This investigation is part of an ongoing large scale study using volumetric breast ultrasound (VBUS) as a screening modality in mammographically dense breasts, offering a substantial benefit to MR imaging of the breast in terms of cost and efficiency. The addition of VBUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone with an overall attributable risk of breast cancer of 19.92 (95% confidence level, 16.75–23.61) in our screened population. These preliminary results may justify the cost benefit of implementing the judicious use of VBUS as an alternative to MR imaging of the breast in conjunction with mammography in the dense breast screening population. 1. Introduction Mammographic density as an independent risk factor for developing breast cancer has been documented since the 1970s [1]. The appearance of breast tissue is variable among women. The appearance of density on mammography is the result of the relative proportion of breast stroma, which is less radiolucent compared to fat, accounting for increased breast density. Wolfe classified breast density as an independent risk factor for breast cancer in women [2, 3]. Approximately 70 to 80% of breast cancers occur in women with no major predictors [4–6]. Population-based screening for early detection of breast cancer is therefore the primary strategy for reducing breast cancer mortality. Mammography has been used as the standard imaging method for breast cancer screening, with reduction in breast cancer mortality [7]. Computer-aided detection (CAD) technology with full-field digital mammography (FFDM) has been shown to have several advantages over screen-film mammography, including higher contrast resolution, better dynamic range, and lower noise [8, 9]. Previous studies have shown that CAD performance is similar for the detection of cancer in fatty breasts and dense breasts with screen-film mammography (90% versus 88%, resp.; ) [10] and with FFDM (95% versus 98%; ) [11]. Sensitivity in extremely dense breasts was only 60% [12]. There are numerous studies showing that CAD performance is limited by background parenchymal breast density, where the sensitivity of the detection of breast masses sensitivity is significantly higher for fatty breasts than for dense breasts [11, 13–15]. Breast density significantly reduces the ability to visualize cancers on mammography. All false-negative lesions detected with CAD manifested as masses [16]. The number of missed cancers is substantially
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