Abstract
Background: Ultrasound is an important modality for breast cancer screening. However, the evidence on the effectiveness of ultrasound screening in population-based cancer screening program in lacking. We aimed to evaluate the diagnostic yield of ultrasound screening in a population-based breast cancer screening in China.Methods: The analyses were conducted in the context of the Cancer Screening Program in Urban China, which recruited 1,938,996 eligible participants aged 40–69 years from 16 provinces in China from 2012 to 2016. We included 72,250 women assessed to be high-risk for breast cancer who undertook ultrasound screening per study protocol. Diagnostic yield according to the Breast Imaging Reporting and Data System (BI-RADS) was evaluated. Risk factors associated with the positive findings of ultrasound were also explored by univariate and multivariable logistic regression analyses.Results: Overall, there were 9,765 (13.51%) women had positive findings of ultrasound screening, including 8,487 (11.75%), 1,210 (1.67%), and 68 (0.09%) of BI-RADS categories of III, IV, and V, respectively. Younger ages, late age of 1st live birth and short-term breast feeding were found to be positively associated with positive findings under ultrasound in multivariate analyses stratified by menopause status and family history of breast cancer. Multivariable prediction models were constructed and yielded only modest prediction accuracy, with AUCs around 0.55.Conclusions: We found the diagnostic yield of ultrasound screening for breast cancer in high-risk population was satisfactory. Prediction models based on environmental risk factors had limited prediction accuracy and need to be improved in the future.
Highlights
With an estimate of 2,088,849 newly diagnosed cases in 2018 worldwide, breast cancer is the most frequently diagnosed cancer for women and is the leading cause of cancer-related deaths [1]
We reported the results of breast cancer screening using ultrasound conducted between October 2012 and October 2016
We aimed to evaluate the diagnostic yield of ultrasound screening in high-risk Chinese populations and to identify risk factors associated with the clinical findings of ultrasound screening
Summary
With an estimate of 2,088,849 newly diagnosed cases in 2018 worldwide, breast cancer is the most frequently diagnosed cancer for women and is the leading cause of cancer-related deaths [1]. The overall sensitivity of mammography for detecting breast cancer was around 85%, but it dropped dramatically to 47.8–64.4% for women with dense breast tissue [6]. Previous studies have demonstrated that women with dense breast had an elevated risk of breast cancer [7]. Such limitation of mammography may limit the its screening efficacy in population having a high proportion of dense breast. The evidence on the effectiveness of ultrasound screening in population-based cancer screening program in lacking.
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