RATIONALE: Screening tests such as ultrasound and mammography may help doctors detect cancer cells early and plan more effective treatment for breast cancer. It is not yet known whether ultrasound is more effective than mammography in detecting breast cancer. PURPOSE: This clinical trial is studying breast ultrasound to see how well it works compared to mammography in detecting cancer in women who are at high risk for breast cancer.
OBJECTIVES: Primary * Determine the diagnostic yield of whole breast bilateral screening ultrasound and mammography for the detection of breast cancer in women at high risk for breast cancer. * Determine the cancer detection yield of a single contrast-enhanced magnetic resonance imaging (MRI) examination after 3 rounds of annual screening with ultrasound and mammography in these participants. (MRI component of the study) Secondary * Determine the independent sensitivity and specificity of these screening methods in these participants. * Correlate performance of these screening methods with selected participant characteristics (e.g., breast density and heterogeneity of the parenchyma). * Validate the sonographic classification of lesions as "probably benign" and estimate the rate of malignancy in participants screened with these methods. * Determine the cost effectiveness associated with screening breast ultrasound, in terms of radiologist and resource time performing the exam and the induced cost of screening ultrasound (e.g., follow-up and biopsy). * Determine the reproducibility of lesion identification, measurement of lesion diameters, and volume and recording of lesion location on ultrasound in these participants. * Determine the size, type, grade, and nodal status of cancers seen only on MRI in these participants. (MRI component of the study) * Estimate the rate of benign biopsies and short interval follow-up induced only by MRI in these participants. (MRI component of the study) * Determine the cost effectiveness of MRI, including induced costs of unnecessary biopsies and follow-up. (MRI component of the study) * Compare the agreement among multiple examiners in sonographic, mammographic, and MRI feature analysis (using terms from the BI-RADS® lexicon) and final assessment (e.g., estimated probability of malignancy and/or recommendation for biopsy) in the enriched set of diagnostic training cases with consensus and histopathologic reference standards. OUTLINE: This is a randomized, multicenter study. Participants are randomized to 1 of 2 screening arms. * Arm I: Participants undergo physician-performed bilateral whole breast ultrasound (US) followed by mammogram within 2 weeks. * Arm II: Participants undergo mammogram followed by physician-performed bilateral whole breast US within 2 weeks. In both arms, participants with negative or benign findings are rescreened according to their screening arm at 1 and 2 years. Participants with "probably benign" findings are rescreened at the 6-month follow-up visit. Participants with findings that are suspicious or highly suggestive of malignancy are recommended for biopsy. A subset of participants\* in both arms undergo contrast-enhanced breast MRI within 4 weeks after completion of the 2-year screening US and mammogram. Participants with "probably benign" findings seen only on MRI may undergo an additional breast MRI at the 6-month follow-up visit. Participants with additional suspicious lesions seen only on MRI undergo second-look targeted US for biopsy guidance or MRI-guided vacuum-assisted biopsy after completion of any biopsies or additional views prompted by the 2-year screening US and mammogram visit. NOTE: \*No diagnosis of metastatic cancer of any type since entering this clinical trial. Participants are followed annually for 3 years. PROJECTED ACCRUAL: A total of 2,808 participants will be accrued for this study within 2 years.
Buenos Aires, Argentina