Fiona Gilbert, MA, MB, discusses breast cancer screening for dense breasts

In a recent interview with Contemporary OB/GYN, Fiona Gilbert, MA, MB, professor of radiology at the University of Cambridge, discussed the implications of dense breast tissue on breast cancer risk and detection.

Women with dense breasts—characterized by higher amounts of glandular tissue compared to fatty tissue—face a slightly increased risk of developing breast cancer. Dense breast tissue is more common in younger women and tends to decrease with age, particularly after menopause. However, it poses a significant challenge for cancer detection because dense tissue can obscure tumors on standard mammograms, making early diagnosis more difficult.

To address this limitation, some countries supplement mammography with additional imaging techniques, particularly for women known to have dense breasts. Approximately 40% of postmenopausal women fall into this category.

Gilbert's research compared various imaging methods to determine which were most effective in detecting cancers in women with dense breasts who had normal mammography results. Inspired by a Dutch study that demonstrated high cancer detection rates using magnetic resonance imaging (MRI), Gilbert’s team investigated a shorter version of MRI and contrast-enhanced mammography. These techniques both involve the use of injected contrast agents—gadolinium for MRI and iodine for mammography—which make tumors more visible because of their enhanced vascularity and permeability.

The study found that both contrast-enhanced imaging techniques were significantly more sensitive in identifying small breast cancers than traditional whole-breast ultrasound. These findings suggest that contrast imaging could be a more effective supplemental tool for women with dense breasts. Currently, ultrasound is widely used in this context, but Gilbert advocated for considering a shift toward contrast-based methods, especially as large trials such as the SEAMLESS study in the United States continue to evaluate their effectiveness.

Gilbert also emphasized the importance of providing women with accurate and contextualized information about breast density. While dense breasts do increase cancer risk, age remains the most significant risk factor. She encouraged lifestyle modifications—such as maintaining a healthy weight, reducing alcohol consumption, eating a balanced diet, and exercising regularly—to mitigate overall breast cancer risk.

Finally, Gilbert highlighted the potential for a future risk-stratified screening approach, where individualized risk assessments, including genetic profiling, could help tailor breast cancer screening and imaging techniques for more effective early detection.

No relevant disclosures.

Reference

Gilbert FJ, Payne NR, Allajbeu I, et al. Comparison of supplemental breast cancer imaging techniques—interim results from the BRAID randomised controlled trial. The Lancet. 2025. doi:10.1016/S0140-6736(25)00582-3