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Screening ultrasound as an adjunct to mammography in women with mammographically dense breasts

      There are potential benefits and harms of screening ultrasound (US) to supplement mammographic screening of women with dense breast tissue. We conducted a comprehensive literature review of studies assessing the efficacy of screening US to supplement mammography among women with dense breasts. From a total of 189 peer-reviewed publications on the performance of screening US, 12 studies were relevant to our analysis. The reporting of breast cancer risk factors varied across studies; however, the study populations tended to be at greater than average risk for developing breast cancer. Overall, US detected an additional 0.3-7.7 cancers per 1000 examinations (median, 4.2) and was associated with an additional 11.7-106.6 biopsies per 1000 examinations (median, 52.2). Significant improvements in cancer detection in dense breasts have been achieved with the transition from film to digital mammography. Thus adjunctive screening with ultrasound should be considered in the context of current screening mammography performance. Clinicians should discuss breast density as 1 of several important breast cancer risk factors, consider the potential harms of adjunctive screening, and arrive at a shared decision consistent with each woman’s preferences and values.

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      References

        • Hall F.M.
        Breast density legislation.
        Radiology. 2013; 266: 997-998
        • Lee C.I.
        • Bassett L.W.
        • Lehman C.D.
        Breast density legislation and opportunities for patient-centered outcomes research.
        Radiology. 2012; 264: 632-636
        • Dehkordy S.F.
        • Carlos R.C.
        Dense breast legislation in the United States: state of the States.
        J Am Coll Radiol. 2013; 10: 899-902
        • Cappello N.M.
        Decade of “normal” mammography reports-the happygram.
        J Am Coll Radiol. 2013; 10: 903-908
        • American College of Radiology. ACR BI-RADS—Mammography
        ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas.
        American College of Radiology, Reston, VA2013
        • Kerlikowske K.
        • Hubbard R.A.
        • Miglioretti D.L.
        • et al.
        Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: a cohort study.
        Ann Intern Med. 2011; 155: 493-502
        • Houssami N.
        • Ciatto S.
        The evolving role of new imaging methods in breast screening.
        Prev Med. 2011; 53: 123-126
        • Lander M.R.
        • Tabar L.
        Automated 3-D breast ultrasound as a promising adjunctive screening tool for examining dense breast tissue.
        Semin Roentgenol. 2011; 46: 302-308
        • Berg W.A.
        • Zhang Z.
        • Lehrer D.
        • et al.
        Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.
        JAMA. 2012; 307: 1394-1404
        • Corsetti V.
        • Houssami N.
        • Ghirardi M.
        • et al.
        Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: interval breast cancers at 1 year follow-up.
        Eur J Cancer. 2011; 47: 1021-1026
        • Stoblen F.
        • Landt S.
        • Stelkens-Gebhardt R.
        • Sehouli J.
        • Rezai M.
        • Kummel S.
        First evaluation of the diagnostic accuracy of an automated 3D ultrasound system in a breast screening setting.
        Anticancer Res. 2011; 31: 2569-2574
        • Kolb T.M.
        • Lichy J.
        • Newhouse J.H.
        Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.
        Radiology. 2002; 225: 165-175
        • Leconte I.
        • Feger C.
        • Galant C.
        • et al.
        Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density.
        AJR Am J Roentgenol. 2003; 180: 1675-1679
        • Crystal P.
        • Strano S.D.
        • Shcharynski S.
        • Koretz M.J.
        Using sonography to screen women with mammographically dense breasts.
        AJR Am J Roentgenol. 2003; 181: 177-182
        • De Felice C.
        • Savelli S.
        • Angeletti M.
        • et al.
        Diagnostic utility of combined ultrasonography and mammography in the evaluation of women with mammographically dense breasts.
