Breast cancer screening: emerging role of new imaging techniques as adjuncts to mammography.
Early detection of breast cancer has been shown to reduce breast cancer deaths in randomised controlled trials (RCTs) of mammography in women aged 50-69 years, with weaker evidence of benefit in those aged 40-49 or 70 years and older. Magnetic resonance imaging (MRI) and ultrasonography have been evaluated in breast cancer screening, relative to, or in addition to, mammography, in selected populations; neither test has been examined in an RCT, and thus evidence of associated screening benefit is uncertain. MRI is more sensitive than mammography in screening women with suspected or proven inherited mutations of the breast cancer genes. The addition of MRI in screening this population detects 8-24 additional cancers per 1000 screens, but also significantly increases a woman's risk of being recalled for investigation or surgical biopsy for false-positive findings. In Australia, Medicare funding for MRI screening of women in specific risk groups was announced in February 2009. Ultrasonography can detect cancers not identified on mammography in asymptomatic women with dense breast tissue. Incremental ultrasound cancer detection is reported in 0.27%-0.46% of women with mammography-negative dense breasts; evidence varies on its association with false-positive findings. Computer-aided detection (CAD) is a complementary tool to mammography, prompting the reader to consider lesions on the mammogram that may represent cancer. Emerging evidence and improved CAD technology are likely to help define its role in breast screening.
Screening and Test Evaluation Program, School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. nehmath@med.usyd.edu.au
Nehmat
N
Houssami
Sarah J
SJ
Lord
Stefano
S
Ciatto
D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D002278:Carcinoma in Situ / Q000175:diagnosis; D017076:Computer-Aided Design; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014463:Ultrasonography