Study finds test after normal mammogram saves few lives while boosting costs and false-positive results
WebMD News from HealthDay
By Kathleen Doheny
HealthDay Reporter
MONDAY, Dec. 8, 2014 (HealthDay News) -- New research questions the value of ultrasound screening for women with dense breasts who've had a normal mammogram.
Although dense breasts are a known risk factor for breast cancer, this increasingly common strategy doesn't appear to improve survival much but does "substantially" boost costs and false-positive results, researchers found.
"Performing ultrasound for all women with dense breasts after a negative mammogram would produce relatively few benefits," said study researcher Brian Sprague, assistant professor of surgery at the University of Vermont.
In the United States, at least 19 states require doctors to notify women of their breast density after undergoing a mammogram, according to background information in the study. Those with dense breasts may then be advised to talk to their doctor about supplemental testing.
Legislation mandating such notification nationwide is also under consideration, the study says.
"Be aware that screening ultrasound may lead to unnecessary biopsies," Sprague said. "There is a small chance it could save your life, but there is a much greater chance you will have a false-positive result."
Breast density is categorized on a scale of 1 to 4, with 1 deemed mostly fatty breasts and 4 being the least fatty and most dense breasts. About 45 percent of women aged 40 to 74 have dense breasts, Sprague found in previous research.
Dense breasts have more fibrous and glandular tissue than fatty tissue, which can also make it difficult for a radiologist to detect cancer on a mammogram. Dense tissue, like cancer, shows up white on the mammogram. Fatty tissue is dark, so any cancer is more visible.
For the study, published in the Dec. 9 online issue of the Annals of Internal Medicine, Sprague and his team used a computer-based simulation model to look at three scenarios. In one, women got routine mammograms only. In the second, women with category 4 breast density got a mammogram and an ultrasound. In the third scenario, Sprague grouped categories 3 and 4 together.
Using information from breast cancer surveillance databases, the researchers looked at how many breast cancer deaths could likely be prevented by adding ultrasound and how many biopsies would occur after a false-positive ultrasound. They also evaluated potential costs.
source : Are Routine Ultrasounds for Women With Dense Breasts Worthwhile?
