Breast ultrasound spots more cancers in dense breasts
With proper training and experience, breast ultrasound consistently improves the detection of node-negative invasive cancer in women with dense breasts on mammography, according to a literature review in the Journal of Breast Imaging. Similar results have been observed after digital breast tomosynthesis (DBT).
Thirty-five studies that involved breast ultrasound -- both handheld and automated breast ultrasound (ABUS) -- were reviewed by a team led by Dr. Wendie Berg, PhD, of the University of Pittsburgh School of Medicine, and Dr. Athina Vourtsis, PhD, from the Diagnostic Mammography Medical Diagnostic Imaging Unit in Athens, Greece. They found adding ultrasound to mammography results in low interval cancer rates and boosted cancer detection rates.
"I think it is important that there are now published results on over 400,000 screening breast ultrasound examinations and the results have been very consistent," Berg told AuntMinnie.com. "In women with dense breasts, ultrasound will find another two to three cancers per 1,000 women screened each year."
Why breast ultrasound?
Dense breast tissue can mask breast cancer on mammography, and furthermore, the denser the breast, the greater the risk of developing breast cancer -- a fourfold increased risk, in fact. Dense breasts are so problematic that 38 states as well as Washington, DC, require some form of density information in mammography results letters sent to patients.
In addition, the February 15 federal budget law included a provision that the U.S. Food and Drug Administration (FDA) must update the national Mammography Quality Standards Act (MQSA) to require that breast density is included in mammography reports sent to providers and in results letters sent to patients. The new rule will likely be effective in early 2021.
Considering dense breasts are harder to image on mammography and more likely to conceal breast cancer, what are physicians supposed to do? The answer: Use supplemental ABUS or breast MRI.
The literature review performed by Berg and Vourtsis covered 361,502 exams. Supplemental handheld ultrasound yielded a cancer detection rate of 2.0 cancers per 1,000 women screening, the authors found (JBI, October 31, 2019). For more results, see the table below.
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