More about whole breast ultrasound and saving breasts.

We are now learning that a breast sonogram (or ultrasound) has potential as a  screening tool.  Traditionally, breast sonograms have been used to further evaluate a palpable mass or mammographic abnormality, but now more women are asking for a sonogram as a screening test in addition to a mammogram and with good reason.  Mammograms do save lives and are the best breast cancer screening test we have, but do not find all breast cancers.


In published studies reviewed by The Society of Breast Imaging (http://www.sbi-online.org/displaycommon.cfm?an=1&subarticlenbr=7) the results for breast sonograms are promising.  In over 42,000 whole breast ultrasounds in addition to mammograms, more cancers were found than by mammograms alone.   Importantly, over 90% of these were in dense breasts.  By definition these are breasts over 50% dense.  The density is categorized as "heterogeneously dense" at 51-75% density or "dense" (>75% dense) and called by some Type 3 or 4.  It is on the mammogram report and now in Texas you will be told about your density as required by Henda's Law.  Thanks to one of our readers, you may find more about "The Negative Mammogram Myth" at http://www.theatlantic.com/health/archive/2012/01/the-negative-mammogram-myth/252020/.


More importantly, those cancers found by ultrasound were small, averaging 10mm and 91% were node negative!  So more treatment options, including lumpectomies and avoiding chemotherapy, were available to these women.


In addition to finding more invasive cancers in dense breast tissue, there were also more found in those with a personal history of breast cancer or a family history of breast cancer.  


Furthermore, the whole breast ultrasound is well tolerated, requires no preparation, has no x-ray risk (because it is safe sound waves), is easily accessible and relatively inexpensive.


In figuring out the risk/benefit ratio, the cons have to be considered as well.  The exam is operator dependent and may produce false positives, which are abnormalities that look like they might be malignant, but eventually prove not to be.  In such a case, there are two options, sonographically guided Fine Needle Aspiration (FNA) (a tiny needle with local anesthesia) or close follow-up.




So, a woman with one of the two denser categories of breast tissue by mammogram, a personal history of breast cancer or a family history of breast cancer should consider whole breast ultrasound as an additional screening test.