Optimising screening intervals and BI-RADS management pathways in ultrasound-based breast cancer screening: real-world evidence from Shenzhen (2018-2023).

Authors

Wanyi Sun, Huan Li, Xuelian Zhao, Shangying Hu, Haifeng Qi, Shuyan Jin, Wenxia Zhang, Fanghui Zhao

Published in

Breast cancer research and treatment. Volume 218. Issue 3. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

To identify screening intervals and BI-RADS-specific management pathways that balance cancer detection yield against recall burden in ultrasound-based breast cancer screening in China.
We analysed 1,694,838 ultrasound examinations reported with BI-RADS (2018-2023). For BI-RADS 1/2, inter-screen intervals were evaluated by recall rate, cancer detection rate (CDR), positive predictive value (PPV), and early-stage proportion. For BI-RADS 0/3/4/5, we assessed associations between biopsy waiting time and PPV/early-stage proportion, and examined imaging follow-up outcomes for BI-RADS 4A.
Among 337,497 screening intervals following BI-RADS 1/2, longer intervals were associated with higher CDR (0.13-0.54 per 1,000) but higher recall (17.4%-22.1%) and lower PPV (61.1%-31.0%), while early-stage proportion remained stable. The interval that best balanced yield and downstream burden was 13-24 months for women aged ≥ 40 years and 25-36 months for women aged < 40 years, achieving higher detection yield and PPV without a material increase in recall. Among 1,949 BI-RADS 4/5 biopsies, PPV was low for 4A (12.3%-25.0%), declined markedly with biopsy delay for 4B (60.5% to 25.0%), and remained consistently high for 4C/5 (> 60%/>93%). Among BI-RADS 4A lesions 64.7% (10,909/16,871) showed imaging downgrading during follow-up. In 487 BI-RADS 3 cases undergoing biopsy, delayed biopsy increased PPV without changing early-stage proportion.
A 2-year screening interval is recommended for women aged 40-64 years, extendable to 3 years for those aged < 40. Prompt biopsy is warranted for BI-RADS 4B/4C/5. The high image downgrade rate of BI-RADS 4A suggests overestimation and supports imaging-based triage, requiring further validation. Imaging surveillance is preferable for BI-RADS 3 lesions.

PMID:
42560548
Bibliographic data and abstract were imported from PubMed on 06 Aug 2026.

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