DR. WALKER

Breast Ultrasound Benefits

About 20% to 30% of women with breast cancer have tumors may be missed by routine mammography. This number may rise closer to 30% for women with dense breasts, which affects thirds of premenopausal and one-quarter of postmenopausal women. Patients with dense breasts affect 25 million U.S. women of breast cancer screening age (between the ages of 40 and 74). Breast ultrasound is a diagnostic imaging technique that uses high-frequency sound waves to create images of the breast tissue. It is often used as an additional tool in breast cancer screening and diagnosis, particularly when a mammogram shows abnormalities or when a patient has lumps or other breast changes that need further evaluation. Some of the benefits of breast ultrasound however is that it is painless, does not involve radiation, implant safe and generally no prescription required. Ultrasound provides real-time images, allowing healthcare providers to observe blood flow and movement within the breast tissue.

Advantages of ultrasound:

 Non-invasive: Ultrasound is a non-invasive procedure that does not require any incisions or injections, making it safer and more comfortable for patients.

 No ionizing radiation: Unlike mammograms, x-rays and CT scans, ultrasound uses sound waves instead of ionizing radiation, making it a safer option, especially for pregnant women and pediatric patients.

 Real-time imaging: Ultrasound provides real-time images, allowing healthcare providers to observe moving structures, such as blood flow or organ function, which can be critical in certain diagnostic scenarios.

 Cost-effective: Ultrasound is generally less expensive than other imaging modalities like MRI or CT scans, making it a more accessible option for many patients and healthcare facilities.

 Portable: Many ultrasound machines are portable, allowing for bedside imaging in emergency situations or in locations where access to traditional imaging facilities may be limited.

 Versatile applications: Ultrasound can be used to evaluate various conditions in many parts of the body including the breasts.

 High-resolution images: Modern ultrasound technology provides high-resolution images that can help in accurate diagnosis and treatment planning.

 Patient-friendly: The procedure is usually quick and does not require extensive preparation, making it convenient for patients.

 Monitoring and follow-up: Ultrasound is often used for monitoring ongoing conditions, and for evaluating the size of masses over time. One report suggested that some patients, especially premenopausal patients, may receive as much as 1 rad exposure [per mammogram] increasing breast cancer risk by about 1% per year for women receiving annual screening mammograms. Theoretically, a patient could receive a cumulative 10% increased breast cancer risk over a decade of screening.

Key concerns about mammography:

• Radiation Exposure: Radiation used in a mammogram is ionizing radiation. Repeated exposure over time may pose a risk, particularly for women with a higher number of screenings.

• False Positives: Mammograms can sometimes yield false-positive results, indicating that a woman may have breast cancer when she does not. This can lead to unnecessary stress, additional imaging studies, and biopsies, which can be invasive and anxiety-inducing.

• False Negatives: Conversely, mammograms can also produce false-negative results, where breast cancer is present but not detected. This is more likely in women with dense breast tissue, where tumors may be obscured.

• Discomfort or Pain: The process of having a mammogram can be uncomfortable or painful for some women, as the breast is compressed between two plates to obtain clear images. In some instance the amount of force used during mammography may exceed 20 pounds.

• Limited Effectiveness in Dense Breasts: Women with dense breast tissue may benefit less from mammography, as dense tissue can obscure tumors, leading to decreased sensitivity of the test.

• Overdiagnosis: Mammograms may detect cancers that would not have caused symptoms or harm during a woman’s lifetime (overdiagnosis). This can lead to overtreatment, including unnecessary surgeries or therapies.

• Cost and Accessibility: Mammograms can be costly, and not all insurance plans cover them fully. Additionally, access to screening facilities may be limited in certain areas, particularly in rural regions.

• Psychological Impact: The experience of undergoing a mammogram, especially if followed by further testing due to abnormal results, can cause significant anxiety and emotional distress for some women.

• Age Considerations: There is ongoing debate about the optimal age to begin screening and how frequently to screen, which can lead to confusion and uncertainty among women regarding their individual screening needs.

Limitations of breast ultrasound:

• Limited Visualization: Ultrasound is less effective at detecting microcalcifications (tiny deposits of calcium in the breast tissue), which can be an early sign of breast cancer. Mammography is generally better for identifying these calcifications.

• Difficulty with Dense Tissue: Although breast ultrasound can be helpful for women with dense breast tissue, it may not always provide a clear picture of the breast structure. In some cases, dense tissue can obscure lesions, making it harder to diagnose problems accurately.

• False Positives: Similar to mammography, breast ultrasound can yield false-positive results, leading to unnecessary anxiety, follow-up tests, or biopsies.

• False Negatives: Breast ultrasound can also produce false-negative results, meaning that it may not detect a tumor that is present, especially if the tumor is small or located in a challenging area.

• Cost and Availability: While generally less expensive than other imaging modalities, breast ultrasound may still not be as widely available as mammography, particularly in some rural or underserved areas.

• Not Suitable for All Cases: Breast ultrasound is most effective for certain situations, such as evaluating palpable lumps or cysts. Not as effective in the evaluation of micro-calcification which could indicated certain types of breast cancers.

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