Abstract
We aimed to determine which combination of physical examination (pe), mammography (mam), and ultrasonography (us) would optimize breast cancer detection in China. We conducted a trial of screening with pe, mam, and us among Chinese women 25 years of age and older. All initial screenings using the three modalities were completed within 30 days of each other, and subjects were followed approximately 1 year later. The performances of the three screening methods used alone, in parallel, or in series were compared. Data were analyzed using exact confidence intervals (cis) and the McNemar test. Between March 2009 and July 2011, 3028 eligible women completed all study examinations. At a mean follow-up of 1.3 years, 33 breast cancers were identified in the study population. Mammography detected 28 cancers; us, 24 cancers; and pe, 22 cancers. During the follow-up period, 2 false-negative cases occurred clinically. The highest sensitivity for breast cancer screening (93.9%) was achieved by paralleling mam with us, but came at the cost of a higher recall rate (12.15%). Using us alone at the first stage, followed by mam when indicated, offered high specificity (99.4%) and the lowest recall rate (1.82%), which were not reached at the expense of sensitivity (84.8%). Used in series, us and mam achieved a sensitivity similar to that for the same modalities used in parallel (McNemar p > 0.05). Taking limited health resources into consideration, the strategy of screening with us alone at the first stage, followed by mam when indicated, may optimize breast cancer detection in most regions of China.
Highlights
Breast cancer is by far the most common female cancer (21.6/100,000) and one of the primary causes of death (5.7/100,000) among Chinese women, with an estimated 169,452 new cases and 44,908 deaths in 2008 1
At a mean follow-up of 1.3 years, 33 breast cancers were identified in the study population
No randomized controlled trials of mam screening have been conducted among Chinese women, and evidence that such screening would reduce breast cancer mortality in China is insufficient
Summary
Breast cancer is by far the most common female cancer (21.6/100,000) and one of the primary causes of death (5.7/100,000) among Chinese women, with an estimated 169,452 new cases and 44,908 deaths in 2008 1. Mammography (mam) is the only evidence-based screening technology available for that purpose, as verified by randomized clinical trials in Western countries 4. Organizations have released conflicting recommendations on the risks and benefits of mam in clinical and societal contexts 5, many Western countries have successfully implemented mass mam screening for breast cancer 6. Evidence to justify population-based breast cancer screening by mam for women in China is currently lacking. No randomized controlled trials of mam screening have been conducted among Chinese women, and evidence that such screening would reduce breast cancer mortality in China is insufficient
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