Supplemental screening for breast cancer in women with dense breasts: A systematic review for the U.S. Preventive services task force

Joy Melnikow, Joshua J Fenton, Evelyn P. Whitlock, Diana L Miglioretti, Meghan S. Weyrich, Jamie H. Thompson, Kunal Shah

Research output: Contribution to journalReview article

105 Citations (Scopus)

Abstract

Background: Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk. Purpose: To perform a systematic review of reproducibility of Breast Imaging Reporting and Data System (BI-RADS) density categorization and test performance and clinical outcomes of supplemental screening with breast ultrasonography, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography results. Data Sources: MEDLINE, PubMed, EMBASE, and Cochrane database from January 2000 to July 2015. Study Selection: Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts. Data Extraction: Quality assessment and abstraction of 24 studies from 7 countries; 6 studies were good-quality. Data Synthesis: Three good-quality studies reported reproducibility of BI-RADS density; 13% to 19% of women were recategorized between "dense" and "nondense" at subsequent screening. Two good-quality studies reported that sensitivity of ultrasonography for women with negative mammography results ranged from 80% to 83%; specificity, from 86% to 94%; and positive predictive value (PPV), from 3% to 8%. The sensitivity of MRI ranged from 75% to 100%; specificity, from 78% to 94%; and PPV, from 3% to 33% (3 studies). Rates of additional cancer detection with ultrasonography were 4.4 per 1000 examinations (89% to 93% invasive); recall rates were 14%. Use of MRI detected 3.5 to 28.6 additional cancer cases per 1000 examinations (34% to 86% invasive); recall rates were 12% to 24%. Rates of cancer detection with DBT increased by 1.4 to 2.5 per 1000 examinations compared with mammography alone (3 studies). Recall rates ranged from 7% to 11%, compared with 7% to 17% with mammography alone. No studies examined breast cancer outcomes. Limitations: Good-quality evidence was sparse. Studies were small and CIs were wide. Definitions of recall were absent or inconsistent. Conclusion: Density ratings may be recategorized on serial screening mammography. Supplemental screening of women with dense breasts finds additional breast cancer but increases false-positive results. Use of DBT may reduce recall rates. Effects of supplemental screening on breast cancer outcomes remain unclear. Primary Funding Source: Agency for Healthcare Research and Quality.

Original languageEnglish (US)
Pages (from-to)268-278
Number of pages11
JournalAnnals of Internal Medicine
Volume164
Issue number4
DOIs
StatePublished - Feb 16 2016

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Advisory Committees
Mammography
Breast
Breast Neoplasms
Information Systems
Magnetic Resonance Imaging
Ultrasonography
Mammary Ultrasonography
Neoplasms
Information Storage and Retrieval
Health Services Research
PubMed
MEDLINE
Databases
Sensitivity and Specificity

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Supplemental screening for breast cancer in women with dense breasts : A systematic review for the U.S. Preventive services task force. / Melnikow, Joy; Fenton, Joshua J; Whitlock, Evelyn P.; Miglioretti, Diana L; Weyrich, Meghan S.; Thompson, Jamie H.; Shah, Kunal.

In: Annals of Internal Medicine, Vol. 164, No. 4, 16.02.2016, p. 268-278.

