When screening high-risk patients, automated whole-breast ultrasound and mammography is superior to mammography alone

A recent study in Academic Radiology explored various screening strategies using automated whole-breast ultrasound (ABUS) to determine a preferred method for treating patients who either have dense breasts or are at high risk of breast cancer. The authors found that a combination of ABUS and screening mammography was more effective than mammography on its own, and screening ultrasound alone “is also an effective screening strategy.”

Ian Grady, MD, of the North Valley Breast Clinic in Redding, California, and colleagues performed a retrospective review of 122 cancer cases found in more than 3,400 moderate- or high-risk patients from April 2011 to August 2016. The team extracted data from each cancer case, noting the “imaging modality on which the cancer could be seen before diagnosis,” and compared the effectiveness of three screening strategies: mammography alone, ABUS alone and a combination of mammography and ABUS.

Overall, mammography alone was found to reduce advanced cancers by 31 percent over no screening at all, ABUS alone reduced advanced cancers by 32 percent and both modalities reduced advanced cancers by 40 percent.

Looking at screening yields, Grady et al. found what they described as “expected” statistics. The mammographic yield was more than 7 cancers per 1,000 patients screened, while the sonographic yield was more than four cancers per 1,000 patients screened that were not observed on a mammogram.

The retrospective review also found that 39 cases involved cancers seen only in the mammography, 42 cases involved cancers seen only in the ABUS, and 41 cases involved cancers seen in both modalities.

“For women with increased breast density or who are at high risk of developing breast cancer, a combination of screening mammography and whole-breast automated ultrasound is superior to mammographic screening,” the authors wrote.

Of course, they added, these options are an improvement over skipping the breast cancer screening process altogether.

“All the screening strategies studied in this report, when performed annually for women with increased density or at an elevated risk of breast cancer, result in profound reductions in rates of advanced-stage cancer diagnoses,” they wrote. “Any of these strategies is far superior to no screening.”