Women with dense breast tissue could soon be offered extra scans on the NHS after Lancet study shows cancers can remain “hidden” during regular mammograms
Better breast cancer screening could identify 3,500 more cancerous lumps every year and save hundreds of lives, research shows.
A new study in the Lancet has shown that two extra scans for women with dense breasts can pick up early-stage cancers that remain “hidden” during regular mammograms. Cambridge University scientists say these additional scans – which make blood vessels more visible during mammograms – should be offered as they would more than treble cancer detection.
Around 10% of women have very dense breasts, which means they have more fibrous and glandular tissue and less fatty tissue.
Study lead Professor Fiona Gilbert, of Cambridge University and honorary consultant radiologist at Addenbrooke’s Hospital, said: “Getting a cancer diagnosis early makes a huge difference for patients in terms of their treatment and outlook.
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“We need to change our national screening programme so we can make sure more cancers are diagnosed early, giving many more women a much better chance of survival.”
Those with dense breasts are already known to face a four-fold increased risk of breast cancer compared to women without. At the moment denser breasts look whiter on mammograms so standard scans cannot pick up all cancers. Early-stage cancers also appear white, meaning they are difficult to distinguish.
The BRAID trial was carried out on 9,361 women across the UK who have dense breasts and had a negative mammogram result. When additional scanning methods were offered an extra 85 cancers were found.
The UK National Screening Committee is reviewing this evidence and it could result in woman with dense breast tissue being offered extra scans on the NHS.
Louise’s Story
Louise Duffield, age 60, was diagnosed with early-stage breast cancer as a result of the trial. The grandmother-of-four was invited to participate in 2023 following her regular mammogram screening, which showed that she had very dense breasts. As part of the trial, Louise had an AB-MRI scan which identified a small lump deep inside one of her breasts.
Louise, from Ely, in Cambridgeshire, said: “When they rang to say they’d found something, it was a big shock. You start thinking all sorts of things but, in the end, I just thought, at least if they’ve found something, they’ve found it early. The staff were brilliant, and so supportive.”
Soon after the MRI, Louise had a biopsy that confirmed she had stage 0 – very early – breast cancer within the ducts of one of her breasts. Six weeks later Louise underwent surgery to remove the tumour, during that time the tumour had already grown larger than it appeared on the scans.
The location of Louise’s tumour meant it would have been difficult for her to find it through self-examination, and since it was not detected during her regular mammogram it would have been at least three years before she was invited for another.
Louise said: “It’s been a stressful time and it’s a huge relief to have it gone. The team have been fantastic throughout. The tumour was deep in the breast so, if I hadn’t been on the trial, it could have gone unnoticed for years. I feel very lucky, it almost doesn’t feel like I’ve really had cancer. Without this research I could have had a very different experience.”
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The two extra scanning methods examined in the trial were contrast enhanced mammography (CEM), where dye is used to make blood vessels more visible, and abbreviated magnetic resonance imaging (AB-MRI), which is faster than a regular MRI.
The experts calculated that adding either of these methods to existing breast screening could detect 3,500 more cancers per year in the UK. Researchers said that because screening reduces death for about 20% of cancers detected and this could mean an extra 700 lives saved each year.
Leading screening expert Professor Stephen Duffy, from Queen Mary University, London, said: “The NHS breast screening programme has made a huge difference to many lives. Thanks to these results, we can see that the technology exists to make screening even better, particularly for the 10% of women with dense breast tissue.”
Dr David Crosby, head of prevention and early detection at Cancer Research UK, said: “This study shows that making blood vessels more visible during mammograms could make it much easier for doctors to spot signs of cancer in women with dense breasts. More research is needed to fully understand the effectiveness of these techniques, but these results are encouraging.”
A third scanning method used in the trial – automated whole breast ultrasound (ABUS) – also picked up cancers but was much less effective than CEM and AB-MRI. Overall, per 1,000 women scanned, CEM detected 19 cancers, while AB-MRI found 17 and ABUS found four.
With mammograms already detecting around eight cancers per 1,000 women with dense breasts, additional scans could therefore more than treble breast cancer detection. The trial was funded by Cancer Research UK with support from the National Institute for Health and Care Research Cambridge Biomedical Research Centre.
Dr Kotryna Temcinaite, of charity Breast Cancer Now, said: “The UK National Screening Committee now needs to consider this research as part of their current review to determine whether women with very dense breasts should be offered additional imaging during their routine screening. If the UK National Screening Committee recommends additional imaging for screening women with very dense breasts, we’ll push for those changes to be rolled out as quickly as possible across the UK.
“Routine breast screening is the most likely route to finding breast cancer early, when treatment is most likely to be successful. While we know that the current process can be less effective in detecting cancers in dense breasts, we still encourage all women to attend mammogram screening when invited.”
A Department for Health and Social Care spokesperson said: “Research is being conducted into the use of additional tests for women with dense breasts, as part of the NHS breast screening programme. The UK National Screening Committee is reviewing this evidence as it becomes available.”