Breast screening with ultrasound in women with mammography-negative dense breasts: evidence on incremental cancer detection and false positives, and associated cost.
BACKGROUND
We evaluated the contribution of ultrasound (US) in detecting breast cancer in women with dense breasts and negative mammograms.


METHODS
9157 (35.8%) of 25,572 self-referring women during 2000-2007 had BI-RADS D3-4 negative mammograms - all were screened with bilateral US.


RESULTS
US detected 37 cancers - incremental cancer detection rate (ICDR) was 0.40% (95% CI: 0.39-0.41%); ICDR was 0.33% in women <50 and 0.51% in those 50 years and older. US detected a larger proportion of cancers below age 50 compared to older women. US-only detected cancers had a more favourable stage (pTis-pT1a-pT1b: 64.8% versus 35.5%, p=0.001; pN1: 13.5% versus 31.3%, p=0.047) than cancers detected on mammography. US caused additional investigations in 4.9% of women and benign surgical biopsies in 0.9%. Cost per US-screened woman, and per US-detected cancer ranged between euro59-62 and euro14,618-15,234, respectively.


CONCLUSIONS
US detects early-stage cancers in women with mammography-negative dense breasts, with higher contribution in women younger than 50 years.
Corsetti
Vittorio
V
Ambulatori Oncologici Raphael, Cooperativa Sociale O.N.L.U.S., Calcinato (BS), Italy.
Houssami
Nehmat
N
Ferrari
Aurora
A
Ghirardi
Marco
M
Bellarosa
Sergio
S
Angelini
Osvaldo
O
Bani
Claudio
C
Sardo
Pasquale
P
Remida
Giuseppe
G
Galligioni
Enzo
E
Ciatto
Stefano
S
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000191:economics / Q000379:methods; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D003365:Costs and Cost Analysis; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics / Q000592:standards; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000191:economics / Q000592:standards*