title: Effects of age, breast density and volume on breast cancer diagnosis: a retrospective comparison of sensitivity of mammography and ultrasonography in China's rural areas.
abstract: OBJECTIVE
  Mammography has been confirmed as the only effective mode to improve the prognosis of patients with breast cancer in Western developed countries, but might not be a good choice in other areas of the world. One of the major challenges in China is to determine an optimal imaging modality for breast cancer screening. This study was designed to clarify the sensitivity of ultrasonography compared with that of mammography in rural China.
  
  
  METHODS
  We retrospectively studied the sensitivity of mammography and ultrasonography based on 306 breast cancer patients detected by the program of "screening for cervical cancer and breast cancer" performed in Chinese rural areas between January 2009 and December 2011, and analyzed the effects of age, breast density and volume on the sensitivity.
  
  
  RESULTS
  Stratified analysis showed that the sensitivity of breast ultrasonography was significantly higher than that of mammography in premenopausal patients (81.4% vs. 61.1%, p=0.02), in women ≤ 55 years of age (82.2% vs. 63.4%, p<0.01), in the high breast density group (American College of Radiology [ACR] levels 3-4) (85.9% vs. 60.6%, p<0.01) and in the small breast volume group (≤ 400 ml) (87.1% vs. 66.7%, p<0.01). Age had a significant effect on sensitivity of mammography (breast density and volume-adjusted odds ratio, 6.39; 95% confidence interval, 2.8-14.4 in age group > 55 compared to age group ≤ 45), but not that of ultrasonography. Neither breast density nor volume had significant effect on sensitivity of mammography or ultrasonography.
  
  
  CONCLUSIONS
  Ultrasonography is more sensitive than mammography in detecting breast cancer in women under 55 year-old Chinese, especially in those with high-density and relatively small breasts.
authors.affiliation: Department of Breast Surgery, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Feng-Liang
authors.initials: FL
authors.lastname: Wang
authors.forename: Fei
authors.initials: F
authors.lastname: Chen
authors.forename: Hong
authors.initials: H
authors.lastname: Yin
authors.forename: Nan
authors.initials: N
authors.lastname: Xu
authors.forename: Xiao-Xiang
authors.initials: XX
authors.lastname: Wu
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Ma
authors.forename: Shen
authors.initials: S
authors.lastname: Gao
authors.forename: Jin-Hai
authors.initials: JH
authors.lastname: Tang
authors.forename: Cheng
authors.initials: C
authors.lastname: Lu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012939:Social Planning; D016217:Ultrasonography, Mammary; D055815:Young Adult