. cancer incidence rate was 9.4% lower than expected in 2020 and 2.7% lower than expected in 2021, equating to 149,577 potentially missed diagnoses. Of all cancers, breast cancer diagnoses showed the greatest improvement in 2021, exceeding the expected incidence rate by 2.5%.
   
   
3. According to the American Association for Cancer Research's annual Cancer Progress Report, the U.S. breast cancer death rate declined by 42% between 1989 and 2022.

Screening rates 

4. In 2023, the U.S. Preventive Services Task Force lowered the age recommendation for breast cancer screening from 50 to 40 years old.
   
   
5. The total U.S. healthcare system costs for initial cancer screenings in 2021 were an estimated $43 billion.
   
   
6. The national breast cancer screening rate in 2022 was 70.2%. For the same year, Wyoming had the lowest screening rate at 59.5% — nearly 20% lower than Rhode Island, the state with the highest rate (78.4%).
   
   
7. The national breast cancer screening recall rate between July 2022 and June 2023 was 9. For the same year, Minnesota had the lowest breast cancer screening recall rate at 5.7 and New York had the highest at 31.4. Recall occurs if additional screening is required after mammogram results are reported.
   
   
8. In a recent Gallup survey, 43% of women said they have missed or delayed preventive cancer screenings, with 41% saying they have skipped or delayed a screening for breast cancer specifically.
   
   
9. Women are less likely to return for additional breast cancer screening if they have received a false-positive mammogram result.

Breast density

10. Effective Sept. 10, all U.S. healthcare facilities providing breast imaging services are required by the FDA to notify patients of their breast density in mammography reports. Patients with dense breasts are at an increased risk of developing breast cancer and may be a good candidate for additional cancer screening, including ultrasound or MRI.
    
    
11. Some experts have expressed concern over the new FDA requirement, citing the lack of guidance over how to proceed once a patient has been identified as having dense breasts.
    
    
12. In a recent study, researchers found mixed results when comparing outcomes for digital breast tomosynthesis (3D mammography) screenings and supplemental MRI. For women with extremely dense breasts, adding MRI to DBT screening averted 7.6 deaths and resulted in 180 false-biopsy recommendations. For women with heterogeneously dense breasts, adding MRI to DBT screening averted 8.0 deaths and resulted in 343 false-positive biopsy recommendations. 

Artificial intelligence

13. In a recent study, researchers developed an AI algorithm and evaluated its ability to identify breast cancer on MRI scans. AI showed the ability to detect cancers one year earlier and was able to identify the region where cancer would be detected in 66 of 115 cases.
    
    
14. Altamonte Springs, Fla.-based AdventHealth launched a pilot program that harnesses AI to assess a patient's risk of developing breast cancer. In the first two months, the program saw a 23% increase in patients identified as high risk.
    
    
15. Tampa (Fla.) General Hospital and Dallas-based UT Southwestern Medical Center are testing a generative AI platform to synthesize patient health history into a report for oncologists, informing breast cancer treatment and trial eligibility.
    
    
16. In a recent study, researchers employed the use of AI to quantify a patient's breast arterial calcification "score." Breast arterial calcifications, benign calcium buildups that look like white parallel lines on mammograms, were found to be predictive of future cardiovascular events among younger women.

Technological innovation

17. A recent study compared the cancer detection rates of digital breast tomosynthesis (3D mammography) and traditional mammography. Of the breast cancer cases analyzed, DBT had a higher rate of cancer depiction (5.3 cancers per 1,000) compared to mammography (four cancers per 1,000).
    
    
18. The FDA has given premarket approval to the 3D breast-imaging technology of Siemens Healthineers' Mammomat B.brilliant mammography platform.
    
    
19. Minneapolis-based Allina Health Cancer Institute launched a first-of-its-kind clinical trial using artificial intelligence and a blood draw to find and diagnose breast cancer.
    
    
20. Researchers at Tucson-based University of Arizona have been awarded $3.3 million by the National Cancer Institute to develop a breast imaging method that does not require physical compression, hoping the alternative method will be an effective option for patients with dense breasts or patients who avoid mammograms due to the pain caused by compression.