Recommendations from European Breast Guidelines
Should tailored screening with automated breast ultrasound system (ABUS) based on high mammographic breast density, in addition to mammography, vs. mammography alone be used for early detection of breast cancer in asymptomatic women?
For women who have no symptoms of breast cancer and who have dense breast tissue, the ECIBC's Guidelines Development Group suggests not to have automated whole breast ultrasound (ABUS) after a negative mammogram but rather to have only the mammogram, within an organised screening programme.
- Strong recommendation against the intervention
- ✓ Conditional recommendation against the intervention
- Conditional recommendation for either the intervention or the comparison
- Conditional recommendation for the intervention
- Strong recommendation for the intervention
A recommendation can be strong or conditional.
When a recommendation is strong, most women will want to follow it. When a recommendation is conditional, the majority of women want to follow it but may need more discussion with their healthcare professional first.
What would following this recommendation mean for you?
It might be important to speak with your healthcare professional to determine if you have dense breast tissue and what it means for you. You may also wish to discuss if you are at high, average or low risk of breast cancer, and whether you have or do not have any symptoms of breast cancer.
To decide on whether to have the additional screening with automated whole breast ultrasound (ABUS) or have only a mammogram, you may wish to speak with your healthcare professional about these tests and how you feel about
- the chances of finding breast cancer or the chance of being called back for further tests which find that you do not have cancer when adding ABUS or when having only a mammogram
- what happens after you have the results of the tests, and
- your comfort during the tests.
Who is this recommendation for?
- You are between 45 and 74
- You do not have symptoms of breast cancer
- You have already had a screening mammogram that did not show breast cancer
- You have dense breast tissue
This recommendation suggests that women who have dense breast tissue not have additional screening with automated whole breast ultrasound (ABUS) because the overall harms may be greater than having only a digital mammogram. It is uncertain whether having additional screening with ABUS may find more breast cancers than having only a digital mammogram. It is not known if more advanced breast cancers are found or if there are fewer deaths by adding ABUS to digital mammography screening. It is also uncertain whether more women who turn out not to have cancer may have to come back for more tests or unnecessary tests.
The ECIBC’s Guidelines Development Group noted that the costs to a country would be higher when ABUS is provided in addition to a mammogram in a screening programme. Special training and equipment may also not be available in some countries and regions.
Monitoring and Evaluation
EvidenceDownload the evidence profile
Detection rate for absolute effects in high risk vs low risk populations cannot be compared. However, relative effects should not differ.
GDG members pointed out that there is an interaction between risk factors (other than breast density) and detection rate, and therefore absolute or relative effects may not be comparable.
As agreement was not reached, voting was conducted among GDG members: Eight members voted the effects were "moderate"; seven members voted they "did not know".
The GDG members felt that interpretation time for ABUS is similar to Digital Breast Tomosynthesis (DBT). Whereas HHUS utilises the same ultrasound machines already used in a hospital, ABUS requires a new machine with significant increased costs.
However, a systematic review (JRC Technical Report PICO 16-17, contract FWC443094032016; available upon request) found a number of barriers associated with breast cancer screening with mammography. See the reviews of mammography screening for details. However, the results of these may not apply specifically to this population of women at enhanced risk and informed as such, due to breast density, and offered additional imaging as a result.
The GDG members felt ABUS would be very acceptable to screening participants, as ABUS-tailored screening has no radiation exposure and the physical discomfort associated with mammography would not be present. Payers may not find it acceptable due to larger costs of ABUS for minor increases in breast cancer detection rates.
- Brem RF(1), Tabár L, Duffy SW, Inciardi MF, Guingrich JA, Hashimoto BE, Lander MR, Lapidus RL, Peterson MK, Rapelyea JA, Roux S, Schilling KJ, Shah BA, Torrente J, Wynn RT, Miller DP. Assessing improvement in detection of breast cancer with three dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology. 2015 Mar;274(3):663-73.
- Giuliano V(1), Giuliano C. Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts. Clin Imaging. 2013 May-Jun;37(3):480-6.
- Kelly KM(1), Dean J, Comulada WS, Lee SJ. Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol. 2010 Mar;20(3):734-42.
- Lee CI, Cevik M, Alagoz O, Sprague BL, Tosteson AN, Miglioretti DL, Kerlikowske K, Stout NK, Jarvik JG, Ramsey SD, Lehman CD. Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts. Radiology. 2015; 274(3): 772-8
- Not applicable
- For more details about the results see the full report (Contract: FWC 443094 012015 PICO 10-11).