Research output: Contribution to journalReview article

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title = "Supplemental screening for breast cancer in women with dense breasts: A systematic review for the U.S. Preventive services task force",
abstract = "Background: Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk. Purpose: To perform a systematic review of reproducibility of Breast Imaging Reporting and Data System (BI-RADS) density categorization and test performance and clinical outcomes of supplemental screening with breast ultrasonography, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography results. Data Sources: MEDLINE, PubMed, EMBASE, and Cochrane database from January 2000 to July 2015. Study Selection: Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts. Data Extraction: Quality assessment and abstraction of 24 studies from 7 countries; 6 studies were good-quality. Data Synthesis: Three good-quality studies reported reproducibility of BI-RADS density; 13{\%} to 19{\%} of women were recategorized between {"}dense{"} and {"}nondense{"} at subsequent screening. Two good-quality studies reported that sensitivity of ultrasonography for women with negative mammography results ranged from 80{\%} to 83{\%}; specificity, from 86{\%} to 94{\%}; and positive predictive value (PPV), from 3{\%} to 8{\%}. The sensitivity of MRI ranged from 75{\%} to 100{\%}; specificity, from 78{\%} to 94{\%}; and PPV, from 3{\%} to 33{\%} (3 studies). Rates of additional cancer detection with ultrasonography were 4.4 per 1000 examinations (89{\%} to 93{\%} invasive); recall rates were 14{\%}. Use of MRI detected 3.5 to 28.6 additional cancer cases per 1000 examinations (34{\%} to 86{\%} invasive); recall rates were 12{\%} to 24{\%}. Rates of cancer detection with DBT increased by 1.4 to 2.5 per 1000 examinations compared with mammography alone (3 studies). Recall rates ranged from 7{\%} to 11{\%}, compared with 7{\%} to 17{\%} with mammography alone. No studies examined breast cancer outcomes. Limitations: Good-quality evidence was sparse. Studies were small and CIs were wide. Definitions of recall were absent or inconsistent. Conclusion: Density ratings may be recategorized on serial screening mammography. Supplemental screening of women with dense breasts finds additional breast cancer but increases false-positive results. Use of DBT may reduce recall rates. Effects of supplemental screening on breast cancer outcomes remain unclear. Primary Funding Source: Agency for Healthcare Research and Quality.",
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AU - Miglioretti, Diana L

AU - Weyrich, Meghan S.

AU - Thompson, Jamie H.

AU - Shah, Kunal

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N2 - Background: Screening mammography has lower sensitivity and specificity in women with dense breasts, who experience higher breast cancer risk. Purpose: To perform a systematic review of reproducibility of Breast Imaging Reporting and Data System (BI-RADS) density categorization and test performance and clinical outcomes of supplemental screening with breast ultrasonography, magnetic resonance imaging (MRI), and digital breast tomosynthesis (DBT) in women with dense breasts and negative mammography results. Data Sources: MEDLINE, PubMed, EMBASE, and Cochrane database from January 2000 to July 2015. Study Selection: Studies reporting BI-RADS density reproducibility or supplemental screening results for women with dense breasts. Data Extraction: Quality assessment and abstraction of 24 studies from 7 countries; 6 studies were good-quality. Data Synthesis: Three good-quality studies reported reproducibility of BI-RADS density; 13% to 19% of women were recategorized between "dense" and "nondense" at subsequent screening. Two good-quality studies reported that sensitivity of ultrasonography for women with negative mammography results ranged from 80% to 83%; specificity, from 86% to 94%; and positive predictive value (PPV), from 3% to 8%. The sensitivity of MRI ranged from 75% to 100%; specificity, from 78% to 94%; and PPV, from 3% to 33% (3 studies). Rates of additional cancer detection with ultrasonography were 4.4 per 1000 examinations (89% to 93% invasive); recall rates were 14%. Use of MRI detected 3.5 to 28.6 additional cancer cases per 1000 examinations (34% to 86% invasive); recall rates were 12% to 24%. Rates of cancer detection with DBT increased by 1.4 to 2.5 per 1000 examinations compared with mammography alone (3 studies). Recall rates ranged from 7% to 11%, compared with 7% to 17% with mammography alone. No studies examined breast cancer outcomes. Limitations: Good-quality evidence was sparse. Studies were small and CIs were wide. Definitions of recall were absent or inconsistent. Conclusion: Density ratings may be recategorized on serial screening mammography. Supplemental screening of women with dense breasts finds additional breast cancer but increases false-positive results. Use of DBT may reduce recall rates. Effects of supplemental screening on breast cancer outcomes remain unclear. Primary Funding Source: Agency for Healthcare Research and Quality.

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