BACKGROUND AND PURPOSE:

• Whole-breast ultrasonography in addition to mammography has been suggested to improve outcomes in women with dense breasts as well as those at high risk for other reasons (e.g., personal history of breast cancer)
  • Data remains limited as to benefits
• Lee et al. (JAMA Intern Med, 2019) sought to determine, in community practice, the performance of
  • Screening mammography alone
  • Screening mammography plus screening ultrasonography

METHODS:

• Observational cohort study
• Participants and data collection
  • Prospectively collected data
  • Same day ultrasound available
  • Data linked to Breast Cancer Surveillance Consortium registries
  • Exclusion criteria: Personal history of breast cancer | Self-reported breast symptoms
• Exposures
  • Screening mammography alone
  • Screening mammography with screening ultrasonography
• Screening mammography plus screening ultrasonography matched 1:5 to mammograms without screening ultrasonography for the following
  • Age | Year of examination, Race/ethnicity | Menopausal status | First-degree family history of breast cancer | Time since last mammogram | Breast density | Prior benign biopsy result
• Primary outcomes
  • Cancer detection rate and rates of interval cancer
  • False-positive biopsy recommendation
  • Short-interval follow-up
  • PPV of biopsy
• Propensity score used to address confounding as well as direct adjustments

RESULTS:

• Screening mammograms with screening ultrasonography: 3386 women | 6081 exams
• Screening mammograms without ultrasonography: 15,176 women | 30,062 from a sample of 113,293 mammograms

Despite matching, screening mammography with ultrasonography was performed more often in women with the following characteristics

• Dense breasts
  • With ultrasonography: 74.3%
  • Without ultrasonography: 35.9%
• <50 years old
  • With ultrasonography: 49.7%
  • Without ultrasonography: 31.7%
• Family history of breast cancer
  • With ultrasonography: 42.9%
  • Without ultrasonography: 15.0%
• At higher risk for breast cancer
  • High or very high (≥2.50%) Breast Cancer Surveillance Consortium 5-year risk scores: 21.4%
  • Women with low or average (<1.67%) risk: 53.6%
• Cancer detection rate was similar in both groups
  • With ultrasonography: 5.4 per 1000 screens
  • Without ultrasonography: 5.5 per 1000 screens
  • Adjusted relative risk (RR), 1.14 (95% CI, 0.76-1.68)
• Interval cancer rates were similar in both groups
  • With ultrasonography: 1.5 per 1000 screens
  • Without ultrasonography: 1.9 per 1000 screens
  • RR 0.67 (95% CI, 0.33-1.37)
• False-positive biopsy rates were significantly higher in the with ultrasonography group
  • With ultrasonography: 52.0 per 1000 screens
  • Without ultrasonography: 22.2 per 1000 screens
  • RR 2.23 (95% CI, 1.93-2.58)
• Short-interval follow-up was significantly higher in the with ultrasonography group
  • With ultrasonography: 3.9%
  • Without ultrasonography: 1.1%
  • RR 3.10 (95% CI, 2.60-3.70)
• PPV of biopsy recommendation was significantly lower in the with ultrasonography group
  • With ultrasonography: 9.5%
  • Without ultrasonography: 21.4%
  • RR 0.50 (95% CI, 0.35-0.71)

CONCLUSION:

• Authors conclude that benefits of supplemental ultrasound across all risk categories did not appear to outweigh the harms of additional biopsies  

Learn More – Primary Sources:

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

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FDA Finalizes New Mammography Dense Breast Notification Rule

Mammography Guidelines for Average-Risk Women

BI-RADS: Standardizing Breast Imaging and Reporting 

Breast Cancer Screening using MRI vs Mammography – How Do They Compare?

How Effective Is Mammography in Reducing the Number of Advanced Breast Cancer Diagnoses?