Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk

Abstract

IMPORTANCE Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. OBJECTIVE To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study. Two Breast Cancer Surveillance Consortium registries provided prospectively collected data on screening mammography with vs without same-day breast ultrasonography from January 1, 2000, to December 31, 2013. The dates of analysis were March 2014 to December 2018. A total of 6081 screening mammography plus same-day screening ultrasonography examinations in 3386 women were propensity score matched 1:5 to 30 062 screening mammograms without screening ultrasonography in 15 176 women from a sample of 113 293 mammograms. Exclusion criteria included a personal history of breast cancer and self-reported breast symptoms. EXPOSURES Screening mammography with vs without screening ultrasonography. MAIN OUTCOMES AND MEASURES Cancer detection rate and rates of interval cancer, false-positive biopsy recommendation, short-interval follow-up, and positive predictive value of biopsy recommendation were estimated and compared using log binomial regression. RESULTS Screening mammography with vs without ultrasonography examinations was performed more often in women with dense breasts (74.3% [n = 4317 of 5810] vs 35.9% [n = 39 928 of 111 306] in the overall sample), in women who were younger than 50 years (49.7% [n = 3022 of 6081] vs 31.7% [n = 16 897 of 112 462]), and in women with a family history of breast cancer (42.9% [n = 2595 of 6055] vs 15.0% [n = 16 897 of 112 462]). While 21.4% (n = 1154 of 5392) of screening ultrasonography examinations were performed in women with high or very high (Ն2.50%) Breast Cancer Surveillance Consortium 5-year risk scores, 53.6% (n = 2889 of 5392) had low or average (<1.67%) risk. Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk [RR], 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71). CONCLUSIONS AND RELEVANCE In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.

Is Ultrasound an Accurate Alternative for Mammography in Breast Cancer Screening in an Asian Population? A Meta-Analysis

“…However, whether ultrasound improves cancer detection remains controversial. A recent retrospective analysis of the Breast Cancer Surveillance Consortium (BCSC) showed that, for the general population, the cancer detection rates were similar for mammography plus ultrasound and mammography alone (5.4 vs. 5.5 per 1000 screens, respectively), albeit with a higher false-positive rate in the mammography plus ultrasound group (55 vs. 22 per 1000, respectively) [ 44 ].…”

Women’s Reports of Dense Breast Notification Following Mammography: Findings from the 2015 National Health Interview Survey

“…2 Examples of research topics that might be beneficial to clinical practice include the use of breast cancer risk calculators 1 as part of discussions about increased breast density, and studies to identify effective adjunctive screening tests. 6 Corresponding Author: Thomas B. Richards, MD; Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA MS S107-4, USA (e-mail: TRichards@cdc.gov).…”

Deep learning-based computer-aided diagnosis in screening breast ultrasound to reduce false-positive diagnoses

“…Despite the well-known benefits of screening breast US, a major limitation is presented by a substantial increase in false-positive findings with low specificities and low positive predictive values 8 . The Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast US has contributed to the standardization of lesion characterization, description, and reporting; moreover, it has proven effective in differentiating benign and malignant breast lesions 9 – 12 .…”