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Observational Study
. 2019 May 1;179(5):658-667.
doi: 10.1001/jamainternmed.2018.8372.

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

Janie M Lee  1 , Robert F Arao  2   3 , Brian L Sprague  4 , Karla Kerlikowske  5   6   7 , Constance D Lehman  8 , Robert A Smith  9 , Louise M Henderson  10 , Garth H Rauscher  11 , Diana L Miglioretti  2   12
Affiliations
Observational Study

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

Janie M Lee et al. JAMA Intern Med. .

Erratum in

  • Typographical Error in Table 3.
    [No authors listed] [No authors listed] JAMA Intern Med. 2019 May 1;179(5):733. doi: 10.1001/jamainternmed.2019.1275. JAMA Intern Med. 2019. PMID: 31034043 Free PMC article. No abstract available.

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 (≥2.50%) 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lee reported receiving grants from the National Cancer Institute and American Cancer Society during the conduct of the study and reported receiving grants, personal fees, and nonfinancial support from GE Healthcare outside the submitted work. Dr Sprague reported receiving grants from the National Institutes of Health. Dr Kerlikowske reported receiving grants from the American Cancer Society. Dr Lehman reported receiving grants from the National Cancer Institute and the American Cancer Society and reported receiving grants and other support from and having a consulting agreement with GE Healthcare. Dr Henderson reported receiving grants from the National Institutes of Health and the National Cancer Institute. Dr Miglioretti reported receiving grants from the American Cancer Society and the National Cancer Institute and reported receiving personal fees from the Hologic Inc Scientific Advisory Board. No other disclosures were reported.

Figures

Figure.
Figure.. Joint Distributions of BCSC 5-Year Risk by BI-RADS Breast Density Category in 5392 Combined Mammography and Ultrasonography Screening Examinations
BCSC indicates Breast Cancer Surveillance Consortium; BI-RADS, Breast Imaging Reporting and Data System.
See this image and copyright information in PMC

Comment in

References

    1. Dehkordy SF, Carlos RC. Dense breast legislation in the United States: state of the states. J Am Coll Radiol. 2013;10(12):899-902. doi: 10.1016/j.jacr.2013.09.007 - DOI - PubMed
    1. Are You Dense Advocacy, Inc . State density reporting efforts—because your life matters: 36 state density reporting laws. https://www.areyoudenseadvocacy.org/dense/. Accessed February 12, 2018.
    1. 115th Congress (2017-2018). S.2006 Breast Density and Mammography Reporting Act of 2017. Introduced in Senate (10/25/2017). https://www.congress.gov/bill/115th-congress/senate-bill/2006/text?q=%7B.... Accessed February 28, 2018.
    1. 115th Congress (2017-2018). H.R.4122 Breast Density and Mammography Reporting Act of 2017. Introduced in House (10/25/2017). https://www.congress.gov/bill/115th-congress/house-bill/4122/text. Accessed February 18, 2018.
    1. American College of Radiology . American College of Radiology Breast Imaging Reporting and Data System Atlas (BI-RADS Atlas). 4th ed. Reston, VA: American College of Radiology; 2003.

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