SAN ANTONIO—Ultrasound breast screenings for women with dense breast tissue improves cancer detection, according to a retrospective chart review presented at the 2014 San Antonio Breast Cancer Symposium.
“Screening breast ultrasound in women with dense breast parenchyma detects mammographically occult malignancy,” reported lead study author Jean M Weigert, MD, FACR, Director of Breast Imaging at the Hospital of Central Connecticut in New Britain, CT. “Over the 4 years studied, the positive predictive value improved from 7% to 17.2%, indicating that the selection of lesions biopsied was more accurate with fewer false positives.”
The improvement reflects, in part, improved differentiation of ultrasound abnormalities likely to be malignancies from other imaging findings. The improvement also “indicates that, as expected, there is a learning curve in deciding which lesions to follow and which to biopsy,” she explained.
Dense breasts increase a woman’s risk of breast cancer and also increase the risk that tumors will be missed in mammography, Dr. Weigert noted.
In Connecticut, state law requires that women with dense breast tissue be told of these risks and offered additional ultrasound or MRI screening. Dr. Weigert sought to determine if adding breast ultrasound to screenings of women with mammographically normal but dense breasts improves detection of breast cancers in Connecticut during the first 4 years of the state law’s implementation.
She analyzed data from five facilities owned by two radiology practices. The specific data collected and analyzed included the total number of screening mammograms, the number of dense breast screening ultrasounds, screening ultrasound Breast Imaging Reporting Data System (BI-RADS) code results, biopsy results, and demographic data for those with biopsy-confirmed tumors.
Tumors detected with ultrasound screening tended to be early-stage and small, with average size less than 1 cm. The women in this cohort had no risk factor associations other than dense breast tissue.
According to Dr. Weigert, the findings suggest that breast cancer screening can be better personalized. Ultrasound could even become a routine part of breast cancer screening, she suggested. “If we could subgroup women with metabolically active dense breast tissue, that would be good” and could lead to more targeted additional breast cancer screening.
“Of concern, the number of eligible women who elect to have the additional test remains low at about 30%,” she said. Dr. Weigert attributed the participation rate to “several factors, including education (level) and costs,” such as insurance co-pays.
No studies of ultrasound breast cancer screening yet reported, including this one, have had control groups, and long-term follow-up data is not yet available, cautioned, Jafi A. Lipson, MD, of the Stanford University School of Medicine in Stanford, CA.
- Weigert J et al. S5-01. Presented at: San Antonio Breast Cancer Symposium 2014. Dec. 9-13, 2014; San Antonio, TX.