Does the addition of screening ultrasonography add benefit or harm to screening mammography alone?
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:LeeJMAraoRFSpragueBLet alPerformance 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 Med2019;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.