title: Combined performance of physical examination, mammography, and ultrasonography for breast cancer screening among Chinese women: a follow-up study.
abstract: OBJECTIVE
  We aimed to determine which combination of physical examination (pe), mammography (mam), and ultrasonography (us) would optimize breast cancer detection in China.
  
  
  METHODS
  We conducted a trial of screening with pe, mam, and us among Chinese women 25 years of age and older. All initial screenings using the three modalities were completed within 30 days of each other, and subjects were followed approximately 1 year later. The performances of the three screening methods used alone, in parallel, or in series were compared. Data were analyzed using exact confidence intervals (cis) and the McNemar test.
  
  
  RESULTS
  Between March 2009 and July 2011, 3028 eligible women completed all study examinations. At a mean follow-up of 1.3 years, 33 breast cancers were identified in the study population. Mammography detected 28 cancers; us, 24 cancers; and pe, 22 cancers. During the follow-up period, 2 false-negative cases occurred clinically. The highest sensitivity for breast cancer screening (93.9%) was achieved by paralleling mam with us, but came at the cost of a higher recall rate (12.15%). Using us alone at the first stage, followed by mam when indicated, offered high specificity (99.4%) and the lowest recall rate (1.82%), which were not reached at the expense of sensitivity (84.8%). Used in series, us and mam achieved a sensitivity similar to that for the same modalities used in parallel (McNemar p > 0.05).
  
  
  CONCLUSIONS
  Taking limited health resources into consideration, the strategy of screening with us alone at the first stage, followed by mam when indicated, may optimize breast cancer detection in most regions of China.
authors.affiliation: Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.forename: M
authors.initials: M
authors.lastname: Kang
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: J Y
authors.initials: JY
authors.lastname: Li
authors.forename: J Y
authors.initials: JY
authors.lastname: Zhang
authors.forename: L H
authors.initials: LH
authors.lastname: Liu
authors.forename: X T
authors.initials: XT
authors.lastname: Liu
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Li
authors.forename: H
authors.initials: H
authors.lastname: Lee