Benefits, Harms, and Cost-Effectiveness of Supplemental Ultrasonography Screening for Women With Dense Breasts

• DOI: 10.7326/m14-0692
• Publication Date: 2014-12-08T23:31:07Z
• Authors: Brian L. Sprague; Natasha K. Stout; Clyde Schechter; Nicolien T. van R...; Mucahit Cevik; Oguzhan Alagoz; Christoph I. Lee; Jeroen J. van den...; Diana L. Miglioretti; Jeanne S. Mandelb...; Harry J. de Koning; Karla Kerlikowske; Constance D. Lehman; Anna N.A. Tosteson
• Keywords: Comparative Effectiveness Research; Biopsy; Cost-Benefit Analysis; Oncology and Carcinogenesis; Clinical Sciences; 610; EMC NIHES-02-65-01; Breast Neoplasms; Sensitivity and Specificity; 03 medical and health sciences; 0302 clinical medicine; SDG 3 - Good Health and Well-being; Clinical Research; Risk Factors; Breast Cancer; Humans; Mass Screening; Computer Simulation; False Positive Reactions; Breast; Early Detection of Cancer; Cancer; Ultrasonography; Aged; Mammary; Biomedical and Clinical Sciences; Prevention; Health Services; Middle Aged; United States; 3. Good health; Good Health and Well Being; Reproductive Medicine; Cost Effectiveness Research; Public Health and Health Services; Women's Health; Biomedical Imaging; Female; 4.4 Population screening; Quality-Adjusted Life Years; Ultrasonography, Mammary; 4.2 Evaluation of markers and technologies; Mammography

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