Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and staging

Mammographic screening of women age 40 and older can reduce breast cancer d eaths by at least 30% to 40%. However, not all cancers are detected by mamm ography. Although a new supplementary modality for screening could, in theo ry, fill in this detection gap, such utilization must be based on rigorous demonstration of its ability to consistently and frequently find early canc ers missed by mammography, such as those occurring in dense breasts or rapi dly growing interval cancers that surface clinically between mammographic s creens. After an abnormality is found at mammographic screening, supplement ary mammographic views and/or ultrasound are now used to match the finding with an ACR BIRADS final diagnostic assessment category to indicate the rel ative likelihood of a normal, benign, or malignant diagnosis so that routin e screening, short interval follow-up, or biopsy can then be advised. Appro priate categorization will maximize early cancer detection and minimize fal se-positive biopsies. Application of a new imaging method to this type of d iagnostic evaluation requires well-designed studies to determine its effect iveness for this purpose. Copyright (C) 1999 by W.B. Saunders Company.