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Breast Imaging

E2838. Recruitment of Intermediate-Risk Women With Dense Breasts to Whole Breast Ultrasound Screening

Chiarolanzio P1,  Watts M2,  Chetlen A.2 1. Penn State College of Medicine, Hershey, PA ; 2. Penn State Health, Milton S. Hershey Medical Center, Hershey, PA

Address correspondence to A. Chetlen (

Objective: Supplemental screening with automated whole breast ultrasound (ABUS) is offered at our institution to women with dense breasts and an intermediate lifetime risk of developing breast cancer. This retrospective study evaluates the effectiveness of current reporting and recruitment practices within the mammogram report and patient lay letter.

Materials and Methods: This HIPAA-compliant, institutional review board–approved study was composed of asymptomatic women ages 35–84 years who presented to our breast clinic for routine screening mammography from April 1, 2016, to April 30, 2017. Five hundred twenty-three women were identified as having heterogeneously dense or extremely dense breasts and a 15–19.9% lifetime risk for breast cancer per the National Cancer Institute Gail model. Radiologists manually inserted a narrative into the official mammogram report and patients received a specific lay letter indicating the availability of ABUS examination for supplemental screening. Mammogram reports were retrospectively assessed for the presence of radiologist-recommended supplemental breast cancer screening with ABUS. Patient characteristics, referral patterns, and success of recruitment efforts were also assessed. Patients excluded from the study included: men, women younger than 35 years old, and women who received a BI-RADS category 0 assessment on screening mammogram.

Results: Of 523 women, 250 (47.8%) received reports that included the recommendation that they consider supplemental screening with ABUS due to their breast density and intermediate risk. Of these 250 women, 144 (57.6%) received a patient lay letter recommending they consider discussing supplemental breast cancer screening, such as ABUS, with the referring physician. The patient lay letter is not an automated selection by the mammography reporting program but rather a specific patient letter that must be manually selected by the interpreting radiologist. Of the 523 women, 63 (12.0%) underwent a screening ABUS examination during the study period. Of the patients who presented for the ABUS examination, only 26 of the 63 (41.3%) had received a patient lay letter. Of the 63 women, 35 (55.6%) were referred for ABUS by the risk assessment breast clinic, 20 (31.7%) were referred from their gynecologist, five (7.9%) from their family medical provider, and three (4.8%) from their internal medicine physician.

Conclusion: Current recruitment practices requiring manual, nonautomatic entry of a narrative into the mammography report and selection of a specific patient lay letter resulted in a relatively low rate (12%) of supplemental ABUS examinations in eligible women. Further research efforts could be directed at improving the process for notifying patients about supplemental breast cancer screening options, notifying and educating referring physicians, and identifying successful community breast health education programs.