{
  "abstract": "Objectives High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. To date, there is no consensus on the best management for women with dense breasts. However, clinical guidelines often recommend supplemental screening using additional imaging modality such as ultrasound, magnetic resonance imaging (MRI) or tomosynthesis. This review aimed to investigate the benefits and harms of supplemental screening for women with dense breasts and provide a perspective on the environmental impact (i.e., carbon footprint) of supplemental screening.Method A systematic review of international clinical guidelines was conducted to determine the benefits and harms including the carbon footprint of supplemental screening for women with dense breasts. CINHAL, Embase, and Medline databases and grey literature including International Guidelines Library, OpenGrey, National Institute for Health and Care Excellence, Mednar, Global Index Medicus and Google were searched. The search strategy combined the terms ‘breast’, ‘density’, ‘guidelines’ and synonyms. Relevant titles, abstracts and full texts were independently screened for eligibility by two researchers using Covidence. Two authors independently assessed guideline eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument).Results Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended supplemental screening (n = 15, 65%), however there was no consensus on the modality, frequency, or target group (i.e., all women with dense breasts or only those with extremely dense breasts). The benefit of supplemental screening included increased cancer detection rates, and the harms included false-positive results, unnecessary biopsies, potential overdiagnosis of breast cancer, and associated additional costs for women and the healthcare system. No guidelines discussed the carbon footprint of supplemental screening for women with dense breasts.Conclusions Although supplemental screening increases the likelihood of cancer detection, several harms exist including the potential for overdiagnosis, false-positives results, and additional costs for women and the healthcare. As per the Conference of the Parties (COP) 26 Health Program commitments, considering the environmental impact from healthcare is now necessary, with more than 85 countries committed to developing sustainable low carbon health systems. However, none of the guidelines reviewed considered the carbon footprint of supplemental screening. The environmental impact is vital to consider in the balance of benefits and harms to ensure an effective and sustainable supplementary breast screening strategy for asymptomatic women with dense breasts.",
  "authors": [
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Jennifer Isautier"
    },
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Alexandra Barratt"
    },
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Kirsten McCaffery"
    },
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Nehmat Houssami"
    },
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Alison Pearce"
    },
    {
      "affiliations": [
        "University of Sydney, Sydney, Australia"
      ],
      "name": "Brooke Nickel"
    }
  ],
  "title": "071 The carbon footprint of imaging should be considered to ensure an effective and sustainable supplementary breast screening strategy for women with dense breasts",
  "uid": "d14cd954-d048-5f5a-9233-33122257c566"
}