Breast screening with ultrasound in women with mammography-negative dense breasts: Evidence on incremental cancer detection and false positives, and associated cost

Background: We evaluated the contribution of ultrasound (US) in detecting breast cancer in women with dense breasts and negative mammograms. Methods: 9157 (35.8%) of 25,572 self-referring women during 2000-2007 had BI-RADS D3-4 negative mammograms - all were screened with bilateral US. Results: US detected 37 cancers - incremental cancer detection rate (ICDR) was 0.40% (9S% CI: 0.39-0.41%); ICDR was 0.33% in women < 50 and 0.51% in those 50 years and older. US - detected a larger proportion of cancers below age 50 compared to older women. US-only detected cancers had a more favourable stage (pTis-pT1a-pT1b: 64.8% versus 3S.5%, p = 0.001; pN1: 13.S% versus 31.3%, p = 0.047) than cancers detected on mammography US caused additional investigations in 4.9% of women and benign surgical biopsies in 0.9%. Cost per US-screened woman, and per US-detected cancer ranged between is an element of 59-62 and is an element of 14,618-15,234, respectively. Conclusion: US detects early-stage cancers in women with mammography-negative dense breasts, with higher contribution in women younger than 50 years. (c) 2008 Elsevier Ltd. All rights reserved.