title: Breast screening with ultrasound in women with mammography-negative dense breasts: evidence on incremental cancer detection and false positives, and associated cost.
abstract: 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.
authors.affiliation: Ambulatori Oncologici Raphael, Cooperativa Sociale O.N.L.U.S., Calcinato (BS), Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Corsetti
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.forename: Aurora
authors.initials: A
authors.lastname: Ferrari
authors.forename: Marco
authors.initials: M
authors.lastname: Ghirardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Bellarosa
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Angelini
authors.forename: Claudio
authors.initials: C
authors.lastname: Bani
authors.forename: Pasquale
authors.initials: P
authors.lastname: Sardo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remida
authors.forename: Enzo
authors.initials: E
authors.lastname: Galligioni
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciatto
mesh_terms: 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*