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Women with dense breast tissue need both mammography and ultrasonography to detect tumours

BMJ 2003; 327 doi: (Published 03 July 2003) Cite this as: BMJ 2003;327:12
  1. Judy Siegel-Itzkovich
  1. Jerusalem

    Researchers have found that performing ultrasound scans on breasts with dense tissue can pick up small tumours that are not detected by mammography. While ultrasonography cannot replace mammography, especially in women who because of a family history are at high risk of developing breast cancer, it should be used as a second line of screening.

    A team of breast specialists and radiologists at Soroka Medical Centre in Beersheba and the Hala-Rachel Nash Jerusalem Comprehensive Breast Clinic in Jerusalem published their findings in the July issue of the American Journal of Roentgenology (2003;181:177-82;

    Drs Pavel Crystal, Shalom Strano, Semyon Shcharynski, and Michael Koretz examined 1517 women, with a mean age of 52, who had dense breast tissue but no sign in mammograms of malignancies.

    Of the women, who ranged in age from 31 to 84 years, 318 had a first degree relative with breast cancer or had themselves previously had breast cancer. Seven breast cancers not found in mammograms were detected by ultrasonography: four in women at high risk and three in women with baseline risk. The short term, follow up specificity of ultrasonography was 94.4%, which the researchers said was an acceptable figure for a screening test.

    The researchers noted that success at detecting small tumours was directly related to the skills and experience in breast imaging of the people operating the ultrasound equipment. Ultrasound screening was done at no extra cost to the patients, even though it is not included in the basket of services covered by the public health funds.

    Women went straight from the mammography unit to the ultrasound unit, thus reducing their anxiety and avoiding a long wait for a result.

    The study did not examine whether the early diagnoses saved lives, as this could be proved only by a very large, long term, and expensive clinical trial, but the authors speculate that early detection and removal of such tumours would lower mortality.

    The study also did not go into whether ultrasound screening in women with dense breast tissue is cost effective, but the researchers noted that ultrasonography is no more expensive than mammography, which it does not replace.

    As women with dense breast tissue, especially younger women, cannot depend on mammography for accurate screening of tumours, subsequent ultrasonography is a boon for this group, the researchers said. For economic reasons they recommend that ultrasonography be used to screen for breast cancer in high risk women with dense tissue, but they noted that it was effective in women with a baseline risk as well.

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