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October 1, 2008

Ultrasound and Mammography for Breast Cancer Screening

JAMA. 2008;300(13):1514-1515. doi:10.1001/jama.300.13.1514-b

To the Editor: Dr Berg and colleagues1 provide evidence on the detection of breast cancer using ultrasound as adjunct screening to mammography, using a risk-based selection of participants, many of whom had a personal history of breast cancer. Although the sensitivity of 50% reported for mammography is within the range of sensitivities reported in screening dense breast tissue, this encompassed a broader distribution of breast tissue density categories (including the less dense category D2) than did other studies of ultrasound screening in women with dense breasts.2,3 The incremental cancer detection with ultrasound is important but should be interpreted relative to the moderate sensitivity of mammography reported in this population of women. A recent study of ultrasound screening in women with dense (D3-D4) breasts used blinded review of mammograms from women with ultrasound-detected cancers that had been previously reported as negative; 8 of 33 had abnormalities on mammography correlating with ultrasound-detected cancers, and these were mainly asymmetric densities, lesions known to be difficult to perceive on mammography.