Ultrasound better than mammography for women younger than 40 years with symptoms of breast cancer

Abstract

Researchers have found that ultrasound is superior to mammography in evaluating women aged 30 years to 39 years with symptoms of breast cancer. They recommend that US clinical practice guidelines, which currently recommend mammography as the first evaluation in these women, should be reconsidered. The study, which to the authors' knowledge is the largest analysis to date comparing these 2 modalities for women in this age bracket, was conducted by researchers at the Seattle Cancer Care Alliance (SCCA) and the University of Washington and published in the American Journal of Roentgenology.1 The study was led by Constance Lehman, MD, PhD, director of radiology at SCCA. She and her colleagues identified all women aged 30 years to 39 years who presented for diagnostic breast imaging evaluation at SCCA between January 2002 and August 2006. In the 1208 cases they identified, sensitivity for ultrasound was 95.7%, compared with 60.9% for mammography. Ultrasound examinations found 22 cancers versus 14 detected by mammography. Dr. Lehman notes that mammography still is the best tool for screening women aged 40 years and older but that ultrasound is “the tool of choice” in evaluating symptomatic women aged younger than 40 years. The use of ultrasound in the under-40 age group is common practice in Europe, where it is recommended as the primary diagnostic imaging tool. Women in this group tend to have symptoms such as palpable lumps, localized pain, and tissue thickening. The risk of malignancy in these women is approximately 1.9%, Dr. Lehman says. The current guidelines for this age group, issued by the American College of Radiology, recommend mammography as the primary diagnostic tool. It's difficult to develop guidelines in this area due to the sparse amount of data available, says Dr. Lehman. She and her coauthors added that the use of adjunct mammography added little diagnostic value, but should still be considered when malignancy is highly suspected.