        J Ultrasound. 2007; 10: 143-151
        • Brancato B.
        • Bonardi R.
        • Catarzi S.
        • et al.
        Negligible advantages and excess costs of routine addition of breast ultrasonography to mammography in dense breasts.
        Tumori. 2007; 93: 562-566
        • Corsetti V.
        • Houssami N.
        • Ferrari A.
        • et al.
        Breast screening with ultrasound in women with mammography-negative dense breasts: evidence on incremental cancer detection and false positives, and associated cost.
        Eur J Cancer. 2008; 44: 539-544
        • Berg W.A.
        • Blume J.D.
        • Cormack J.B.
        • et al.
        Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.
        JAMA. 2008; 299: 2151-2163
        • Leong L.C.
        • Gogna A.
        • Pant R.
        • Ng F.C.
        • Sim L.S.
        Supplementary breast ultrasound screening in Asian women with negative but dense mammograms-a pilot study.
        Ann Acad Med Singapore. 2012; 41: 432-439
        • Hooley R.J.
        • Greenberg K.L.
        • Stackhouse R.M.
        • Geisel J.L.
        • Butler R.S.
        • Philpotts L.E.
        Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41.
        Radiology. 2012; 265: 59-69
        • Weigert J.
        • Steenbergen S.
        The connecticut experiment: the role of ultrasound in the screening of women with dense breasts.
        Breast J. 2012; 18: 517-522
        • Parris T.
        • Wakefield D.
        • Frimmer H.
        Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458.
        Breast J. 2013; 19: 64-70
        • Girardi V.
        • Tonegutti M.
        • Ciatto S.
        • Bonetti F.
        Breast ultrasound in 22,131 asymptomatic women with negative mammography.
        Breast. 2013; 22: 806-809
        • Kelly K.M.
        • Dean J.
        • Comulada W.S.
        • Lee S.J.
        Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts.
        Eur Radiol. 2010; 20: 734-742
        • Giuliano V.
        • Giuliano C.
        Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts.
        Clin Imaging. 2013; 37: 480-486
        • Rosenberg R.D.
        • Yankaskas B.C.
        • Abraham L.A.
        • et al.
        Performance benchmarks for screening mammography.
        Radiology. 2006; 241: 55-66
        • Lee C.H.
        • Dershaw D.D.
        • Kopans D.
        • et al.
        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. 2010; 7: 18-27
        • Mainiero M.B.
        • Lourenco A.
        • Mahoney M.C.
        • et al.
        ACR Appropriateness Criteria Breast Cancer Screening.
        J Am Coll Radiol. 2013; 10: 11-14
        • Nothacker M.
        • Duda V.
        • Hahn M.
        • et al.
        Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review.
        BMC Cancer. 2009; 9: 335
        • Maughan K.L.
        • Lutterbie M.A.
        • Ham P.S.
        Treatment of breast cancer.
        Am Fam Phys. 2010; 81: 1339-1346
        • Senie R.T.
        • Lesser M.
        • Kinne D.W.
        • Rosen P.P.
        Method of tumor detection influences disease-free survival of women with breast carcinoma.
        Cancer. 1994; 73: 1666-1672
        • Independent UK Panel on Breast Cancer Screening
        The benefits and harms of breast cancer screening: an independent review.
        Lancet. 2012; 380: 1778-1786
      1. United States Food and Drug Administration. Mammography Quality Standards Act and Program Facility Scorecard. 2013. Available at: http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/DocumentArchives/ucm337647.htm. Accessed Sept. 13, 2013.

        • Fischer U.
        • Baum F.
        • Obenauer S.
        • et al.
        Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography.
        Eur Radiol. 2002; 12: 2679-2683
        • Pisano E.D.
        • Gatsonis C.
        • Hendrick E.
        • et al.
        Diagnostic performance of digital versus film mammography for breast-cancer screening.
        N Engl J Med. 2005; 353: 1773-1783
        • Carney P.A.
        • Miglioretti D.L.
        • Yankaskas B.C.
        • et al.
        Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography.
        Ann Intern Med. 2003; 138: 168-175