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Adjunctive ultrasonography for breast cancer screening

Autier, Philippe and Boniol, Mathieu (2016) Adjunctive ultrasonography for breast cancer screening. Lancet, 387 (10036). p. 2380. ISSN 0140-6736

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Abstract

Refers To Noriaki Ohuchi, Akihiko Suzuki, Tomotaka Sobue, Masaaki Kawai, Seiichiro Yamamoto, Ying-Fang Zheng, Yoko Narikawa Shiono, Hiroshi Saito, Shinichi Kuriyama, Eriko Tohno, Tokiko Endo, Akira Fukao, Ichiro Tsuji, Takuhiro Yamaguchi, Yasuo Ohashi, Mamoru Fukuda, Takanori Ishida, J-START investigator groups Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial The Lancet, Volume 387, Issue 10016, 23–29 January 2016, Pages 341-348 PDF (234 K) Supplementary content Referred to by Noriaki Ohuchi, Akihiko Suzuki, Seiichiro Yamamoto, Shinichi Kuriyama, Takanori Ishida Adjunctive ultrasonography for breast cancer screening – Authors' reply The Lancet, Volume 387, Issue 10036, 11–17 June 2016, Pages 2381-2382 PDF (93 K) The primary goal of cancer screening is to decrease cancer mortality through detecting cancer at an earlier curable stage. Thus effective screening implies a decrease in the rate of advanced cancers. The randomised trial of Noriaki Ohuchi and colleagues suggests that the systematic addition of an ultrasonography examination to mammography and clinical breast examination increases the sensitivity of breast screening. Two screening rounds were done, but reported results concerned the first round only. The search for interval cancers was restricted to the period extending between the first and the second round and their stage distribution was not reported. Because of the absence of data about screen-detected cancers found at further rounds and interval cancers diagnosed during longer follow-up, the results of this single-round trial cannot be interpreted correctly. For example, how many of the extra 65 stage 0–1 cancers (36% of all stage 0 and 1 cancers) found with additional ultrasonography would represent overdiagnosis (ie, the detection of cancer that would not become clinical in the absence of screening)? If a sizeable portion of these 65 extra cancers represented overdiagnosis, then the gain in sensitivity is overestimated because earlier detection is of no relevance for overdiagnosed cancers. Another question is raised by the similar number of advanced (stage 2–4) cancers found in both groups. Do these similar numbers mean that the addition of ultrasonography does not improve the capacity of screening to detect cancers at an earlier stage? In our view, this Article adds confusion to investigations into the value of ultrasonography for breast screening. We declare no competing interests.