The interval cancer rate was halved in the arm that received US screening, from the baseline level of 0.10% to 0.05%. Using Breast Cancer Surveillance Consortium data, Lee et al [62] assessed the performance of the addition of screening US in women with dense breasts in the community. The CDR of mammography plus US was 5.4/1,000 versus 5.5/1,000 for mammography alone. The false-positive biopsy rate and PPV of biopsy recommendations for Supplemental Screening Based on Breast Density mammography plus US were 52.0/1,000 and 9.5%, respectively, compared with 22.2/1,000 and 21.4%, respectively, for mammography alone. The interval cancer rate did not differ significantly in the 2 arms: the mammography plus US arm was 1.5/1,000 versus 1.9/1,000 for mammography alone. Utilizing the registry data and data from the literature, Sprague et al [63] used simulation models to assess the outcomes of supplemental US screening after negative screening mammography in women with dense breasts. Per 1,000 women screened, the authors concluded there would be 0.36 breast cancer deaths averted, 354 additional biopsy recommendations, and 1.7 quality-adjusted life-years gained at a cost $325,000 for each quality-adjusted life-year gained [63]. Although the supplemental screening debate was initiated partly because of the limitations of screening mammography in women with dense breast tissue, there is some evidence to suggest that breast density alone may not be sufficient reason to recommend supplemental screening. One way to assess the failure of mammography is by determining the interval cancer rate in the study population. Using the Breast Cancer Surveillance Consortium data, the women most likely to present with interval cancers were women with an elevated 5-year risk for breast cancer >1.67% and with dense breast tissue, representing approximately 24% of all women with dense breasts [64].
Supplemental Breast Cancer Screening Based on Breast Density. The interval cancer rate was halved in the arm that received US screening, from the baseline level of 0.10% to 0.05%. Using Breast Cancer Surveillance Consortium data, Lee et al [62] assessed the performance of the addition of screening US in women with dense breasts in the community. The CDR of mammography plus US was 5.4/1,000 versus 5.5/1,000 for mammography alone. The false-positive biopsy rate and PPV of biopsy recommendations for Supplemental Screening Based on Breast Density mammography plus US were 52.0/1,000 and 9.5%, respectively, compared with 22.2/1,000 and 21.4%, respectively, for mammography alone. The interval cancer rate did not differ significantly in the 2 arms: the mammography plus US arm was 1.5/1,000 versus 1.9/1,000 for mammography alone. Utilizing the registry data and data from the literature, Sprague et al [63] used simulation models to assess the outcomes of supplemental US screening after negative screening mammography in women with dense breasts. Per 1,000 women screened, the authors concluded there would be 0.36 breast cancer deaths averted, 354 additional biopsy recommendations, and 1.7 quality-adjusted life-years gained at a cost $325,000 for each quality-adjusted life-year gained [63]. Although the supplemental screening debate was initiated partly because of the limitations of screening mammography in women with dense breast tissue, there is some evidence to suggest that breast density alone may not be sufficient reason to recommend supplemental screening. One way to assess the failure of mammography is by determining the interval cancer rate in the study population. Using the Breast Cancer Surveillance Consortium data, the women most likely to present with interval cancers were women with an elevated 5-year risk for breast cancer >1.67% and with dense breast tissue, representing approximately 24% of all women with dense breasts [64].