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

• Published in: Cancer Vol. 129; no. 16; pp. 2456 - 2468
• Main Authors: Sprague, Brian L., Ichikawa, Laura, Eavey, Joanna, Lowry, Kathryn P., Rauscher, Garth, O’Meara, Ellen S., Miglioretti, Diana L., Chen, Shuai, Lee, Janie M., Stout, Natasha K., Mandelblatt, Jeanne S., Alsheik, Nila, Herschorn, Sally D., Perry, Hannah, Weaver, Donald L., Kerlikowske, Karla
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.08.2023
• Subjects: Breast cancer; Breast Cancer Surveillance Consortium; Breast Density; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - epidemiology; Cancer screening; Early Detection of Cancer - methods; Failure; Female; Health risks; Humans; Invasiveness; Mammography; Mammography - methods; Mass Screening - methods; Medical screening; Oncology; Prediction models; Risk; Risk Factors; screening; Ultrasonic imaging; Ultrasonography, Mammary; Ultrasound; breast cancer; risk factors; screening; mammography; Breast Cancer Surveillance Consortium; ultrasound
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.34768

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. Whole‐breast ultrasound screening is highly targeted to women with dense breasts, but only a modest proportion are at high risk of interval or advanced breast cancer. Consideration of other breast cancer risk factors beyond breast density could facilitate identification of women at high risk of mammography screening failures who may be appropriate for supplemental ultrasound screening.