title: Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts.
abstract: BACKGROUND
  Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness.
  
  
  OBJECTIVE
  To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts.
  
  
  METHODS
  Comparative modeling with 3 validated simulation models.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature.
  
  
  METHODS
  Contemporary cohort of women eligible for routine screening.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Payer.
  
  
  METHODS
  Supplemental ultrasonography screening for women with dense breasts after a negative screening mammography result.
  
  
  METHODS
  Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs.
  
  
  RESULTS
  Supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75), gained 1.7 QALYs (range, 0.9 to 4.7), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained (range, $112,000 to $766,000). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246,000 per QALY gained (range, $74,000 to $535,000).
  
  
  RESULTS
  The conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age.
  
  
  CONCLUSIONS
  Provider costs for coordinating supplemental ultrasonography were not considered.
  
  
  CONCLUSIONS
  Supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits.
  
  
  BACKGROUND
  National Cancer Institute.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Stout
authors.forename: Clyde
authors.initials: C
authors.lastname: Schechter
authors.forename: Nicolien T
authors.initials: NT
authors.lastname: van Ravesteyn
authors.forename: Mucahit
authors.initials: M
authors.lastname: Cevik
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van den Broek
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
mesh_terms: D000368:Aged; D001706:Biopsy / Q000191:economics; D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects / Q000191:economics*; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000009:adverse effects / Q000191:economics*; D014481:United States / Q000453:epidemiology