The photo on the left is a screening mammogram that shows a small cancer (the white blob near the top). The woman whose mammogram is on the right has a big lump that is cancer. Can you see it? No one can. She has dense breasts. Normal dense issue is white. Cancer is white. Looking for cancer in dense breasts is "like trying to see a snowball in a snowstorm." The photo on the left is the ultrasound of the small cancer (too small to feel). The photo on the right is the ultrasound of the big cancer.

Connecticut has been doing screening US for all women with C and D density with no other risk factors since 2009, and finding 3-4 cancers per thousand women screened, essentially doubling the cancer detection rate over mammo alone.

https://twitter.com/kavita_dayal/status/1100543184655052800

The vast majority are small, invasive (not DCIS) and node negative, with PPV low at first but improving over time. That would be my first choice. If forced to ration, perhaps screening US for all category Ds and for category C with another risk factor, like + family history, but

Canada, please take note:
The law specifies the FDA must develop standard reporting language and ensure mammography reports and summaries Include, at a minimum the following three pieces of information:

https://twitter.com/HealthImaging/status/1097957681623691264

1. How breast density may mask cancer on a mammogram.
2. A qualitative assessment of breast density as performed by the reader.
3. A reminder to individuals with dense breasts to talk with their provider if they have questions.