Mammograms have been the go-to test for breast cancer screening for decades. They were first recommended by the American Cancer Society in 1976. Millions of women receive an annual mammogram to check for breast cancer. But there are two types of breast tissue, fatty tissue and dense breast tissue, and mammograms work best at detecting breast cancer in fatty tissue.
Fatty tissue appears black on a mammogram and cancer appears white. So it is fairly easy for a radiologist to spot cancer in fatty breast tissue. Dense breast tissue, however, is much thicker than fatty breast tissue and appears white on a mammogram just like cancer does. As a result, breast cancers can be missed in women with dense breast tissue who rely on mammograms alone for cancer screening.
According to the Susan G. Komen Foundation, 40-50% of U.S. women ages 40-74 have dense breast tissue, and these women are four to five times more likely to get breast cancer than women with mostly fatty breast tissue. So what should women with dense breast tissue do? Should they continue receiving an annual mammogram? Or should they opt for a breast ultrasound instead?
One option for women with dense breast tissue is to get a breast ultrasound, also called a breast sonogram, in addition to their annual mammogram. Breast cancer appears black on a breast ultrasound result as opposed to white on a mammogram result. This makes a breast ultrasound a little more reliable when it comes to finding breast cancer in dense breast tissue.
A traditional handheld ultrasound (HHUS) of the breast works in the same way as an ultrasound of other parts of the body. It uses sound waves to create an internal image of the breast. An ultrasound technician gently glides a wand over the breast to get images. HHUS of the breast is noninvasive, unlike a breast biopsy which requires puncturing the breast tissue to get a sample of any suspicious lumps or tissue. Unlike mammograms, breast ultrasound is usually painless with little to no discomfort for the patient. Breast ultrasounds also do not use any radiation, making it a safer option for women who are pregnant or trying to become pregnant.
Ultrasounds are also a safer and less painful choice for women with breast implants. According to the American Cancer Society, women who have breast implants should still get an annual mammogram. But women with breast implants need to receive additional x-rays with their mammograms, called implant displacement, in which their implants are pushed back against their chest to get a better look at the breast tissue. This comes with some added risks such as additional pain, especially if the woman has a lot of scar tissue, and possible rupture of the implants. Breast ultrasound, on the other hand, does not require any squeezing or pressing of the breasts and is usually pain free.
Automated Whole Breast Ultrasound (AWBUS)
Breast ultrasounds, like mammograms, are not foolproof, especially when it comes to dense breast tissue. A step above HHUS is the SonoCine Automated Whole Breast Ultrasound (AWBUS). AWBUS works similarly to HHUS of the breast but the imaging captured through AWBUS goes beyond the bra area alone. AWBUS captures images of the entire breast, including under the arm/lymph nodes, above the breasts, between the breasts, and the sides of the breasts.
The AWBUS captures thousands of pictures of the breast that are then played back like a movie for the radiologist to review. It can be used on all types of breasts including dense breast tissue and breast implants. Like HHUS, AWBUS is painless and it usually takes about 30 minutes to complete your visit.
The AWBUS was approved by the FDA in 2012 to be used for breast cancer screening in addition to mammography, but not to replace an annual mammogram. The inventor of the AWBUS is board-certified diagnostic radiologist Dr. Kevin Kelly of the Breast Ultrasound Center in Pasadena, California. Dr. Kelly highlights the following advantages of the AWBUS over HHUS:
- Slow scanning speed
- Fast review of images to help the physician see disruptions
- Small images
- No other visual distractions
- No multitasking such as handheld scanning
- Automated procedure leaving no missed areas
Realizing that dense breasts require a different approach to breast cancer screening, Dr. Kelly invented the SonoCine AWBUS in 1999. Dr. Kelly is an advocate of breast health education and wants women to understand their breast type, risk factors, and options when it comes to breast cancer screening and diagnostics. He has given a Tedx Talk in which he highlighted the dangers of inadequate breast cancer screenings and the importance of making ultrasound procedures like AWBUS the standard in care.
Breast Ultrasound vs. Mammogram
According to Dr. Kelly, approximately 50% of American women have dense breast tissue, and 70% of all breast cancers occur in dense breasts. Dr. Kelly has stated that one of the biggest misconceptions currently surrounding breast cancer screenings is that mammograms are believed to be fully able to find cancer whenever it’s in the breast, but this is not necessarily true. Dr. Kelly has stated that 50% of cancers in dense breasts are felt before they’re seen on a mammogram. According to Dr. Kelly, mammograms work well, but unfortunately, they don’t work often.
Another common misconception about mammograms that Dr. Kelly has observed is the belief that mammograms usually find cancers when they’re small. But Dr. Kelly has stated that this is not true. The average size of breast cancer when it is detected by mammogram is 17 mm. The ideal size for treatment of cancer is between 5-10 mm. While mammograms often find cancer once it’s past the ideal treatment stage, the AWBUS can find 5 mm invasive breast cancer. The AWBUS is far more accurate in detecting breast cancer in women with dense breast tissue and implants, and in clinical trials was 300% more accurate than mammograms at detecting small invasive breast cancers. The earlier cancer is discovered, the more likely that it can be monitored and treated, eliminating extreme and traumatic treatments like chemotherapy and mastectomies and saving tens of thousands of lives in the U.S. every year.
How Much Does a Breast Ultrasound Cost?
Breast ultrasound may be covered by insurance, but it is always a good idea to verify before scheduling an appointment just in case. The out-of-pocket cost of a breast ultrasound is typically between $150-500 depending upon where the test is performed and other factors such as whether it is both breasts for a general screening or one breast for an area of concern.
As with traditional breast ultrasound, it’s a good idea to verify whether insurance will cover an AWBUS before booking an appointment. If paying out of pocket, the cost of getting an AWBUS is generally between $160-400. Unfortunately, AWBUS is not widely available yet like traditional breast ultrasounds are. The SonoCine location finder allows searching for a local AWBUS facility. If no local options are found, it’s a good idea to bring the AWBUS up with a local OB-GYN to help spread awareness and availability of this new screening technology.
While no test has been proven or approved to fully substitute a mammogram, it is important for women to know their risk factors and what other breast cancer screenings are available in addition to a mammogram. Breast ultrasound and Automated Whole Breast Ultrasound are two options that may be particularly helpful for women with dense breast tissue or implants. They are radiation free and pain free and may be used in conjunction with an annual mammogram to detect cancer in its early stages.