Adding Breast Ultrasound Screening to Mammography Reveals Cancers not Seen on Mammography Alone in Women at Increased Risk for Breast Cancer

13 May, 2008, 01:00 ET from American College of Radiology

    PHILADELPHIA, May 13 /PRNewswire-USNewswire/ -- In women at increased
 risk for breast cancer, adding a screening ultrasound examination to
 routine mammography revealed 28 percent more cancers than mammography
 alone. However, the additional ultrasound exam substantially increased the
 rates of false positive findings and unnecessary biopsies, according to an
 American College of Radiology Imaging Network (ACRIN) study published in
 the May 14, 2008 issue of the Journal of American Medical Association.
 
 
 
     This ACRIN study enrolled 2,809 women at increased risk for breast
 cancer at 21 sites and 2,637 of these women were eligible for analysis. The
 criteria used to determine an increased breast cancer risk included:
 participant age of 25 years or older, dense breasts, prior atypical breast
 biopsy, personal and/or or moderate family history of breast cancer. The
 study was made possible through funding from a novel private-public
 partnership between the Avon Foundation and the National Cancer Institute
 (NCI), part of the National Institutes of Health (NIH).
 
 
 
     Forty women were diagnosed with breast cancer within 12 months of the
 initial screening. Mammography alone revealed 20 cancers (50 percent of all
 cancers detected) for a cancer detection rate of 7.6 women per 1,000 women
 screened, though one cancer was dismissed. The combination of mammography
 plus screening ultrasound revealed 31 cancers (78 percent of all cancers
 detected) for a cancer detection rate of 11.8 women per 1,000 women
 screened. Eight of the 40 cancers were not seen with either mammography or
 ultrasound at the time of the initial screen, but were discovered later
 during the twelve month period for a rate of three cancers missed per 1,000
 women screened.
 
 
 
     The risk of incurring an unnecessary biopsy due to a false positive
 exam result from the supplemental screening ultrasound was also
 substantially increased in this study. Mammography alone prompted an
 unnecessary biopsy for one in 40 women in this study. The combination of
 mammography and ultrasound screening prompted an unnecessary biopsy for one
 in 10 women, or four times more women having an unnecessary biopsy.
 
 
 
     According to the study's principal investigator, Wendie Berg, M.D.,
 Ph.D., a radiologist specializing in breast imaging with American Radiology
 Services at Johns Hopkins Green Spring, Lutherville, Md., "The study
 results confirm that screening ultrasound in combination with mammography
 detects more cancers than mammography alone in women at increased risk for
 breast cancer. However, this benefit comes with the added risk of a false
 positive result. If we are going to offer screening ultrasound, we need to
 inform women of the substantial risk of receiving an unnecessary biopsy."
 
 
 
     The study's statistician, Jeffrey Blume, Ph.D., associate professor and
 deputy director of the ACRIN Biostatistics and Data Management Center at
 Brown University in Providence, R.I., emphasized the reliability of these
 results: "Rigorous, well controlled trials like this one - where
 participants uniformly undergo both screening exams in a randomized order
 and investigators interpreting one exam are masked to the results of the
 other - yield the highest level of medical evidence. A study as large as
 this one could not have been completed without the ongoing support and
 cooperation of NCI and Avon."
 
 
 
     The American Cancer Society recently recommended that certain women at
 very high risk for breast cancer be screened with magnetic resonance
 imaging (MRI) in addition to mammography, and these results do not change
 that recommendation. Women who do have screening MRI do not need screening
 ultrasound. Women who are at increased risk, who are currently undergoing
 mammographic screening and are not recommended for MRI, or for whom it is
 not available or not tolerated, may wish to consider adding screening
 ultrasound. Women should talk with their doctor about their breast cancer
 risk profile and whether a screening ultrasound exam supplemental to
 mammography might be beneficial, keeping in mind the potential for a false
 positive result and an unnecessary biopsy. At present, there is a limited
 supply of trained personnel and facilities who offer screening ultrasound.
 Women also should consult their health insurance policy regarding the
 coverage for breast cancer screening options. An annual mammogram is still
 recommended: neither MRI nor ultrasound is meant to replace mammography.
 
 
 
     The study continues to follow participants to examine the potential
 benefit of routine annual combination screening of mammography and
 ultrasound.
 
 
 
     For a listing of participating sites, please visit:
 
 
 
     http://www.acrin.org/PROTOCOLSUMMARYTABLE/PROTOCOL6666/6666PARTICIPATIN
 GSITES/tabid/169/Default.aspx
 
 
 
 
 
     Today, there are more than 33,000 radiologists practicing in the United
 States. As the medical doctors who specialize in diagnosing and treating
 disease and injury through medical imaging, radiologists are the experts in
 imaging care. Most radiologists have completed at least 13 years of
 training, including medical school, licensing, a four-year residency, and
 often a one- to two-year fellowship of specialized training.
 
