Supplemental MRI Screening for Women with Extremely Dense Breast Tissue

Marije F. Bakker, Stephanie V. de Lange, Ruud M. Pijnappel, Ritse M. Mann, Petra H. M. Peeters, Evelyn M. Monninkhof, Marleen J. Emaus, Claudette E. Loo, Robertus H. C. Bisschops, Marc B. I. Lobbes, Matthijn D. F. de Jong, Katya M. Duvivier, Jeroen Veltman, Nico Karssemeijer, Harry J. de Koning, Paul J. van Diest, Willem P. T. M. Mali, Maurice A. A. J. van den Bosch, Wouter B. Veldhuis, Carla H. van Gils*DENSE Trial Study Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.


In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period.


The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P


The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period.

Original languageEnglish
Pages (from-to)2091-2102
Number of pages12
JournalNew England Journal of Medicine
Issue number22
Publication statusPublished - 28 Nov 2019
EventClinical Trials in Radiology Session at the European Congress of Radiology - Vienna, Austria
Duration: 27 Feb 20193 Mar 2019


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