SBI 2025: A Sea Change in Supplemental Screening
As I leave the Society of Breast Imaging 2025 annual meeting in beautiful Colorado Springs, I can’t help but reflect on the cultural shift I witnessed. The old message — that tomosynthesis alone is enough for women with dense breast tissue — is firmly in the past.
Today’s clear and urgent message: we must work to provide supplemental screening beyond mammography for women with dense breasts.
During the main sessions, several powerful (non-verbatim) statements captured this new ethos:
Women didn’t do anything to have dense breasts. Why should they suffer the consequences of delayed diagnosis because of it?
Telling a woman with dense breasts that her mammogram is normal is actually incomplete information.
This meeting felt like a real turning point — and one that will ultimately lead to better care for millions of women.
Challenges to fully implementing supplemental screening were also front and center. While MRI and contrast-enhanced mammography (CEM) were presented as the most effective options for supplemental screening in women with dense breasts, it was clear that neither will be universally accessible. Financial, geographic, and system-level barriers currently limit access for many women who would benefit.
The new SBI stance on ultrasound was particularly notable: ultrasound is now acknowledged as effective for cancer detection beyond mammography, but inferior to "vascular-based screening" like MRI and CEM. The message was clear — ultrasound should only be used when MRI or CEM is unavailable or impractical for a particular woman or region.
There was also an important discussion about refining which women would benefit most from supplemental screening, moving beyond density alone. Although few concrete solutions were presented, there was clear anticipation that AI, genomics, and new risk models will eventually help personalize screening recommendations.
One glaring omission from the formal discussions: Molecular Breast Imaging (MBI). Despite its long track record of scientific evidence supporting efficacy, MBI was notably absent from the broader conversation. It took an audience comment during a molecular breast imaging session to bring attention to its exclusion.
Meanwhile, a session on CEM implementation was so packed it was standing room only, reflecting growing excitement and interest among breast imagers for this emerging technology.
Among the conference highlights, Joanne Pushkin was awarded an honorary SBI Fellowship for her work and advocacy on supplemental screening — a truly meaningful moment, considering that not long ago, many breast imagers actively opposed her efforts on dense breast tissue notification. It was gratifying to see someone once considered a "rebel" finally recognized as correct and courageous.
Paula Gordon, MD, also received the SBI Gold Medal for her early work on ultrasound and supplemental screening. She shared personal stories of overcoming skepticism and resistance to prove that mammography alone misses meaningful cancers in dense tissue — paving the way for today's broader discussions around supplemental screening options.
One surprising takeaway: AI played a noticeable second fiddle to supplemental screening at this conference. That said, it wasn’t absent. In the Exhibit Hall, I spent time talking with AI vendors and came away with this impression — there’s still a lot of hype and over-marketing, even as the scientific foundation for AI in breast imaging is improving. I'll be writing a separate article soon focused specifically on AI takeaways from this meeting (click here to read it), but the short version is this: current AI tools are moderately useful, and vendors need to be more honest and transparent about efficacy, rather than relying on idealized, best-case scenarios.
Two final thoughts:
The joy of reconnecting with friends and colleagues reminds me that the in-person conference experience can never truly be replaced.
The job market for breast radiologists — and radiologists in general — remains extremely strong.
Overall, SBI 2025 was noticeably larger, with more radiologist and industry participation than in recent years. It’s a good sign for the future.
And finally, a personal note: Garden of the Gods in Colorado Springs absolutely lives up to its name. An evening run before the meeting offered a moment of connection to the breathtaking natural beauty of this area — a perfect start to an enlightening meeting.
“Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.”
― Steve Jobs
