ultrasound wand

Part 2 – Breast Ultrasound 

Why Do I Need a Breast Ultrasound?

Heather was just notified that in addition to her mammogram, it was also recommended that she have a breast ultrasound because her breast tissue was dense. She was confused. Why do I need that, she wondered? Is there something wrong and why didn’t they just do the ultrasound in the first place?

These are all good questions and they come up with patients, friends, and women I talk to all the time.

Why Does Dense Breast Tissue Matter?

As it turns out the tissue inside our breast can range from being very fatty with little density to being very dense with minimal fat. If you examine your breasts, there’s no difference in how they feel if they’re more dense, but on a mammogram, the way the breast tissue looks will be different. 

Fatty tissue makes it much easier to spot the tell-tale signs of cancer that shows up white. When the breast tissue is dense, it all looks white, so when using a mammogram trying to find breast cancer in dense breast tissue, is like looking for a snowflake in a snowstorm.

The best way to explain this is to show you how different the mammographic images look.

Here is a mammographic image of breast tissue that is fattier:

Mammogram

You can see above that there is a lot of white tissue here, and still, you need to be a trained radiologist to spot areas of concern. In this next image, you can see how everything is white, and how difficult it would be to see an area of concern that would also be showing up white.

Now here is one that is denser:

X-ray mammography cancer checking mamary tumor real scan

Dense Breast Tissue Increases the Risk of Breast Cancer

Not only is it more difficult to spot breast cancer in dense breast tissue with mammography, but women with dense breast tissue are also at an increased risk of developing breast cancer. 

Thanks to the tireless advocacy of Dr. Nancy Capello, who founded AreYouDense.org and pushed for national legislation to ensure that women would be notified when their breast tissue was dense and they would need an ultrasound. By the way, I was friends with Nancy, we were in a documentary together, and helped work on the legislation that mandated that women be notified of their breast density here in California. 

Sadly, Nancy passed away because her breast cancer was detected at an advanced stage, but while she was healthy, she traveled across the country and made sure that other women would have access to life-saving breast cancer detection, which is now the standard in all 50 states! We are all indebted to Nancy, who changed the way we care for women.

What About 3D Automated Breast Ultrasound (ABUS)?

For Heather and other women, like me, with dense breasts, the next step is to look at the breast tissue with an ultrasound, which is very good for detecting invasive cancers that can be hidden in a cloudy mammogram. 

The guidelines are that first, a woman needs the mammogram to determine if there’s increased density, and then she can have an ultrasound. What I order is this:

• Screening mammogram

• Automated Breast Ultrasound (ABUS) if indicated 

This means that my patients can schedule everything on the same day, or if it’s their first mammogram, we will already have the order in for the ultrasound. This saves time and reduces worry.

What is ABUS like?

With an Automated Breast Ultrasound, you lie down and have a lot of ultrasound gel (hopefully it’s warmed) placed all over one breast. Then a specially trained technician places a large notebook-sized ultrasound scanner over the breast.

This video shows the procedure.

There are those who argue that this painless, radiation-free screening should be readily available to all women. It works like an echocardiogram for the heart or a sonogram for a baby. It is relatively inexpensive but does require skilled technicians to run the test. And minimal breast squishing! 

This type of screening does find more cancers but also leads to more detection of benign growths that end up being biopsied. Many women would find this trade-off a good one – life-saving early detection along with increased biopsy. Each woman should make the choice, and many health professionals agree that this screening should at least be available to all women with dense breast tissue. I have this done every year and it gives me more peace of mind.

Targeted Breast Ultrasound

Often patients will need what’s known as a targeted breast ultrasound if there’s any areas of concern in the ABUS or if a woman has a lump that can be felt. In this case, the radiologist will use a hand-held ultrasound to look more closely at any areas of concern. This provides a more detailed look and can be magnified. In addition, a woman’s position can be changed to get a better view.

Sometimes a woman will have a sudden onset of breast pain and I’ll use the ultrasound in my office to look for a fluid-filled cyst. These are easy to spot, can be recurrent, and often occur prior to a period and then get reabsorbed and go away. Doing a quick ultrasound in the office can help ease a woman’s mind as we monitor her symptoms. Of course, if there’s any cause for concern, I send my patients to have more breast imaging and see breast specialists for follow-up. 

Because of my family history of breast cancer, my multiple breast biopsies and dense breast tissue, I’ve had all of these procedures, and am happy to share my experience with you.  As I read this over, one thing is very apparent. Women’s health is complicated! We deserve specialized care from providers who are staying up to date with the latest research and recommendations to provide personalized care that is tailored to a woman’s own unique experience. 

Disclosure: I am not working with any of the companies mentioned in this blog. 

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