Breast Screening: Adding Ultrasonography Doesn't Seem Worth Associated Harms

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Adding ultrasonography to mammography in screening for breast cancer carries risks for overdiagnosis that outweigh its benefits, according to a JAMA Internal Medicine study.

Researchers compared outcomes in some 3400 women who underwent screening mammography plus same-day ultrasonography against outcomes in roughly 15,000 propensity-score-matched women who had mammography alone. The women represented the entire range of breast cancer risk (75% of the dual-screened women had elevated breast density).

Rates of cancer detection and interval cancers were similar between the two groups. However, false-positive screens resulting in biopsy were more common among those undergoing supplemental ultrasonography at screening (52 vs. 22 per 1000 screens). Rates of short-interval imaging follow-up were also higher with ultrasonography (3.9% vs. 1.1%).

The authors, having noted that many states have mandated insurance coverage of supplemental ultrasonography, conclude that "additional efforts are needed to more accurately identify women who will benefit from supplemental screening."