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Published on: January 12, 2017
Performance of Supplemental US Screening in Women with Dense Breasts and Varying Breast Cancer Risk: Results from the
Brian L Sprague1, Laura Ichikawa1, Joanna Eavey1
1From the Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.); University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O., D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vt (D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, Calif (K.K.); and Department of Veterans Affairs, General Internal Medicine Section, University of California San Francisco, San Francisco, Calif (K.K.).
Abstract:
Background It is unclear whether breast US screening outcomes for women with dense breasts vary with levels of breast cancer risk. Purpose To evaluate US screening outcomes for female patients with dense breasts and different estimated breast cancer risk levels. Materials and Methods This retrospective observational study used data from US screening examinations in female patients with heterogeneously or extremely dense breasts conducted from January 2014 to October 2020 at 24 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries. The primary outcomes were the cancer detection rate, false-positive biopsy recommendation rate, and positive predictive value of biopsies performed (PPV3). Risk classification of participants was performed using established BCSC risk prediction models of estimated 6-year advanced breast cancer risk and 5-year invasive breast cancer risk. Differences in high- versus low- or average-risk categories were assessed using a generalized linear model. Results In total, 34 791 US screening examinations from 26 489 female patients (mean age at screening, 53.9 years ± 9.0 [SD]) were included. The overall cancer detection rate per 1000 examinations was 2.0 (95% CI: 1.6, 2.4) and was higher in patients with high versus low or average risk of 6-year advanced breast cancer (5.5 [95% CI: 3.5, 8.6] vs 1.3 [95% CI: 1.0, 1.8], respectively; P = .003). The overall false-positive biopsy recommendation rate per 1000 examinations was 29.6 (95% CI: 22.6, 38.6) and was higher in patients with high versus low or average 6-year advanced breast cancer risk (37.0 [95% CI: 28.2, 48.4] vs 28.1 [95% CI: 20.9, 37.8], respectively; P = .04). The overall PPV3 was 6.9% (67 of 975; 95% CI: 5.3, 8.9) and was higher in patients with high versus low or average 6-year advanced cancer risk (15.0% [15 of 100; 95% CI: 9.9, 22.2] vs 4.9% [30 of 615; 95% CI: 3.3, 7.2]; P = .01). Similar patterns in outcomes were observed by 5-year invasive breast cancer risk. Conclusion The cancer detection rate and PPV3 of supplemental US screening increased with the estimated risk of advanced and invasive breast cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Helbich and Kapetas in this issue.
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