Screening for breast cancer with sonography.

C a c It has been well established that early detection of breast cancer through screening and the resulting treatment improve outcomes in breast cancer, which is the most common malignancy worldwide among women.1 Mammography is till the modality of choice for screening women for the early etection of breast cancer, because it is relatively fast, reasonbly accurate, widely available, reproducible, and cost-effecive in quality-adjusted years of life saved.2 Currently, the nly screening test that has been shown to reduce deaths aused by breast cancer is mammography.3 The decrease in mortality rates is almost entirely attributable to a decrease in the size of the cancers detected on screening mammography.4 The sensitivity of mammography in the diagnosis of breast cancer is variable and inversely proportional to the breast density.5,6 Mammographic sensitivity may be as low as 30%48% in patients with dense breasts, with much higher interval cancer rates noted in dense breasts.6 Furthermore, mammographically dense breast tissue is now considered a significant risk factor for the development of breast cancer.6-11 Kerlikowske et al12 reported results of 27,281 screening ammograms and found the sensitivity to be 98.4% in omen age 50 years or older with fatty breasts and 83.7% in omen with dense breasts (P 0.01). In women 50 years f age with a family history of breast cancer, mammographic ensitivity decreased to 68.8%. In women with dense breasts, nd particularly in women with a high lifetime risk for breast ancer, methods to supplement mammographic screening re needed. Digital mammography has been shown to be more sensiive than screen-film mammography in women with dense arenchyma and the overlapping groups of premenopausal omen and those under the age of 50 years.13 However, igital mammography does not eliminate the fact that small,