• Brian L Sprague, Natasha K Stout, Clyde Schechter, Nicolien T van Ravesteyn, Mucahit Cevik, Oguzhan Alagoz, Christoph I Lee, Jeroen J van den Broek, Diana L Miglioretti, Jeanne S Mandelblatt, Harry J de Koning, Karla Kerlikowske, Constance D Lehman, and Anna N A Tosteson.
• Ann. Intern. Med. 2015 Feb 3; 162 (3): 157-66.

BackgroundMany states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness.ObjectiveTo evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts.DesignComparative modeling with 3 validated simulation models.Data SourcesSurveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature.Target PopulationContemporary cohort of women eligible for routine screening.Time HorizonLifetime.PerspectivePayer.InterventionSupplemental ultrasonography screening for women with dense breasts after a negative screening mammography result.Outcome MeasuresBreast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs.Results Of Base Case AnalysisSupplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75), gained 1.7 QALYs (range, 0.9 to 4.7), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained (range, $112,000 to $766,000). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246,000 per QALY gained (range, $74,000 to $535,000).Results Of Sensitivity AnalysisThe conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age.LimitationProvider costs for coordinating supplemental ultrasonography were not considered.ConclusionSupplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits.Primary Funding SourceNational Cancer Institute.

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