Performance of Ultrasound as an Adjunct to Screening Mammography
BCSC study finds little benefit from adding ultrasound to screening mammography
To evaluate the performance of screening ultrasonography as a supplement to screening mammography, BCSC investigators examined 6,081 screening mammography plus same-day screening ultrasonography examinations performed in 3,386 women, which were matched to 30,062 screening mammograms without screening ultrasonography in 15,176 women.
The study described breast cancer screening in United States community practice, outside of the clinical trial setting. While screening mammography plus ultrasound was most frequently performed in women with dense breasts, a substantial portion of women who received supplemental ultrasound had non-dense breasts (25.7%). The majority of screening ultrasound examinations were performed in women who had low or average (<1.67%) BCSC 5-yr risk (53.6%); only about one-fifth (21.4%) of examinations were performed in women with high or very high (≥2.50%) risk.
Comparing mammography plus ultrasonography with mammography alone, significantly higher rates of recommendation for non-invasive imaging follow up and biopsies were observed, without significantly increased cancer detection rate or decreased interval cancer rates. For every 1000 women screened with mammography plus ultrasonography, approximately 5 women would be diagnosed as having breast cancer, while 57 women would receive a recommendation for biopsy, and 52 of these women would have benign, false-positive results at pathology. An additional 39 women would receive recommendations for short-interval follow up of detected findings.
These results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms. Additional efforts are needed to more accurately identify women who will benefit from supplemental ultrasound screening.
Full Text Citation and Link: Lee JM, Arao RF, Sprague BL, Kerlikowske K, Lehman CD, Smith RA, Henderson LM, Rauscher GH, Miglioretti DL. Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk. JAMA Internal Medicine. 2019. Epub 2019/03/19. PubMed PMID: 30882843. [Link to Article]
Study highlighted in the following media sources:
- Healio Primary Care Today News: https://www.healio.com/internal-medicine/oncology/news/online/%7B3fb77db3-5d7c-4cf4-bb49-464bb0eccaef%7D/supplemental-ultrasonography-for-breast-cancer-screening-may-cause-more-harm-than-benefit
- AuntMinnie.com: https://www.auntminnie.com/index.aspx?sec=sup&sub=wom&pag=dis&ItemID=124928
- MedPage Today: https://www.medpagetoday.com/hematologyoncology/breastcancer/78760
- Radiology Business: https://www.radiologybusiness.com/topics/quality/supplemental-whole-breast-ultrasound-value-jama
- MDLinx Internal Medicine: https://www.mdlinx.com/journal-summaries/short-interval-biopsy-screening-mammography-ultrasonography/2019/03/20/7561209/?rcid=67
Posted by: Janie Lee, MD