Ultrasonography
Is ultrasonography an alternative to mammography?
In general, ultrasonography is used to diagnose rather than screen for breast cancer. For example, if a woman has a lump in her breast or a suspicious mammogram, ultrasonography is often used to determine if the problem area is a common fluid-filled cyst or a solid mass of some sort. However, ultrasonography is not considered an adequate substitute for screening by mammography, because it is not as good as mammography in identifying small cancers. However, ultrasonography is often able to identify early-stage invasive cancers in women who have dense breasts when those cancers are too small to be felt as lumps and are hidden, on mammogram, by milk duct tissue.
Who should undergo ultrasonography?
For some women, ultrasonography may be preferable to mammography as a way of screening for breast cancer. For one thing, mammography uses radiation, and ultrasonography does not. What groups of women might consider ultrasonography as an alternative to mammography to screen for breast cancer?
- Young women who have a high risk of breast cancer Women younger than 30 or premenopausal women with a family history of breast cancer are (or may be) more susceptible to damage from the radiation that occurs with mammography. A premenopausal woman who chooses routine breast screening because of a family risk may want to ask her doctor about the pros and cons of ultrasonography versus mammography.
- Women who have especially dense breasts Mammograms are unable to see through dense breasts and can miss some of the tiny cancers that may be present. The exact proportion is uncertain, but ultrasonography identifies 35% more cancers than mammography. A woman whose previous mammogram report noted "dense breasts" might consider using ultrasonography instead of mammography on every other screening visit. The question is worth discussing with a doctor.
- Women who have small breasts or who find mammograms painful Mammograms do not adequately image the outer boundaries of small breasts. By contrast, ultrasonography does not require compression of the breast from top to bottom and can visualize the entire circumference of smaller breasts. Some women, especially those with fibrocystic conditions, find breast compression extremely painful. A woman who believes that breast screening is a good choice for her but avoids mammograms because of the discomfort, might reasonably choose ultrasound examination for routine screening.