 
 
 
 

SOURCE American College of Radiology
    PHILADELPHIA, May 13 /PRNewswire-USNewswire/ -- In women at increased
 risk for breast cancer, adding a screening ultrasound examination to
 routine mammography revealed 28 percent more cancers than mammography
 alone. However, the additional ultrasound exam substantially increased the
 rates of false positive findings and unnecessary biopsies, according to an
 American College of Radiology Imaging Network (ACRIN) study published in
 the May 14, 2008 issue of the Journal of American Medical Association.
 
 
 
     This ACRIN study enrolled 2,809 women at increased risk for breast
 cancer at 21 sites and 2,637 of these women were eligible for analysis. The
 criteria used to determine an increased breast cancer risk included:
 participant age of 25 years or older, dense breasts, prior atypical breast
 biopsy, personal and/or or moderate family history of breast cancer. The
 study was made possible through funding from a novel private-public
 partnership between the Avon Foundation and the National Cancer Institute
 (NCI), part of the National Institutes of Health (NIH).
 
 
 
     Forty women were diagnosed with breast cancer within 12 months of the
 initial screening. Mammography alone revealed 20 cancers (50 percent of all
 cancers detected) for a cancer detection rate of 7.6 women per 1,000 women
 screened, though one cancer was dismissed. The combination of mammography
 plus screening ultrasound revealed 31 cancers (78 percent of all cancers
 detected) for a cancer detection rate of 11.8 women per 1,000 women
 screened. Eight of the 40 cancers were not seen with either mammography or
 ultrasound at the time of the initial screen, but were discovered later
 during the twelve month period for a rate of three cancers missed per 1,000
 women screened.
 
 
 
     The risk of incurring an unnecessary biopsy due to a false positive
 exam result from the supplemental screening ultrasound was also
 substantially increased in this study. Mammography alone prompted an
 unnecessary biopsy for one in 40 women in this study. The combination of
 mammography and ultrasound screening prompted an unnecessary biopsy for one
 in 10 women, or four times more women having an unnecessary biopsy.
 
 
 
     According to the study's principal investigator, Wendie Berg, M.D.,
 Ph.D., a radiologist specializing in breast imaging with American Radiology
 Services at Johns Hopkins Green Spring, Lutherville, Md., "The study
 results confirm that screening ultrasound in combination with mammography
 detects more cancers than mammography alone in women at increased risk for
 breast cancer. However, this benefit comes with the added risk of a false
 positive result. If we are going to offer screening ultrasound, we need to
 inform women of the substantial risk of receiving an unnecessary biopsy."
 
 
 
     The study's statistician, Jeffrey Blume, Ph.D., associate professor and
 deputy director of the ACRIN Biostatistics and Data Management Center at
 Brown University in Providence, R.I., emphasized the reliability of these
 results: "Rigorous, well controlled trials like this one - where
 participants uniformly undergo both screening exams in a randomized order
 and investigators interpreting one exam are masked to the results of the
 other - yield the highest level of medical evidence. A study as large as
 this one could not have been completed without the ongoing support and
 cooperation of NCI and Avon."
 
 
 
     The American Cancer Society recently recommended that certain women at
 very high risk for breast cancer be screened with magnetic resonance
 imaging (MRI) in addition to mammography, and these results do not change
 that recommendation. Women who do have screening MRI do not need screening
 ultrasound. Women who are at increased risk, who are currently undergoing
 mammographic screening and are not recommended for MRI, or for whom it is
 not available or not tolerated, may wish to consider adding screening
 ultrasound. Women should talk with their doctor about their breast cancer
 risk profile and whether a screening ultrasound exam supplemental to
 mammography might be beneficial, keeping in mind the potential for a false
 positive result and an unnecessary biopsy. At present, there is a limited
 supply of trained personnel and facilities who offer screening ultrasound.
 Women also should consult their health insurance policy regarding the
 coverage for breast cancer screening options. An annual mammogram is still
 recommended: neither MRI nor ultrasound is meant to replace mammography.
 
 
 
     The study continues to follow participants to examine the potential
 benefit of routine annual combination screening of mammography and
 ultrasound.
 
 
 
     For a listing of participating sites, please visit:
 
 
 
     http://www.acrin.org/PROTOCOLSUMMARYTABLE/PROTOCOL6666/6666PARTICIPATIN
 GSITES/tabid/169/Default.aspx
 
 
 
 
 
     Today, there are more than 33,000 radiologists practicing in the United
 States. As the medical doctors who specialize in diagnosing and treating
 disease and injury through medical imaging, radiologists are the experts in
 imaging care. Most radiologists have completed at least 13 years of
 training, including medical school, licensing, a four-year residency, and
 often a one- to two-year fellowship of specialized training.
 
 
 
 
 SOURCE American College of Radiology