Breast density is a risk factor for breast cancer, and having dense breasts makes breast cancer detection on mammography more difficult. Efforts in the past decade to educate women on these issues have led to some states mandating insurance coverage for screening ultrasonography in women who have dense breasts.

Researchers retrospectively analyzed data from two breast cancer registries to determine whether screening ultrasonography in addition to mammography improved the effectiveness of breast cancer screening in community practice compared with screening mammography alone. They identified a total of 6,081 mammography plus ultrasonography examinations in 3,386 women. Women who underwent mammography plus ultrasonography tended to be white, be younger than age 50, have a first-degree family history of breast cancer, have dense breasts, and have high five-year breast cancer risk scores. Of note, more than a quarter of the women who had both screening examinations didn't have dense breasts.

Mammography plus ultrasonography examinations were matched to 30,062 mammography examinations in 15,176 women. Women who underwent both examinations were less likely to need a second visit to complete diagnostic evaluations, but they were almost twice as likely to be referred for biopsy. The short-interval follow-up rate for probably benign findings was also significantly higher in those who'd had a mammography plus ultrasonography. In this group, the false-positive biopsy recommendation rate was more than double, with a corresponding decrease in positive predictive value. The researchers also observed increased sensitivity and decreased false-negative results among those who'd had mammography plus ultrasonography, but these differences weren't significant. The cancer detection rate was similar in the two groups.

The study didn't include information on the expertise or experience of the personnel performing the ultrasonography examinations, nor whether these exams were performed using handheld or automated devices. The authors suggest that further efforts are needed to more accurately identify women who will benefit from supplemental ultrasonography screening.

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