Women With Dense Breast Tissue Need......

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Women with dense breast tissue need both mammography and

ultrasonography to detect tumors

http://bmj.bmjjournals.com/cgi/content/full/bmj%3b327/7405/12-e

News extra

Judy Siegel-Itzkovich Jerusalem

Researchers have found that performing ultrasound scans on breasts

with dense tissue can pick up small tumours that are not detected by

mammography. While ultrasonography cannot replace mammography,

especially in women who because of a family history are at high risk

of developing breast cancer, it should be used as a second line of

screening.

A team of breast specialists and radiologists at Soroka Medical

Centre in Beersheba and the Hala- Nash Jerusalem Comprehensive

Breast Clinic in Jerusalem published their findings in the July issue

of the American Journal of Roentgenology (2003;181:177-82;

www.ajronline.org/cgi/content/full/181/1/177).

Drs Pavel Crystal, Shalom Strano, Semyon Shcharynski, and

Koretz examined 1517 women, with a mean age of 52, who had dense

breast tissue but no sign in mammograms of malignancies.

Of the women, who ranged in age from 31 to 84 years, 318 had a first

degree relative with breast cancer or had themselves previously had

breast cancer. Seven breast cancers not found in mammograms were

detected by ultrasonography: four in women at high risk and three in

women with baseline risk. The short term, follow up specificity of

ultrasonography was 94.4%, which the researchers said was an

acceptable figure for a screening test.

The researchers noted that success at detecting small tumours was

directly related to the skills and experience in breast imaging of

the people operating the ultrasound equipment. Ultrasound screening

was done at no extra cost to the patients, even though it is not

included in the basket of services covered by the public health funds.

Women went straight from the mammography unit to the ultrasound unit,

thus reducing their anxiety and avoiding a long wait for a result.

The study did not examine whether the early diagnoses saved lives, as

this could be proved only by a very large, long term, and expensive

clinical trial, but the authors speculate that early detection and

removal of such tumors would lower mortality.

The study also did not go into whether ultrasound screening in women

with dense breast tissue is cost effective, but the researchers noted

that ultrasonography is no more expensive than mammography, which it

does not replace.

As women with dense breast tissue, especially younger women, cannot

depend on mammography for accurate screening of tumors, subsequent

ultrasonography is a boon for this group, the researchers said. For

economic reasons they recommend that ultrasonography be used to

screen for breast cancer in high risk women with dense tissue, but

they noted that it was effective in women with a baseline risk as

well.

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