Adjunct ultrasonography for breast cancer screening in women at average risk: A systematic review

Gerald Gartlehner, Kylie J. Thaler, Andrea Chapman, Angela Kaminski, Dominik Berzaczy, Megan G. Van Noord, Thomas H. Helbich

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. Aims: The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. Methods: We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. Results: We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. Conclusions: No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. Implications for practice: Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.

Original languageEnglish (US)
Pages (from-to)87-93
Number of pages7
JournalInternational Journal of Evidence-Based Healthcare
Volume11
Issue number2
DOIs
StatePublished - Jun 1 2013
Externally publishedYes

Fingerprint

Early Detection of Cancer
Ultrasonography
Breast Neoplasms
Mammography
Breast
Mammary Ultrasonography
Literature
Registries
Research Personnel
Databases
Biopsy
Neoplasms

Keywords

  • Breast cancer
  • Mammography
  • Mass screening
  • Ultrasonography

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Adjunct ultrasonography for breast cancer screening in women at average risk : A systematic review. / Gartlehner, Gerald; Thaler, Kylie J.; Chapman, Andrea; Kaminski, Angela; Berzaczy, Dominik; Van Noord, Megan G.; Helbich, Thomas H.

In: International Journal of Evidence-Based Healthcare, Vol. 11, No. 2, 01.06.2013, p. 87-93.

Research output: Contribution to journalArticle

Gartlehner, Gerald ; Thaler, Kylie J. ; Chapman, Andrea ; Kaminski, Angela ; Berzaczy, Dominik ; Van Noord, Megan G. ; Helbich, Thomas H. / Adjunct ultrasonography for breast cancer screening in women at average risk : A systematic review. In: International Journal of Evidence-Based Healthcare. 2013 ; Vol. 11, No. 2. pp. 87-93.
@article{4757f68b43444bf18f9c7c064c8fbb25,
title = "Adjunct ultrasonography for breast cancer screening in women at average risk: A systematic review",
abstract = "Background: Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. Aims: The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. Methods: We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. Results: We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98{\%}. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. Conclusions: No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. Implications for practice: Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.",
keywords = "Breast cancer, Mammography, Mass screening, Ultrasonography",
author = "Gerald Gartlehner and Thaler, {Kylie J.} and Andrea Chapman and Angela Kaminski and Dominik Berzaczy and {Van Noord}, {Megan G.} and Helbich, {Thomas H.}",
year = "2013",
month = "6",
day = "1",
doi = "10.1111/1744-1609.12022",
language = "English (US)",
volume = "11",
pages = "87--93",
journal = "International Journal of Evidence-Based Healthcare",
issn = "1744-1595",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Adjunct ultrasonography for breast cancer screening in women at average risk

T2 - A systematic review

AU - Gartlehner, Gerald

AU - Thaler, Kylie J.

AU - Chapman, Andrea

AU - Kaminski, Angela

AU - Berzaczy, Dominik

AU - Van Noord, Megan G.

AU - Helbich, Thomas H.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Background: Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. Aims: The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. Methods: We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. Results: We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. Conclusions: No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. Implications for practice: Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.

AB - Background: Screening with mammography has the ability to detect breast cancer at an early stage but misses some cancers. Supporters of adjunct ultrasonography to the screening regimen argue that it might be a safe and inexpensive approach to reduce the false-negative rates of screening. Critics are concerned that adjunct ultrasonography will also increase the rate of false-positive findings and can lead to unnecessary biopsies and treatments in women at average risk. Aims: The purpose of this review was to systematically assess the comparative benefits and harms of mammography with adjunct breast ultrasonography and mammography only in breast cancer screening. Methods: We searched multiple electronic databases and the Cochrane Breast Cancer Group's Specialised Register (from 1995 to February 2012). To detect ongoing or unpublished studies, we searched trial registries and multiple sources of grey literature. Two researchers independently reviewed all abstracts and full-text articles against pre-defined eligibility criteria. We dually rated the risk of bias of studies and the strength of evidence based on established guidance. Results: We did not detect any controlled studies that provide evidence for (or against) the use of adjunct ultrasonography for screening in women at average risk for breast cancer. Extrapolations of results from women at elevated risk for breast cancer indicate that the false-positive rates in women at average risk who were recalled because of positive ultrasonographies will exceed 98%. In women with dense or very dense breast tissue, the evidence regarding the use of adjunct ultrasonography is not conclusive. Conclusions: No methodologically sound evidence is available justifying the routine use of ultrasonography as an adjunct screening tool in women at average risk for breast cancer. Implications for practice: Clinicians should not use ultrasonography as a screening tool for breast cancer screening on a routine basis. The use should be limited to women with dense breasts for whom the accuracy of mammography is low, or for diagnostic purposes.

KW - Breast cancer

KW - Mammography

KW - Mass screening

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=84878995730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878995730&partnerID=8YFLogxK

U2 - 10.1111/1744-1609.12022

DO - 10.1111/1744-1609.12022

M3 - Article

C2 - 23750571

AN - SCOPUS:84878995730

VL - 11

SP - 87

EP - 93

JO - International Journal of Evidence-Based Healthcare

JF - International Journal of Evidence-Based Healthcare

SN - 1744-1595

IS - 2

ER -