This patient with high breast density should receive routine digital screening mammography. High breast density, categorized as either heterogeneously dense breast tissue or extremely dense breast tissue (using the Breast Imaging Reporting and Data System [BI-RADS] breast density categories) on mammography, imparts an increased risk of breast cancer (relative risk [RR] of 1.2 for heterogeneously dense breast tissue, RR of 2.1 for extremely dense breast tissue). Approximately 50% of women have high breast density, and some states mandate that increased breast density on mammography is directly reported to patients to inform them of this increased risk. High breast density also decreases the sensitivity of mammography to detect small lesions. Although high breast density alone does not necessitate additional or more frequent breast imaging other than routine screening mammography, there is evidence that digital mammography has an increased sensitivity for detecting small lesions in dense breasts compared with film mammography; it is therefore the preferred modality for routine screening, if available.

MRI is not recommended for either primary screening or as a supplemental test for women with increased breast density due to a lack of documented effectiveness and a high false-positive rate leading to unnecessary biopsies.

Breast ultrasonography is recommended by some organizations as supplemental testing in addition to mammography in women with dense breasts. However, no prospective trials of breast ultrasonography as a primary screening modality currently exist, and its role as a supplemental test to mammography has not been clearly defined. It is therefore not recommended as a replacement to digital mammography.