US Breast In high-risk women undergoing annual mammography plus annual supplemental screening MRI, the addition of supplemental screening with US does not identify additional cancers and is therefore not routinely performed. Screening US may be useful in high-risk patients as an alternative to MRI. However, high-risk women who do not undergo supplemental screening MRI should be counseled that the CDR of US is inferior to MRI. MRI has a higher CDR than mammography, DBT, or mammography/DBT combined with US [61-64]. The ACRIN 6666 trial enrolled women with elevated breast cancer risk [61]. Compared to mammography alone, screening US detected 5.3 cancers per 1,000 in year 1 and 3.7 cancers per 1,000 in years 2 and 3 and resulted in a larger number of false- positive examinations and false-positive biopsies each year [61]. After 3 consecutive rounds of mammography plus US, the incremental CDR of MRI was 14.7 per 1,000, although false-positive examinations also increased [61]. In a prospective multicenter study of 687 high-risk women who underwent clinical breast examination, mammography, US, and MRI for screening, the combination of MRI plus mammography maximized the breast cancers detected [62]. Mammography identified 5 cancers per 1,000 compared to 6 per 1,000 for US, 7.7 per 1,000 for mammography plus US, 14.9 per 1,000 for MRI, 14.9 per 1,000 for MRI plus US, 16 per 1,000 for mammography plus MRI, and 16 per 1,000 for mammography plus US plus MRI [62]. In a prospective study of BRCA mutation carriers and high-risk women, sensitivity of mammography was 25% and 66% whereas US was 23% and 34%, respectively [76]. In the high-risk group, mammography combined with biannual US demonstrated 100% sensitivity [76]; however, MRI was not performed. In a subset analysis of BRCA mutation carriers, MRI sensitivity was 94% [76]. In another study of 529 high-risk women suspected or proven to carry a deleterious BRCA mutation, the performance of US was also inferior to MRI [82].
Female Breast Cancer Screening. US Breast In high-risk women undergoing annual mammography plus annual supplemental screening MRI, the addition of supplemental screening with US does not identify additional cancers and is therefore not routinely performed. Screening US may be useful in high-risk patients as an alternative to MRI. However, high-risk women who do not undergo supplemental screening MRI should be counseled that the CDR of US is inferior to MRI. MRI has a higher CDR than mammography, DBT, or mammography/DBT combined with US [61-64]. The ACRIN 6666 trial enrolled women with elevated breast cancer risk [61]. Compared to mammography alone, screening US detected 5.3 cancers per 1,000 in year 1 and 3.7 cancers per 1,000 in years 2 and 3 and resulted in a larger number of false- positive examinations and false-positive biopsies each year [61]. After 3 consecutive rounds of mammography plus US, the incremental CDR of MRI was 14.7 per 1,000, although false-positive examinations also increased [61]. In a prospective multicenter study of 687 high-risk women who underwent clinical breast examination, mammography, US, and MRI for screening, the combination of MRI plus mammography maximized the breast cancers detected [62]. Mammography identified 5 cancers per 1,000 compared to 6 per 1,000 for US, 7.7 per 1,000 for mammography plus US, 14.9 per 1,000 for MRI, 14.9 per 1,000 for MRI plus US, 16 per 1,000 for mammography plus MRI, and 16 per 1,000 for mammography plus US plus MRI [62]. In a prospective study of BRCA mutation carriers and high-risk women, sensitivity of mammography was 25% and 66% whereas US was 23% and 34%, respectively [76]. In the high-risk group, mammography combined with biannual US demonstrated 100% sensitivity [76]; however, MRI was not performed. In a subset analysis of BRCA mutation carriers, MRI sensitivity was 94% [76]. In another study of 529 high-risk women suspected or proven to carry a deleterious BRCA mutation, the performance of US was also inferior to MRI [82].