EARLY results from a UK trial suggest that abbreviated MRI and contrast-enhanced mammography detect significantly more breast cancers than ultrasound in women with dense breasts and a negative mammogram.
Dense breast tissue can obscure cancer on standard mammograms, making it difficult to detect disease early. To address this, the study compared three supplemental imaging methods (abbreviated MRI, automated whole breast ultrasound [ABUS], and contrast-enhanced mammography) with standard mammography in a randomised controlled trial across ten breast screening sites. Women aged 50–70 years with dense breasts and a negative mammogram were randomly allocated to one of the imaging techniques based on day or mobile van schedule, depending on modality availability at each centre. The primary outcome was the cancer detection rate, defined by histologically confirmed diagnoses following a positive supplemental imaging result. Data were analysed using a network meta-analysis, treating each site as a separate study.
Between October 2019–March 2024, 9,361 women were enrolled, with 6,305 undergoing supplemental imaging. Abbreviated MRI detected 17.4 cancers per 1000 exams (n=37), ABUS detected 4.2 (n=9), and contrast-enhanced mammography 19.2 (n=39). Rates for invasive cancers followed a similar pattern: 15.0 for abbreviated MRI, 4.2 for ABUS, and 15.7 for contrast-enhanced mammography. Abbreviated MRI’s detection rate was significantly higher than ABUS (p=0.047) and comparable to contrast-enhanced mammography (p=0.62). Adverse events were rare, with one minor reaction in the MRI group, none in ABUS, and 24 contrast-related reactions and three extravasations in the contrast-enhanced mammography group.
These interim findings indicate that abbreviated MRI and contrast-enhanced mammography are more effective than ultrasound for cancer detection in women with dense breasts. While promising for earlier diagnosis, further data are needed to assess potential overdiagnosis and long-term outcomes.
Reference
Gilbert FJ et al. Comparison of supplemental breast cancer imaging techniques—interim results from the BRAID randomised controlled trial. Lancet. 2025; DOI: https://doi.org/10.1016/S0140-6736(25)00582-3.
