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Wednesday, 14 May 2008 19:33

Mammogram, ultrasound finds cancer better, but more false-positives

A new Johns Hopkins study shows that the use of breast ultrasound and mammography together is much better at finding breast cancer than mammogram alone, but causes more false-positive readings.

The lead researcher in the study was Dr. Wendie A. Berg, a radiologist at the American Radiology Services outpatient center in Lutherville, Maryland (near Columbia, Maryland), which is affiliated with Johns Hopkins Medical Center.

The Berg researchers stated that ultrasound can detect small, node-negative breast cancers much better than mammography.

The study found that the dual use of ultrasound and mammography finds more cancers in women, especially in women that are at high risk for getting breast cancer. Those at increased risk for breast cancer are women with "exceptionally dense breast tissue."

However, at the same time, the use of both ultrasound and mammography for the detection of breast cancer also increases the rate of false-positive readings. A false-positive reading indicates something abnormal (in this case, breast cancer) then the situation is actually normal.

In the Berg study, 2,809 female patients, from twenty-one different medical centers, were tested for breast cancer using only mammography, or were tested using mammography and ultrasound.

Between April 2004 and February 2006, they were randomly selected to receive only mammography or both mammography and ultrasound.

The average age of the women was 55 years and each of them had an above-normal risk for breast cancer.

When using only mammography, 50% of the cancers were found—twenty cancers in all. However, when the researchers used both methods, they found 78% of the cancers—an increase of 28%. In all, thirty-one cancers were found.

On the down side, the researchers discovered that the rate of false-positive readings dramatically increased. With mammography alone, the researchers saw that a biopsy taken of breast tissue—thought to be cancerous after the mammogram—had a one in forty chance of not being cancer. The false-positive reading was only at 2.5%.

However, when mammography and ultrasound was used, the biopsy came back one in 10 times without a cancer reading. The false-positive reading was larger at 10%.

The conlusion stated by the researchers in their paper follows. Please read on.

The researchers concluded the following: “Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives.”

The results of the study were published in the May 14, 2008 issue of the Journal of the American Medical Association (JAMA).

The title of the JAMA article is “Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer.”

The other researchers in the study included: Jeffrey D. Blume, Jean B. Cormack, Ellen B. Mendelson, Daniel Lehrer, Marcela Böhm-Vélez, Etta D. Pisano, Roberta A. Jong, W. Phil Evans, Marilyn J. Morton, Mary C. Mahoney, Linda Hovanessian Larsen, Richard G. Barr, Dione M. Farria, Helga S. Marques, and Karan Boparai.

An editorial in JAMA noted that ultrasound is not frequently used in the United States as a compliment to mammography because it is costly and has a high frequency of false-positive readings.

However, the editorial also stated that the use of both methods has been verified in the past as providing better cancer screening for women.

Additional information is found in the CNN Money article “Ultrasound Finds Breast Cancer, Triggers False Alarms –Study.”


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