Radiologists who specialize in breast imaging, such as myself, have long been aware of the ability for small invasive cancers to remain diagnostically
occult on mammography, in women with dense breast tissue, and yet be clearly evident on ultrasound.
Two important large studies have recently confirmed our experience. In summary, in high-risk women, the diagnostic yield for breast cancer on
mammography is 7.6 cancers per 1,000 women screened. The diagnostic yield for mammography and ultrasound is 11.8 cancers per 1,000 women screened.
Therefore ultrasound screening in high-risk women with dense breast finds another 4.2 cancers per 1,000 women screened. That is half as many again
as mammography picks up!
Pre-invasive Ductal Carcinoma In Situ is found on mammography by finding calcifications, but the small non-calcified invasive cancers that can be
missed in the dense portion of the breast (more fibroglandular tissue) are more easily seen on ultrasound. In the fatty portion of the breast, however, small
invasive cancers are well seen mammographically.
More than half of women younger than 50 have either heterogeneously dense breast tissue (visually estimated at 51% to 75% glandular) or extremely dense breast
tissue (greater than 95% glandular tissue) as do at least 1/3 of women older than fifty years of age. In young women, the reduced benefit of mammography screening
is attributed to increased breast density, biologically more aggressive breast cancers and reduced prevalence of disease.
Screening with ultrasound, I believe, is a viable alternative to screening young high-risk women with MRI. It is cheaper, quicker and involves no injections.
The false positive rate for ultrasound screening when performed by an experienced radiologist is less than the false positive rate for MRI. A negative mammogram and
ultrasound has a 2% chance of missing a breast cancer. A negative MRI and mammogram has a less than 1 % chance of missing breast cancer in high-risk women.
We are offering screening breast ultrasound for high-risk women with dense breast tissue. Insurance still does not reimburse for screening ultrasound however, and the
cost to the patient is $300.00. We have recently acquired an automated ultrasound SonoCiné device, which allows us to store images of the whole breast for documentation, review and comparison.
I recently mailed you a letter, which included a few brochures of the SonoCiné device, but wanted to follow it up with this email as well. If you have any questions,
comments or concerns about screening ultrasound, please feel free to call my office at 480-314-7600. My e-mail address is
BBW@Breastnet.net.
Radiologists who specialize in breast imaging, such as myself, have long been aware of the ability for small invasive cancers to remain diagnostically
occult on mammography, in women with dense breast tissue, and yet be clearly evident on ultrasound.
