Should tailored screening with hand-held ultrasound based on high mammographic breast density, in addition to mammography, vs. mammography alone be used for early detection of breast cancer in asymptomatic women?
For asymptomatic women, with high mammographic breast density and a negative mammography, in the context of an organised screening programme, the ECIBC's Guidelines Development Group (GDG) suggests not implementing tailored screening with hand-held ultrasound (HHUS) over mammography screening alone, where such is not already the practice.
Conditional recommendation against the intervention
Low certainty of the evidence
Considerations for implementation and policy making
If resources and implementation are not a concern, or where HHUS has already been implemented, countries may decide to keep HHUS-based screening programmes.
The GDG felt that information and education for women about mammographic breast density is critical. The opinion of women regarding HHUS depends on the quality of the information provided to them with regards to the evidence behind this modality for tailored screening, including the information concerning the limitations or uncertainty about the effects of HHUS and inter-operator variability.
The GDG expressed concern about the quality assurance for HHUS in contexts where training is variable and screening is opportunistic and not organised. No new technology would likely be necessary in most settings, although some institutions may not have the ultrasound equipment which fulfils the requirements for performing breast ultrasound.
There are additional training requirements for radiologists performing HHUS.
Pressure to implement HHUS exists, which may have to be considered with regards to the conditional recommendation against based on the evidence reviewed by the GDG.
Monitoring and evaluation
Quality assurance of HHUS appears challenging to conduct or implement. In settings where they decide to implement HHUS, the GDG recommends consideration be given to quality assurance of HHUS.