Little gain from supplemental ultrasound in women with dense breasts

Since many US states require by law that mammography providers inform women with dense breasts about the option of supplemental screening.  Sprague et al reported in the Ann Intern Med the cost-effectiveness of supplemental ultrasonography screening for women with dense breasts using data from SEER (Surveillance, Epidemiology, and End Results Program). 

Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs.

They found that supplemental 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 deaths), gained 1.7 QALYs (range, 0.9 to 4.7 QALYs), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421 recommendations) per 1000 women with dense breasts compared with biennial screening by mammography alone. Supplemental ultrasonography screening for only women with extremely dense breasts cost $246 000 per QALY gained (range, $74 000 to $535 000 per QALY gained).

They concluded that supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits.