Is mammography enough?

Nearly half of all women need additional screening to look for breast cancer

Mammography is heralded as the end all be all when it comes to breast cancer detection. It’s become so effective over the years that many experts have eased recommendations on breast self-exams, because regular mammography can detect cancers before they’re big enough to feel. But it’s not a perfect screening, and for the 40 percent of women who have dense breasts, it’s not enough.

Breasts consist of fatty, fibrous, and glandular tissue. Women with dense breasts have more fibrous and glandular tissue than fatty tissue. That dense tissue is more difficult to distinguish from abnormalities on mammography.

“On a mammogram, dense tissue, solid masses, and cysts all show up as bright white,” says Natalie Simmons, MD, a radiologist with Chesapeake Regional Medical Center who specializes in breast imaging.

If a radiologist is unable to distinguish breast tissue from solid masses, breast cancer can be missed. And it happens more frequently than one might imagine. That’s why women with dense breasts should be adding whole breast ultrasound to their screening regimens.

What Is It?
Whole breast ultrasound uses the same technology — sound waves — like ultrasounds for pregnancy use, and there’s no radiation involved. The screening can differentiate between dense breast tissue and abnormalities better than mammography, and should be used in conjunction with mammography in women with dense breasts.

One study, published in European Radiology, found that whole breast ultrasound, when used as a complement to mammography, doubled the number of cancers detected in women with dense breasts as compared with mammography alone. Another study, published in the Journal of Clinical Oncology, found whole breast ultrasound to outperform even 3-D mammography at detecting cancers. But that’s not to say whole breast ultrasound is a replacement for the standard screening mammogram. Mammography can pick up abnormalities, such as calcifications, that ultrasound can’t.

“The mammogram remains the gold standard when it comes to detecting breast cancer,” Simmons says. “Ideally, women with dense breasts should have both screenings yearly, either performed at the same time or six months apart.”

How It Works
The Sofia whole breast ultrasound requires no external compression devices, so it’s more comfortable than mammography or other whole breast ultrasound systems. It can be done manually using a handheld probe, or it can be done with an automated system like the one at Chesapeake Regional Medical Center.

“With our Sofia system, the woman lies on her stomach on a soft, spa-like table. An ultrasound technologist is in the room with the patient to help guide her, but it’s a pretty discrete process because you’re not exposed,” Simmons says. “The device then rotates around the breast in a circle. The whole acquisition time is only about a minute after positioning.”

Detecting Dense Breasts
Not only do women with dense breasts have a higher risk of breast cancer not being detected by mammography alone, but they also have an increased risk of developing breast cancer in the first place.

So how can women tell if they have dense breasts? They can’t themselves. Radiologists determine breast density upon reading the mammogram. In many states, including Virginia, women must be notified if they have dense breasts after going in for a mammogram. Simmons encourages women to ask their breast density. Breast density does not necessarily correlate with breast size and can change with age as well as weight loss or gain.

“You wouldn’t know without the imaging,” she says. “If you have dense breasts, then you can work with your doctor to get the screening you need. And if you don’t have dense breasts, then you can feel that much more confidant in your mammography results.”


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