Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone

Brian L. Sprague, Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Laura Ichikawa, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Joanna Eavey, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Kathryn P. Lowry, Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, Washington, USA.
Garth Rauscher, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA.
Ellen S. O'Meara, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Shuai Chen, Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California, USA.
Janie M. Lee, Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, Washington, USA.
Natasha K. Stout, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Jeanne S. Mandelblatt, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, District of Columbia, USA.
Nila Alsheik, Advocate Aurora HealthFollow
Sally D. Herschorn, Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Hannah Perry, Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Donald L. Weaver, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Karla Kerlikowske, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, USA.

Affiliations

Advocate Lutheran General Hospital

Abstract

Background: There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone.

Methods: A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%.

Results: A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p < .0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio, 1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio, 0.91; 95% CI, 0.89-0.94).

Conclusions: Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.

Document Type

Article

PubMed ID

37303202

Teammate Access


 

Share

COinS