Breast cancer incidence in women has increased from one in 20 in 1960 to one in eight today. Breast ultrasound is a tool of growing importance, both as a screening method and in assisting surgical procedures.
Experts say it should not be used with every woman. Rather, the key is to use it with certain higher risk woman with dense breasts as well as women that fall into a high risk category for breast cancer for other reasons.
The results of the American College of Radiology Image Network (ACRIN) trial published in May 2008 offer some of the most relevant data to date on breast ultrasound.
The ACRIN trial found that in women at increased risk for breast ultrasound, adding a screening ultrasound exam to routine mammography revealed 28% more cancers than mammography alone. However, the additional ultrasound exam substantially increased the rates of false-positive findings and unnecessary biopsies.
The ACRIN study results says that mammography alone prompted an unnecessary biopsy for one in 40 women in the study. But with a combination of mammography and ultrasound screening an unnecessary biopsy occurs for with one in 10 women. So with ultrasound screening, four times more women are having a biopsy.
The study results confirm that screening ultrasound in combination with mammography detects more cancers than mammography alone in women at increased risk for breast cancer. For this process that offers better detection of cancer in women there is a price.
Is an increased rate of biopsy an acceptable price to pay to find some of the small breast cancers that are being missed without ultrasound?
As with other screening procedures it is something that patients and doctors need to decide together.
If we are going to offer screening ultrasound, we need to inform women of the substantial risk of receiving an unnecessary biopsy. After they are educated with all the facts let them decide the best way to proceed.
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