Early identification of Breast Cancer (BC) through mammography screening programs of general population is amply demonstrated in several studies conducted over the past years,
that report a reduction in mortality of about 22% for women aged 50-69 years old [1,5].
Actually Mammography (MMG),
although not perfect,
can be considered the main screening test in order to detected early BC with a sensitivity of 75%-85% calculated in general population [2],
up to 80%-98% in women with fat breast tissue (ACR D1-D2) [3].
Less promising results have achieved for study of dense (estimated as 51%-75% glandular; ACR D3) or extremely dense (as >75% glandular; ACR D4) breast parenchyma,
frequent present in more than one half of women younger than 50 years [4,5] with a sensitivity as low as 30% to 50% [2].
High breast density (ACR D3-D4) represents a great limit for mammography performance; its sensitivity is inversely proportional to breast tissue density and leads to a higher probability of occurrence of Interval Breast Cancer (IBC) detected during a screening program [5,6,7,8].
Ultrasound (US),
as a MMG support,
represents a useful and often indispensable diagnostic tool for detection of invasive BC if compared to MMG alone in young women and with dense breast [5,9].
Still now no medical organization recommends US as an additional screening on the base of breast density,
but is true that The American College of Radiology and the Society of Breast Imaging recommend adding US approach to MMG only in a very subgroup of people with a strong hereditary risk (>20% lifetime risk) and/or with contraindications to Magnetic Resonance (MR) [6,10,11].
Lehman et al.
study involving symptomatic women between 30 and 39 years with focal,
clinical breast signs and risk of malignancy,
suggests that US has high sensitivity (95,7%) and high negative predictive value (99,9%) in this setting,
considered the first imaging technique of choice; MMG adds low value,
but in addition to US approach can be reserved for particular high risk cases,
including those with BRCA mutation carriers [12].
The first confirmation about the ability of US in BC screening dates back to 1980.
Thanks to technological and physical advances in US,
in 1995 Gordon and Goldemberg publish the results of their report about the ability of this imaging modality for identification of mammographically occult,
solid tumors,
in particular in asymptomatic patients [1].
Since then,
other authors analyzed the accuracy of US in women with dense breasts showing its ability to detect hidden cancers to mammography,
with a detection rate variable from 0,3% to 0,4%,
the majority of which in early stage [9].
It is well known that high breast x-ray density is an important risk factor for general population,
but still more representative for hereditary-family risk group of patients [5].
For women with BRCA mutation carriers,
the National Comprehensive Cancer Network (NCCN) has issued recommendations for BC surveillance,
including monthly breast self-examination,
semi-annual clinical breast examination,
annual mammogram,
and annual breast MR [13].
At the Center of Breast and Ovarian Familiar Tumors,
a dedicated Center at the Department of Oncology and Hematology located in Modena,
is employed an activity of multimodal breast diagnosis since 1994,
for BC prevention and early diagnosis for women at increased,
familiar risk.
According to Modena criteria [17],
women are incorporated into a surveillance program based on their customized risk profile.
The purpose of this study was to evaluate the contribution of US screening in detecting BC in women at increased,
familiar risk,
particularly when clinical examination and mammograms were negative.