We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Supplementary Imaging for Breast Cancer Screening in High-Risk Women—Reply

Wendie A. Berg, MD, PhD; Richard G. Barr, MD, PhD; Zheng Zhang, PhD
JAMA. 2012;308(3):236. doi:10.1001/jama.2012.7549.
Text Size: A A A
Published online


In Reply: As Dr Fujita points out, our study showed that supplemental ultrasound screening increased the cancer detection rate. To achieve this, recall rates increased from 10.2% to 20.3% on average (16.8% with incidence screenings). While a benchmark mammography recall rate of 10% has been suggested, acceptable benchmarks for combined screening with other modalities have not been established.

We agree with Fujita that a better management strategy for sonographically detected BI-RADS 3 lesions, as well as BI-RADS 4a, is needed. In year 1, of 2637 mammogram results, 177 (6.7%) were BI-RADS 3 (including 1 cancer), as were 401 (15.2%) mammography plus ultrasound results (4 malignancies).1 In additional analyses from this study, we found that, in part due to the elevated risk of our participants, nearly 17% of sonographically BI-RADS 3 lesions underwent biopsy and 0.8% proved to be malignant. For sonographically BI-RADS 4a lesions, the biopsy rate was 82.5% with 2.8% proving to be malignant. BI-RADS 3 and BI-RADS 4a ultrasound lesions together accounted for 71.1% of biopsies in our study. Multiple similar benign-appearing masses that should be classified as BI-RADS 2, benign, were frequent among BI-RADS 3 lesions. Adding elastography, a measure of stiffness, can reduce unnecessary biopsy of sonographically BI-RADS 4a masses.2 With any screening strategy, continued monitoring of outcomes and physician education can help reduce unnecessary recall and biopsy.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




July 18, 2012
Tetsuji Fujita, MD
JAMA. 2012;308(3):236. doi:10.1001/jama.2012.7545.
July 18, 2012
Steven A. Narod, MD
JAMA. 2012;308(3):236. doi:10.1001/jama.2012.7547.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.