Jean M. Weigert MD, Presenter: Stockholder, Tractus Company Limited

 To determine if the addition of screening breast ultrasound in women with mammographically normal but dense breasts in the 3rd and 4th year since the legislation was enacted has continued to improve breast cancer detection while demonstrating an improvement in PPV.

The study utilized a retrospective chart review. Data collected included: (1) total number of screening mammograms; (2) total number of dense breast screening ultrasounds; (3) screening ultrasound Breast Imaging Reporting Data System (BI-RADS) code results; (4) biopsy results; and (5) demographic data on women with malignant biopsies. Data was obtained from included sites throughout 2012 and 2013.  

 Data from 2 Connecticut radiology practices with 5 sites was collected. A total of 32230 screening mammograms and 4128 dense breast ultrasounds were performed in year 3 and 27937 screening mammograms and 3330 dense breast ultrasounds in year 4. In year 3, of the screening ultrasounds 148 were BI-RADS 4 or 5, and 13 were found to have a cancer on biopsy. In year 4, there were 52 BI-RADS 4 or 5 ultrasounds and 10 cancers. The rate of detection is 3.1/1000 in year 3 and 3.0/1000 in year 4. The positive predictive value increased from 8.1% in year 3 to 16.1% in year 4. Of the women eligible for the screening ultrasound, 32% and 30% requested the test respectively in years 3 and 4.

Based on the data collected from these sites, screening breast ultrasound in women with dense breast parenchyma continues to detect mammographically occult malignancy in years 3 and 4 at the same rate as year 1 and 2. The rate of detection remains stable at 3.0/1000. However, the PPV increased in year 4 indicating that the selection of lesions biopsied was more accurate with fewer false positives. Of concern, the number of eligible women who elect to have the additional test remains low at about 30% which is due to several factors including education and cost.  

Adding  screening breast ultrasound in patients with mammographically dense breasts continues to diagnose a significant number of additional cancers in the 3rd and 4th year since the legislation was enacted and the PPV has also improved.

Weigert, J, The Connecticut Experiment Continues: Ultrasound in the Screening of Women with Dense Breasts Years 3 and 4.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004644.html