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1. In this large observational cohort study, mammography-based ultrasound screening was not badociated with improved cancer detection rates compared with mammography alone.
2. The positive predictive value of the biopsy recommendation was significantly lower with ultrasound screening plus mammography compared with mammography alone.
Level of evidence: level 2 (good)
Detailed study: Breast cancer has enormous costs in terms of mortality, morbidity and health care resources around the world. There is increasing concern that women with denser bads will have lower rates of cancer detection than screening mammography alone. This was a large observational cohort study of 3,386 women with screening mammography and ultrasound (dual screening), compared to 15,176 women matched by a propensity score with a screening mammogram alone. The study found that dual screening was not badociated with improved cancer detection rates, but was badociated with a significant increase in the number of false positives leading to unnecessary biopsies. There was a nonsignificant decrease in false negative screenings with double screening.
Overall, this study corroborates existing evidence that questions the utility of ultrasound screening in addition to mammography when examining women with a wide range of bad cancer risks. The population in this study was heterogeneous and low-risk and new studies would therefore be useful for specific subgroups (ie, higher-risk women).
Click to read the study in JAMA Internal Medicine
Relevant Reading: Breast Cancer Screening: US Preventive Services Working Group Recommendation Statement
In depth [prospective cohort]: This was an observational cohort study conducted in Vermont and San Francisco comparing mammography screening to ultrasound (dual screening tests) to mammography alone. Data were collected for imaging between January 2000 and December 2013. Exclusion criteria included anterior bad cancer, mastectomy, unilateral examinations, or self-reported symptoms (excluding pain). . The total sample size was 18,562 women, of whom 3,386 with ultrasound screening and a mammography propensity score corresponding to 1: 5 to women with mammography screening alone. Even after matching, there were fewer patients in the single bad cancer group at high / very high risk at 5 years according to the BCSC (14.0% versus 21.4%) and the Results were then adjusted to correct this problem. Women were followed for 12 months after screening or until the next exam, whichever comes first. Findings of interest included cancer detection rates, interval cancer rates, false-positive biopsy recommendations, short-term follow-up, and the positive predictive value of the biopsy recommendation. Before matching, women who underwent screening ultrasound and mammograms were more likely to be under 50 years of age (49.7% vs. 31.7%), a family history of bad cancer ( 42.9% vs. 15.0%) and having dense bads 35.9%). The biopsy recommendation rate was significantly higher in women who underwent a double screening test (57.4 vs. 27.7 per 1,000 screens, RR 2.05, 95% CI 1.79 – 2.34) . The rate of false positive biopsies was also significantly higher with dual screening tests (52.0 versus 22.0 per 1000 screenings, RR 2.23, 95% CI 1.93 – 2.58). The positive predictive value was significantly lower with dual screening tests (9.5% vs. 21.4%, RR 0.50, 95% CI 0.35-0.71). There was a nonsignificant trend towards decreasing the false negative rate with dual screening tests (1.5 vs 1.9 for 1000 tests, RR 0.67, 95% CI 0.33 – 1.37). The cancer detection rate was not significantly different with dual screening tests (5.4 vs 5.5 per 1000 screenings, aRR 1.14, 95% CI 0.76 – 1.68). The interval cancer detection rate was similar in both groups.
Picture: PD
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