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Study: How do ultrasound and mammography compare in breast cancer screening?

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Contents

At a glance                  Questions for your doctor
Findings               In-depth                
Clinical trials Limitations
Guidelines Resources


STUDY AT A GLANCE

What is this study about?

The study looks at the effectiveness of as compared to for breast cancer screening.

Why is this study important?

In general, the number of breast cancer cases worldwide is increasing. Women in developing countries do not have easy access to , and some lack breast cancer screening entirely. has many advantages:  it does not use ionizing radiation, the machinery is portable and not as expensive as , making it a more viable alternative for women in developing countries.

What did this study find?

  • A total of 111 breast cancers were found in three years. (The study included a total of 7473 breast cancer screens in patients at increased risk for breast cancer.) Of these 111 breast cancers, 58 were found through and 59 were found through .
  • There were more false positives among the patients who got ultrasounds compared to patients who got . The recall rate for ultrasounds was about 11% while the recall rate for mammograms was about 9%.

What does this mean for me?

and have similar cancer detection rates, although there are more false positives found through . However, this finding does not mean that should replace . According to the study authors, “…these results suggest that screening [ultrasound] could be a viable alternative to in countries lacking organized screening, particularly with availability of low-cost, portable [ultrasound] systems. Where is available, [ultrasound] should be seen as a supplemental test for women with dense breasts who do not meet high-risk criteria for screening and for high-risk women with dense breasts who are unable to tolerate .National guidelines recommend that women who have mutations in or other genes that increase their risk of breast cancer undergo increased surveillance for breast cancer using both and . It is important to remember that this study looked at women at high risk for breast cancer. The results may not apply to women with an average lifetime risk of breast cancer.

Posted 2/16/16

References

Berg WA, Bandos AI, Mendelson EB, et al. “ as the Primary Screening Test for Breast Cancer: Analysis from ACRIN 6666.” Journal of the National Cancer Institute. Published online first on December 28, 2015.   

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Young women at high risk for breast cancer with limited access to mammography and MRI is not easily accessible

This article is also relevant for:

Previvors

People with a genetic mutation linked to cancer risk

Women under 45

Women over 45

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IN DEPTH REVIEW OF RESEARCH

Study background:

Previous work has shown that mammograms reduce the number of breast cancer deaths. In women from age 40-49, researchers have seen a 15% reduction in breast cancer deaths; a 22% reduction has been seen in women from age 50 -74. It is believed that older women benefit more from because their breasts are not as dense as those of younger women. In addition to ’s portability and cost benefits, the quality of images are not as limited by breast density as are images.

In January 2016, Wendie Berg and colleagues at the Magee-Womens Hospital of University of Pittsburgh Medical Center and other institutions published a study in the Journal of the National Cancer Institute that compared all aspects of cancer detection from and .

What researchers of this study wanted to know:

Is a viable alternative to ?

Population(s) looked at in the study:

This study included 2,662 women who did not have breast cancer, but did have dense breasts. These women also had to have one other risk factor for breast cancer (for example, a mutation, an atypical breast biopsy, or high risk scores through the Gail test for Breast Cancer Risk Assessment).

Study findings: 

  1. One hundred and eleven breast cancers were found in  a three- year period from a total of 7473 breast cancer screens in patients at increased risk for breast cancer. Of these 111 breast cancers, 58 were found through and 59 were found through .
  2. It took 129 screens to detect 1 cancer.
  3. It took 127 screens to detect 1 cancer.
  4. 89 of the breast cancers were invasive. Of the 89 invasive cancers, 53 were found by and 41 were found by .
    • Fifty-three of the 58 cancers found by were invasive; the other five were ductal carcinoma in situ (). Forty-one of the 59 cancers found by were invasive; the other 18 were . These results indicate that screening may be better able to identify invasive cancers.
  5. There were more false positives found in patients who got ultrasounds compared to patients who got mammograms. The recall rate for ultrasounds was about 11% while the recall rate for mammograms was about 9%.
    • The biopsy rate for the women who got called back based on their results was about 6% while it was 2% for women who got called back based on their results.

Limitations:

In order to participate in this study, women had to have dense breasts and at least one other risk factor for breast cancer, meaning that they were all at greater risk for breast cancer than women in the general population. Therefore, the results of this study may be more applicable to young breast cancer survivors. Had study participants been at average risk for breast cancer, the results may have been different. For now, the results apply only to women at high risk of breast cancer. 

Conclusions:

This study suggests that may be a viable alternative to for women in countries that do not have access to . should not be a replacement, however, for women who can access .  The researchers saw that more invasive cancers were detected by as compared to mammography; however, they write, “a larger study is needed to statistically support greater sensitivity of to invasive cancers.”

Posted 2/16/16

Expert Guidelines
Expert Guidelines

There are laws and guidelines for screening in women with dense breasts. The laws on breast density notification vary by state. The National Comprehensive Cancer Network (NCCN) has guidelines on breast screening. The panel notes that dense breasts are associated with an increased risk for breast cancer, and they recommend the following: 

  • Women with dense breasts on  should be counseled on the risks and benefits of additional breast screening. 
  • Digital mammograms benefit young women and women with dense breasts.
  • (3D mammograms) can increase cancer detection and lower the chances of additional call backs.
  • may improve the detection of cancers in women with dense breasts but it can also increase the number of call backs and biopsies of benign (noncancerous) tissue. 

Updated: 02/06/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • I carry a mutation in a gene that increases cancer risk. How does this change the breast cancer screenings I should receive?
  • I have dense breasts—can I get ultrasounds in addition to mammograms?
  • Will my health insurance cover breast ? If they do not cover it, are there financial assistance programs? 
  • I have difficulty accessing mammograms. Can I get ultrasounds instead?
  • I have a medical reason why I cannot have , should I get ultrasounds?

Open Clinical Trials
Open Clinical Trials

The following are breast cancer screening or prevention studies enrolling people at high risk for breast cancer.   

Additional risk-management clinical trials for people at high risk for breast cancer may be found here.

Updated: 01/10/2023

Who covered this study?

Reuters

Ultrasound may be useful supplemental test for breast cancer This article rates 5.0 out of 5 stars

HealthDay

Breast ultrasound, mammography may be equally effective: study This article rates 4.5 out of 5 stars

HeraldNet

Study: Add ultrasound in cancer fight for some This article rates 4.0 out of 5 stars

How we rated the media

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