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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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.