A landmark clinical trial has demonstrated that additional imaging tests could more than triple breast cancer detection rates in women with dense breast tissue, potentially transforming screening protocols for this high-risk population. The BRAID (Breast Screening: Risk Adaptive Imaging for Density) trial, led by researchers at Cambridge University, found that contrast-enhanced mammography (CEM) and abbreviated magnetic resonance imaging (AB-MRI) detected 85 cancers among more than 9,000 women with dense breasts who had previously received negative mammogram results.
Enhanced Detection Rates Across Imaging Modalities
The trial, published in The Lancet on May 21, 2025, evaluated three additional screening technologies in women with dense breasts. Per 1,000 women screened, CEM detected 19 cancers using injected contrast agents to improve tumor visibility, while AB-MRI identified 17 cancers through contrast dye highlighting of abnormalities. Automated whole breast ultrasound (ABUS) detected only 4 cancers per 1,000 women, proving significantly less effective than the contrast-enhanced methods.
"Getting a cancer diagnosis early makes a huge difference for patients in terms of their treatment and outlook," said Professor Fiona Gilbert, Department of Radiology at the University of Cambridge and lead researcher. "We need to change our national screening programme so we can make sure more cancers are diagnosed early, giving many more women a much better chance of survival."
Addressing Critical Screening Gap
Approximately 10% of women aged 50-70 have very dense breast tissue with low levels of fatty tissue, making them up to four times more likely to develop breast cancer compared to women with low breast density. The challenge lies in mammographic interpretation, as both dense tissue and early-stage cancers appear white on standard mammograms, significantly reducing cancer visibility.
Current breast cancer screening guidelines in both the United States and United Kingdom recommend standard mammograms for all women, without considering breast density variations. While breast density reporting is mandated in the U.S., no consensus exists regarding optimal screening protocols for women with dense breasts.
Clinical Impact and Patient Outcomes
The trial's findings suggest that implementing CEM and AB-MRI as additional screening measures could detect up to 3,500 more cancers annually, potentially saving an estimated 700 lives per year through earlier diagnosis. Standard mammograms already detect approximately 8 cancers per 1,000 women with dense breasts, meaning these enhanced protocols could more than triple detection rates.
Louise Duffield, a 60-year-old grandmother from Ely, UK, exemplifies the trial's clinical impact. Despite receiving a normal mammogram result in 2023, her participation in the BRAID trial led to MRI detection of a small, deep-seated tumor that would have remained undetected for at least three years under current UK guidelines.
"When they rang to say they'd found something, it was a big shock," Duffield said. "You start thinking all sorts of things but, in the end, I just thought, at least if they've found something, they've found it early." Following surgical removal and radiation therapy, Duffield is now cancer-free.
Study Design and Methodology
Between October 2019 and March 2024, researchers recruited nearly 9,400 women with dense breasts who had received negative mammogram results. Three-quarters were randomly assigned to receive one of three additional screening tests—CEM, AB-MRI, or ABUS—while the remaining participants served as controls without additional scanning.
The research team concluded that CEM and AB-MRI demonstrated three times greater effectiveness than ABUS and should be considered as supplemental screening measures for women with dense breasts.
Future Implications for Screening Programs
"This study shows that making blood vessels more visible during mammograms could make it much easier for doctors to spot signs of cancer in women with dense breasts," said Dr. David Crosby, head of prevention and early detection at Cancer Research UK. "More research is needed to fully understand the effectiveness of these techniques, but these results are encouraging."
The findings support calls for revising national screening programs to incorporate breast density assessment and tailored imaging protocols. Implementation of these enhanced screening measures could significantly improve early detection rates and survival outcomes for women with dense breast tissue, addressing a critical gap in current cancer screening approaches.
