title: A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women.
abstract: BACKGROUND
  Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials.
  
  
  METHODS
  At 14 breast centres across China during 2008-2010, 13 339 high-risk women aged 30-65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrollment and 1-year follow-up.
  
  
  RESULTS
  A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0%; P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively.
  
  
  CONCLUSIONS
  Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.
authors: Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
authors: S
authors: S
authors: Shen
authors: Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
authors: Y
authors: Y
authors: Zhou
authors: Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
authors: Y
authors: Y
authors: Xu
authors: Department of Breast Surgery, Cancer Institute & Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
authors: B
authors: B
authors: Zhang
authors: Department of Breast Surgery, First Hospital affiliated to Peking University, 7 Xishenku, Xicheng District, Beijing 100034, China.
authors: X
authors: X
authors: Duan
authors: Department of Breast Surgery, Maternity & Child Care Center of Qinhuangdao, 452 Hongqi Road, Qinhuangdao, Hebei 066000, China.
authors: R
authors: R
authors: Huang
authors: Department of Breast Surgery, Beijing Hospital affiliated to Ministry of Health, 1 Dahua Road, Dongcheng District, Beijing 100005, China.
authors: B
authors: B
authors: Li
authors: Department of Breast Surgery, ShanXi Traditional Medicine Hospital, 46 Bingzhouxi Street, Taiyuan, Shanxi 030012, China.
authors: Y
authors: Y
authors: Shi
authors: Department of Breast Surgery, Cancer Hospital affiliated to Fudan University, 270 Dong'an Road, Xuhui District, Shanghai 200032, China.
authors: Z
authors: Z
authors: Shao
authors: Department of Breast Surgery, Yingbin Hospital of Yancheng, Yingbinnan Road, Yancheng, Jiangsu 224005, China.
authors: H
authors: H
authors: Liao
authors: Department of Breast Surgery, Southwest Hospital affiliated to the Third Military Medical University, 30 Tanyanzheng Street, Chongqing, 400038, China.
authors: J
authors: J
authors: Jiang
authors: Department of Women Health, Population and Family Planning Service Center of Zhuhai, 2 Jilian Road, Zhuhai, Guangdong 519000, China.
authors: N
authors: N
authors: Shen
authors: Department of Breast Surgery, Cancer Hospital affiliated to Tianjin Medical University, Huanhuxi Road, Hexi District, Tianjin 300060, China.
authors: J
authors: J
authors: Zhang
authors: Department of Breast Surgery, Chinese 307 Hospital affiliated to the People's Liberation Army, 8 Dongda Street, Fengtai District, Beijing 100071, China.
authors: C
authors: C
authors: Yu
authors: Department of Breast Surgery, Beijing Chaoyang Hospital affiliated to the Capital Medical University, 8 Gongtinan Road, Chaoyang District, Beijing 100043, China.
authors: H
authors: H
authors: Jiang
authors: Department of Breast Surgery, General Hospital affiliated to Beijing Military Area Command, 5 Nanmencang, Dongcheng District, Beijing 100700, China.
authors: S
authors: S
authors: Li
authors: Department of Epidemiology and Medical Statistics, Institute of Basic Medical Science, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
authors: S
authors: S
authors: Han
authors: Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors: J
authors: J
authors: Ma
authors: Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
authors: Q
authors: Q
authors: Sun
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D016022:Case-Control Studies; D002681:China; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014465:Ultrasonics / Q000191:economics / Q000379:methods; D014463:Ultrasonography