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In Reply: We agree with Dr Magee that it is important to consider both survival and cost consequences of imaging tests. This is particularly true of breast cancer screening, which involves large numbers of women and repeated annual testing. The cancers seen only with screening ultrasound are nearly all invasive and node-negative at detection. Left undetected, these invasive cancers may spread to axillary nodes prior to diagnosis, worsening the prognosis. Across 7 RCTs of mammography, the decrease in mortality observed parallels reduction in node-positive cancers.¹

Drs Houssami and Ciatto point out that our study showed a detection yield from screening ultrasound. The Italian multicenter study of screening ultrasound initially reported a supplemental yield of 4.4 per 1000,² similar to the 4.2 per 1000 yield we reported. In an update, among 9157 women screened, 166 cancers had been found at initial mammography, and 50 cancers were found only on ultrasound (yield . . . [Full Text of this Article]

Wendie A. Berg, MD, PhD
wendieberg@gmail.com
American Radiology Services
Johns Hopkins Green Spring
Lutherville, Maryland

Ellen B. Mendelson, MD
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

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Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer
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Ultrasound and Mammography for Breast Cancer Screening
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