Ultrasound for Breast Cancer Screening in Resource-Limited Settings: Current Practice and Future Directions

SIMPLE SUMMARY: Breast cancer (BC) screening is significantly important for reducing disease mortality. Mammography (MAM) is the gold standard for BC screening in high-income countries, while it is usually unavailable and infeasible in low- and middle-income countries (LMICs). Ultrasound (US) has been widely employed as an adjunct to MAM, particularly showing advantages over MAM for women of younger ages and with dense breasts. Nevertheless, it remains controversial whether US could be utilized as a primary tool for BC screening in underserved settings. This review focuses on randomized controlled trials and observational studies that demonstrated the role of US in BC screening. Furthermore, advanced techniques that might be useful to improve BC screening in LMICs are discussed. The results suggest that US, showing high sensitivity and an early detection rate, holds promise to achieve cost-effective screening initiatives where MAM is not available. The resource-appropriate recommendations on implementing BC screening in LMICs are also presented. ABSTRACT: Breast cancer (BC) is the most prevalent cancer among women globally. Cancer screening can reduce mortality and improve women’s health. In developed countries, mammography (MAM) has been primarily utilized for population-based BC screening for several decades. However, it is usually unavailable in low-resource settings due to the lack of equipment, personnel, and time necessary to conduct and interpret the examinations. Ultrasound (US) with high detection sensitivity for women of younger ages and with dense breasts has become a supplement to MAM for breast examination. Some guidelines suggest using US as the primary screening tool in certain settings where MAM is unavailable and infeasible, but global recommendations have not yet reached a unanimous consensus. With the development of smart devices and artificial intelligence (AI) in medical imaging, clinical applications and preclinical studies have shown the potential of US combined with AI in BC screening. Nevertheless, there are few comprehensive reviews focused on the role of US in screening BC in underserved conditions, especially in technological, economical, and global perspectives. This work presents the benefits, limitations, advances, and future directions of BC screening with technology-assisted and resource-appropriate strategies, which may be helpful to implement screening initiatives in resource-limited countries.