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Supplementary breast cancer screening in women with dense breasts across Europe: A mixed-methods study to inform
1Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, MSD 2080, Malta.
Introduction:
Women with dense breasts have increased breast cancer risk and reduced mammographic sensitivity, contributing to more interval cancers and delayed diagnosis. Although supplementary modalities such as magnetic resonance imaging, digital breast tomosynthesis, and ultrasound improve detection, their integration into organised screening programmes remains inconsistent across Europe. This study evaluated professional practice, knowledge, and system-level barriers to supplementary screening to inform harmonised policy and practice.
Methods:
A multi-phase mixed-methods design was used. Phase 1 comprised a systematic review of screening effectiveness and implementation strategies. Phase 2 involved semi-structured interviews with European screening professionals exploring experiences, challenges, and training needs. Phase 3 included a cross-sectional pan-European online survey assessing awareness, current practices, and readiness to implement supplementary pathways. Quantitative data were analysed descriptively and qualitative data thematically. Findings were integrated to identify priorities and recommendations.
Results:
Marked variation in access, protocols, and reporting was observed. Barriers included lack of clear guidance, inconsistent density assessment and communication, limited infrastructure and equipment, workforce and training gaps, and organisational pressures. Most professionals expressed willingness to adopt risk-stratified supplementary screening with adequate resources, education, and policy support.
Conclusion:
Recommendations include standardised density reporting, harmonised guidelines, targeted training, and strategic investment in imaging services. A coordinated European framework could reduce inequities, strengthen radiography practice, and improve early detection for women with dense breasts.
Implications For Practice:
Standardised density reporting, clear guidelines, and targeted workforce training are needed to support consistent implementation of supplementary screening. Strengthening infrastructure and professional education may reduce practice variation and improve early detection for women with dense breasts.