Wendie A. Berg MD, PhD, Presenter: Consultant, Naviscan, Inc

Zheng Zhang PhD, Abstract Co-Author: Nothing to Disclose

Jean B. Cormack PhD, Abstract Co-Author: Nothing to Disclose

Daniel E. Lehrer MD, Abstract Co-Author: Nothing to Disclose

Marcela Böhm-Vélez MD, Abstract Co-Author: Nothing to Disclose

Etta D. Pisano MD, Abstract Co-Author: Institutional research agreement, General Electric Company Institutional contract, Konica Minolta Group Institutional contract, VuCOMP, Inc Institutional contract, Real Imaging Institutional contract, Sectra AB

Roberta A. Jong MD, Abstract Co-Author: Research Consultant, General Electric Company

W. Phil Evans MD, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc

Marilyn J. Morton DO, Abstract Co-Author: Nothing to Disclose

Mary C. Mahoney MD, Abstract Co-Author: Consultant, Johnson & Johnson Speakers Bureau, Johnson & Johnson Consultant, SenoRx, Inc Speakers Bureau, SenoRx, Inc Scientific Advisory Board, Hologic, Inc

Linda Hovanessian-Larsen MD, Abstract Co-Author: Nothing to Disclose

Richard Gary Barr MD, PhD, Abstract Co-Author: Consultant, Siemens AG Consultant, Koninklijke Philips Electronics NV Research grant, Siemens AG

Dione Marie Farria MD, Abstract Co-Author: Nothing to Disclose

Ellen Bachman Mendelson MD, Abstract Co-Author: Medical Advisory Board, Hologic, Inc Speaker, The Medipattern Corporation, Toronto, ON Scientific Advisory Board, Siemens AG Research support, Supersonic Imagine, Aix-en-Provence, FR Equipment support, Koninklijke Philips Electronics NV Speaker, Toshiba Corporation

Helga Marques MS, Abstract Co-Author: Nothing to Disclose

Amanda Adams MPH, Abstract Co-Author: Nothing to Disclose

Glenna Gabrielli BS, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To compare the cancer detection rate (yield) of combined mammography plus ultrasound to mammography alone in incidence screens of ACRIN 6666.

2809 women at elevated risk for breast cancer with nonfatty breasts were recruited 4/04 to 2/06 from 21 IRB-approved sites to undergo mammography (M) and physician-performed ultrasound (US) exams, randomized in order, masked, and interpreted by different physicians prior to integrated interpretation, with screening at times 0 (year 1), 12 (year 2), and 24 months (year 3). Reference standard is based on biopsy and/or 12-month follow-up for each screen. Results from screens in years 2 and 3 were compared to those in year 1.

2648 eligible women had reference standard for year 1 [mean age 55.2 yr, range 25-91], and were at elevated risk due to: personal history of breast cancer (53%); familial high-risk by Gail or Claus models (43%); prior ADH/ALH/LCIS/atypical papilloma (3%); BRCA-1 or -2 mutation (1%). In year 1, of 2648 screened, cancer was found in 36 (1.4%) women: 8 on both M and US; 12 M alone; 12 US alone; 4 neither. In year 2, of 2487 screened, 28 (1.1%) had cancer: 7 on both M and US; 6 on M alone; 9 on US alone; 6 neither. In year 3, of 1921 screened, 46 (2.4%) had cancer: 7 on M and US; 14 on M alone; 9 on US alone; 16 neither (with 8 seen only on MRI in a substudy). Supplemental yield of US was 4.2/1000 in year 1 (95% CI 1.1 to 7.2); 4.0/1000 in year 2 (95% CI 1.1 to 6.9); and 4.7/1000 in year 3 (95% CI 0.8 to 8.6). 110 participants were diagnosed with cancer, including 23 (21%) DCIS and 87 invasive, with 12/66 (18%) node positive among those staged. Of participants with cancer seen only on US, 28/30 (93%) were invasive, with median size of 10 mm (range 2 to 40), and 1/24 (4.2%) was node positive among those staged. Of 26 participants with cancer not depicted by M or US, only 8 presented clinically in the interval between screens, for an interval cancer rate of 7.3%. There was no difference in supplemental yield of US among 41.4% of exams performed with digital vs. film-screen mammography (p = .38).  

The supplemental yield of screening US after mammography is constant, averaging 4.3 per 1000 annual screens [95% CI 2.7 to 6.0] among women at elevated risk of breast cancer. [Support from The Avon Foundation and National Cancer Institute (CA079778, CA80098).]

Detection of mammographically-occult node-negative invasive breast cancer is improved by supplemental annual screening with US.  

Berg, W, Zhang, Z, Cormack, J, Lehrer, D, Böhm-Vélez, M, Pisano, E, Jong, R, Evans, W, Morton, M, Mahoney, M, Hovanessian-Larsen, L, Barr, R, Farria, D, Mendelson, E, Marques, H, Adams, A, Gabrielli, G, et al, 0, Screening Breast Ultrasound as a Supplement to Mammography: Yield of Annual Screening in ACRIN* 6666 *American College of Radiology Imaging Network.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8002537.html