A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women

S Shen, Y Zhou, Y Xu, B Zhang, X Duan, R Huang, B Li, Y Shi, Z Shao, H Liao, J Jiang, N Shen, J Zhang, C Yu, H Jiang, S Li, S Han, J Ma, Q Sun
British Journal of Cancer 2015 March 17, 112 (6): 998-1004

BACKGROUND: Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials.

METHODS: At 14 breast centres across China during 2008-2010, 13 339 high-risk women aged 30-65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrollment and 1-year follow-up.

RESULTS: A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0%; P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively.

CONCLUSIONS: Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.

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