Supplemental breast cancer screening with ultrasound may increase costs more than overall health in women with dense breasts

Supplemental ultrasound screening for all US women with dense breasts would substantially increase health care costs with little improvement in overall health, according to a new study published in the Annals of Internal Medicine (2014; doi:10.7326/M14-0692).

The study provides evidence on the benefits and harms of adding ultrasound to breast cancer screening for women who have had a negative mammogram and also have dense breasts. The study, led by researchers at Norris Cotton Cancer Center and The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire, will help inform the national legislative discussion about potential regulations requiring health providers to tell women if their mammogram shows that they have dense breasts.

Dense breasts are a risk factor for breast cancer and also make it more difficult to recognize potential problem areas amongst the dense tissue on screening mammograms. Senior author Anna Tosteson, ScD, explained the impact of the research: "Our study is timely because with existing breast density notification laws in some 19 states, and with national legislation pending, it is critical that we understand what approaches to supplemental breast cancer screening are most effective for women with dense breasts."

The study estimates that, for every 10,000 women ages 50 to 74 years with dense breasts who receive supplemental ultrasound screening after a normal mammogram, about four breast cancer deaths would be prevented, but an extra 3,500 biopsies would be performed for women who did not have breast cancer.

Tosteson and colleagues used data from the Breast Cancer Surveillance Consortium (BCSC) and three simulation models developed independently within the National Cancer Institute (NCI)-funded Cancer Intervention and Surveillance Modeling Network consortium to evaluate the health outcomes and expense of supplemental screening via ultrasound.

Because an estimated 40% of US women 40 to 74 years old may have dense breasts, the value of notifying them of their status and recommending next steps in screening for breast cancer is of national significance.

Tosteson and colleagues recently published a separate simulation modeling study using preliminary data on digital breast tomosynthesis that suggested the new technology may provide an effective way to screen women with dense breasts.

"Those projections were based on very limited data from US populations and we are expanding these data through our ongoing NCI-sponsored research within the Breast Cancer Surveillance Consortium and the PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) Consortium," cautioned Tosteson.

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