Why Don’t We Have Annual Ultrasounds Instead of Annual Mammograms?

mammogram machine
Mammogram Machine. Credit: Art © A.D.A.M.

Question: Why Don’t We Have Annual Ultrasounds Instead of Annual Mammograms?

If breast ultrasound is better at detection of abnormalities, why does my doctor still ask me to get an annual (and painful) mammogram?  Why don't doctors ask for an annual ultrasound instead of a mammogram?  Is it because there are so many mammogram machines currently in existence?

Answer.

I too, have felt the pain from a mammogram -- and have benefited from a breast ultrasound.

Many women would like to know why don't we have annual ultrasounds instead of annual mammograms.

Ultrasounds Are Diagnostic, Mammograms Are For Screening

Breast ultrasound is good at distinguishing between a fluid-filled cyst and a solid mass in the breast. Ultrasound cannot image the entire breast at once, so it's used for a diagnostic spot check of areas that a screening mammogram has already revealed as having a suspicious mass or dense area.

Ultrasound can not:

  • Ultrasound cannot take an image of the whole breast at once
  • Ultrasound cannot take an image of areas deep inside the breast
  • Ultrasound cannot make 100% accurate diagnostic images
  • Ultrasound doesn't show microcalcifications -- the most common feature of tissue around a tumor

Neither technology, mammogram or ultrasound, is perfect. And in the case of ultrasound, the skill level of the operator makes a great difference in your results. One technician may miss something, while another technician may find it.

For example, my breast tumor was found by ultrasound following a mammogram. It was a palpable lump that was not very deep in the breast. It did show up on the mammogram, but ultrasound was used to check on it and confirm what it was.

However, when I went in for a lumpectomy, the hospital ultrasound tech could not find my mass.

I had to show him how to position me and how to point the transducer. Then the tech had to go get the chief radiologist, who took over the ultrasound, and found the mass.

Other Breast Imaging Technologies

There is also elastography and digital mammography. Some day, optical mammography without compression may be available. Breast thermography works for some women. For women at high risk, breast MRI is a good choice. The technologies will continue to evolve.

Radiation Concern with Mammograms

The radiation exposure in a mammogram is very small. It is about the same as is used in a dental x-ray, and less than what is needed for a standard chest x-ray. Mammograms are painful but brief; as I found out, they are much less painful than breast surgery. The National Cancer Institute says the benefits of mammography outweigh the potential harm from the radiation exposure. However, be sure to alert your health care provider and the x-ray technician if there is any possibility you are pregnant, as they will want to avoid any radiation exposure to the fetus.

Bottom line: You have the whole breast imaged first, to see where dense areas are located. Ultrasound is used after a mammogram, to further check on the dense masses.

Sources:

Imaginis.com. Breast Cancer Diagnosis. Ultrasound Imaging of the Breasts. Last Updated: July 2007.

How is Breast Cancer Diagnosed? American Cancer Society, Updated 02/22/2016.

Breast Ultrasound, American Cancer Society, Updated 10/20/2015

Mammograms, National Cancer Institute, March 25, 2014.

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