Patient-Oriented Evidence That Matters

Adding Ultrasonography to Mammography Increases False-Positive Findings Without an Increase in Cancer Detection


Am Fam Physician. 2020 Jan 1;101(1):53-54.

Clinical Question

Does the addition of screening ultrasonography add benefit or harm to screening mammography alone?

Bottom Line

Adding ultrasonography to screening mammography in women younger than 50 years at low, intermediate, or high breast cancer risk is not associated with an increase in breast cancer detection. It is associated with increased unnecessary biopsy recommendations and results in more frequent follow-up. (Level of Evidence = 2b)


The researchers compared the results from 6,081 women who were screened for breast cancer with mammography and ultrasonography, with 30,062 screening mammograms from 15,176 women drawn from 13 years of data from two breast cancer surveillance registries in the United States. When compared to the mammography-alone group, ultrasound screens were performed in women with dense breasts (74.3%), women more likely to be at higher risk of breast cancer, and women younger than 50 years. The cancer detection rate was similar across groups (5.4 vs. 5.5 per 1,000 screens), as was the development of cancer between screenings (interval cancer rate). The rate of unnecessary biopsies was more than twice as high for the combination screening (52.0 vs. 22.2 per 1,000 screens), as were calls for rescreening at shorter-than-normally-recommended intervals (relative risk = 3.10; 95% CI, 2.6 to 3.7).

Study design: Cohort (retrospective)

Funding source: Government

Setting: Outpatient (any)

Reference: Lee JM, Arao RF, Sprague BL, et al. Performance of screening ultrasonography as an adjunct to screening mammography in women across the spectrum of breast cancer risk [published correction appears in JAMA Intern Med. 2019;179(5):733]. JAMA Intern Med. 2019;179(5):658–667.

Editor's Note: Dr. Ebell is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell. Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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