MMG is a recommended imaging modality for detection of BC in general population,
although with a sensitivity that progressively and greatly decreases in a proportional way according to the increment of breast density [10] with low performance for young women where the added value of MMG is very low [12].
In women aged 30-39 years who manifest clinical symptoms,
breast US should be the primary imaging approach,
while MMG represents the first modality in the older group [12].
In high risk population MMG alone is not so effective.
It is necessary to associate MMG to supplemental screening techniques as US and MR in particular in young women [2,10,12,18].
The benefit from adding US to MMG is validated and leads to an increase of sensitivity compared to either modality alone,
but its specificity remains low because it comes with a high risk of false positives rate [10,18].
As regards our experience conducted on a selected group of women at high or genetic risk,
our outcomes are the consequence of an analysis expressed in terms of Relative Incremental Cancer Detection (RICD) of US-breast screening for identification BC according to different ages of distribution.
Our intensified clinical-US screening led to the identification of a high percentage of BC in a more favorable stage and low proliferative index.
The biggest advantage in term of “Early diagnosis”,
is obtained in young women (<50 years) where US alone or associated to negative mammograms identified BC for almost half of the total group (60%),
of which 62,5% in dense breast cohort (ACR D3-D4).
Encouraging results we have obtained for the asymptomatic cases,
the majority of them with negative mammograms,
very small radiological size (≤1cm:93%) and histological dimensions pT (pTis,pT1a,pT1b:87%),
but more frequently infiltrating histotypes (93%) and with low proliferative index (71%) (Fig.
9-10-11-12-13-14).
For this group without clinical signs,
US alone,
or in addiction to negative mammograms,
has increased the detection of BC,
showing a higher contribution in subjects aged <50 years (BC:67%; RICD:24%) (Fig.
8).
In conclusion the diagnostic contribution of US screening in the present study is not been negligible.
This procedure involves significant additional costs,
in economic terms,
that may be acceptable in this women at increased risk,
because reduces the incidence of IBC (only 11% in our experience) anticipating the diagnosis of BC with a higher contribution in women younger than 50 years and with negative MMG.