Rationale and Objectives
This study aimed to determine the best screening strategy using automated whole-breast
ultrasound and mammography in women with increased breast density or an elevated risk
of breast cancer.
Materials and Methods
After an institutional review board waiver was obtained, a retrospective review of
122 cancer cases diagnosed in 3435 women with increased breast density or an elevated
risk of breast cancer, screened with mammography and supplemental automated whole-breast
ultrasound, was performed. The imaging modality on which each cancer was seen was
noted. Screening strategies were postulated.
For each screening strategy, rates of advanced cancer diagnosis, with 95% confidence
limits, are calculated using the Clopper-Pearson method. Differences in outcomes were
calculated using Cochrane Q test and McNemar test for paired observations. Results
were expressed for all stages of cancer and for invasive cancers only.
Results
When all cancer stages are considered, mammographic screening reduces advanced cancers
by 31% over no screening. Ultrasound-only screening results in a 32% reduction. The
combination of mammographic and ultrasound screening reduces advanced cancers by 40%
(P < .05).
Compared to mammographic screening, mammographic plus ultrasound screening reduces
advanced-stage cancers by 5.7% (P = 0.03) for all stages and 10.8% (P = 0.02) for invasive cancers.
Conclusions
For women with increased breast density or who are at high risk of developing breast
cancer, a combination of screening mammography and whole-breast automated ultrasound
is superior to mammographic screening. Screening ultrasound alone is also an effective
screening strategy.
Key Words
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References
- Screening for breast cancer: an update for the US Preventive Services Task Force.Ann Intern Med. 2009; 151: 727-737
- Comparison of treatment costs for breast cancer, by tumor stage and type of service.Am Health Drug Benefits. 2016; 9: 23-32
- The case for early detection.Nat Rev Cancer. 2003; 3: 243-252
- Breast density as a determinant of interval cancer at mammographic screening.Br J Cancer. 2004; 90: 393-396https://doi.org/10.1038/sj.bjc.6601548
- Mammographic density and the risk and detection of breast cancer.NEJM. 2007; 356 (PubMed PMID): 227-236https://doi.org/10.1056/NEJMoa062790
- Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.JAMA. 2008; 299: 2151-2163
- Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: report from a hospital-based, high-volume, single-center breast cancer screening program.Eur J Radiol. 2016; 85: 1554-1563https://doi.org/10.1016/j.ejrad.2016.06.004
- Adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts: interim report of a prospective comparative trial.J Clin Oncol. 2016; 34: 1882-1888
- Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study.Radiology. 2014; 274: 663-673
- Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts.Clin Imaging. 2013; 37: 480-486
- Automated breast ultrasound in breast cancer screening of women with dense breasts: reader study of mammography-negative and mammography-positive cancers.Am J Roentgenol. 2016; 206: 1341-1350https://doi.org/10.2214/AJR.15.15367
- Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer.J Am Coll Radiol. 2009; 7: 18-27https://doi.org/10.1016/j.jacr.2009.09.022
- A breast cancer prediction model incorporating familial and personal risk factors.Stat Med. 2004; 23: 1111-1130https://doi.org/10.1002/sim.1913
- ACR BI-RADS atlas, breast imaging reporting and data system.5th ed. American College of Radiology, Reston, VA2013
- AJCC cancer staging manual.7th ed. Springer, Verlag New York2010
- The use of confidence or fiducial limits illustrated in the case of the binomial.Biometrika. 1934; 26: 404-413
- Performance benchmarks for screening mammography.Radiology. 2006; 241 (PubMed PMID): 55-66https://doi.org/10.1148/radiol.2411051504
Article Info
Publication History
Published online: July 28, 2017
Accepted:
June 19,
2017
Received in revised form:
May 14,
2017
Received:
March 25,
2017
Footnotes
The funding source ( GE Healthcare Inc., Wauwatosa, WI ) provided an unrestricted grant for this research. The data used for this project are from the clinical practice of one of the authors (IG) and remained under the author's control. The results and conclusions expressed in this paper are exclusively those of the authors.
Identification
Copyright
© 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
