"The risk is higher for cancer compared to fatty breasts," she said. "The topic is well established."

Nevertheless, the issue of breast density is gaining traction in the U.S., driven in part by new legislation. Connecticut was the first state to enact a law three years ago, requiring doctors to inform women of their breast density and possible risks following a mammogram. Similar laws have since been adopted in California, New York, Texas and Virginia. Other states are also considering breast density bills — but not without contention among medical experts and lawmakers. Connecticut is also the only state that requires insurance coverage for supplemental screenings, specifically ultrasound and MRI.


Europe has no such laws.

Frigerio said he believes in education, training and an organized environment to decrease interval cancer rates. He said working with radiologists in a dedicated setting already makes a difference in decreasing the rate of interval cancers, and that mammography screening is an effective method.

"We have lots of evidence it [mammography] decreases mortality significantly," he said.

In addition, Frigerio, said that ultrasound as a screening adjunct for women with dense breasts is not feasible with a limited workforce.

"We strive for dedicated breast radiologists, we have so few of them," said Frigerio.

However, he did add that other technologies could help reduce interval cancers.

"I believe tomosynthesis is the technological option at hand," he said.

Unlike a screening digital mammogram, which involves two X-ray images of each breast, breast tomosynthesis, or 3-D mammography, captures a series of images at different degrees around the breast in 1-millimeter slices.

Frigerio said he looks forward to increased use of automated breast ultrasound as well, which also provides 3-D ultrasound images of breast tissue.

During her lecture, Berg acknowledged that it was important to touch on tomosynthesis.

"It's easy to implement if you have the unit," she said. "The technologist just has to push another button."

She referenced the Oslo University Hospital study, recently published in Radiology, where researchers found that adding the 3-D technology to normal 2-D cancer screenings resulted in a 27 percent increase in the detection of cancer, a 40 percent increase in the detection of invasive cancer and a 15 percent drop in false-positives. Berg said this is the first time false-positives have been reduced in a study. One of the downsides to ultrasounds, she noted, includes a higher percentage of false-positives than mammograms.

Before the panel was over, one audience member said he believed tomosynthesis would become the next breast screening standard. This seemed to leave many wondering what role ultrasound will play once this happens.

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