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Comment & Response
August 2019

Benefits of Supplemental Ultrasonography With Mammography—Reply

Author Affiliations
  • 1Department of Radiology, University of Washington, Seattle
  • 2Breast Imaging, Seattle Cancer Care Alliance, Seattle, Washington
  • 3Cancer Screening, American Cancer Society, Atlanta, Georgia
  • 4Department of Medicine, University of California, San Francisco
  • 5Department of Epidemiology and Biostatistics, University of California, San Francisco
JAMA Intern Med. 2019;179(8):1150-1151. doi:10.1001/jamainternmed.2019.2376

In Reply We thank Mendelson and colleagues for their interest in our study.1

In their letter, it is suggested that our sample size of 6081 examinations was “small” and should be considered in the context of results across 25 series encompassing more than 363 000 screens. Of the studies cited, 18 were single-institution studies, and 12 had sample sizes smaller than our study. The studies also included heterogeneous populations of women with varying distributions of breast density and underlying risk, which precludes summation of conclusive evidence across studies, as suggested. Our study of women receiving screening ultrasonography as part of routine clinical practice in the United States reported significant increases in false-positive biopsy rates without significant increase in cancer detection rates or decrease in interval cancer rates. Our conclusions apply to the observed cohort, and our study of multiple facilities with linkage to state and regional cancer registries adds high-quality evidence to the published literature.

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