The “Coming of Age” of Nonmammographic Screening for Breast Cancer

The study by Berg and colleagues1 published in this issue of JAMA addresses important clinical questions: What is the additional cancer diagnosis yield of screening ultrasound in women at increased risk of breast cancer, and what are the "costs " of such strategies in terms of false-positive diagnoses. The design of this American College of Radiology Imaging Network (ACRIN) trial, from the multi-institutional setting to source documentation and independent data analysis, is excellent from every aspect. This study and several other previously published trials2-4 demonstrate how important it is to have institutions like ACRIN sponsor and help organize prospective clinical trials that follow good clinical practice in the world of diagnostic imaging, which, unlike clinical research in the therapeutic sector, has to proceed without the financial support and scientific infrastructure usually provided by the pharmaceutical and medical device industries. The results of this study are impressive. Ultrasound was associated with a 55% increase in diagnosing breast cancer compared with mammography alone: a 7.6 per 1000 to 11.8 per 1000. The sensitivity with which breast cancer was detected was