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However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone.<\/jats:p><\/jats:sec>Methods<\/jats:title>A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014\u20132020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5\u2010year breast cancer risk \u22652.5% or extremely dense breasts and BCSC 5\u2010year breast cancer risk \u22651.67%. Intermediate\/high advanced cancer risk was defined as BCSC 6\u2010year advanced breast cancer risk \u22650.38%.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p<\/jats:italic>\u00a0<\u00a0.0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio,\u00a01.35; 95% CI, 1.30\u20131.39); intermediate\/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio,\u00a00.91; 95% CI, 0.89\u20130.94).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34768","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T03:03:13Z","timestamp":1686538993000},"page":"2456-2468","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Breast cancer risk characteristics of women undergoing whole\u2010breast ultrasound screening versus mammography alone"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7948-8317","authenticated-orcid":false,"given":"Brian L.","family":"Sprague","sequence":"first","affiliation":[{"name":"Office of Health Promotion Research Department of Surgery University of Vermont Larner College of Medicine Burlington Vermont USA"},{"name":"Department of Radiology University of Vermont Larner College of Medicine Burlington 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