Why mammogram and not ultrasound?

[nevergiveup]

Since mammograms are notorious for missing cancer in dense breast tissue, why do doctors still insist we dense tissue ladies still have mammograms and not just skip them in favor of ultrasounds?  I am truly puzzled.

[Mrs Mungo]

Mammograms are good at showing changes in breast tissue over time. Young women (with dense tissue) in high risk categories are usually given MRIs in addition to mammograms. The trouble with MRIs is that they are TOO sensitive. With ultrasound, they generally want to be looking for something specific. So, when my last mammogram/MRI showed some spots that looked different (which is what they are usually looking for-changes over time), they did an ultrasound to check those spots. They decided that some of them were lymph nodes. There was one they thought was a fibroid and one that might have been a lymph node but it didn't look totally normal, so they did biopsies on those two areas. It came back as they expected-one as a lymph node and one as a fibroid. 

 

They don't do breast MRIs for everyone because they are much more time consuming and difficult than mammograms. I only had one tech for my mammogram. There were 4 or 5 people helping with the breast MRI. The ultrasound was done by an actual radiologist, not a tech, which is what makes it more expensive. 

[Laurie4b]

It would be hard to u/s a whole breast. u/s seems to be used to look more closely at an area that is suspicious. It would also likely be very expensive. A technician has to be there the whole time and go over every centimeter. That would be a lengthy procedure unless one's breasts were very small.

 

An MRI is a better alternative if a doctor thinks a mammogram is not a good option for a particular woman.

[nevergiveup]

Thanks, ladies, that helps some.  I do have small breasts so just doing an ultrasound might be a good option for me:

I had an initial mammogram last year.  Small, very dense breasts.  The images looked like snow--solid white.  They couldn't see anything, so did another mammogram.  Still could not tell so did an ultrasound after that.  I had to have a cyst biopsied and the doctor, who had been practicing for years and years could barely get the needle in.  Finally, on the third try, he was able to get the biopsy.  So, since the mammograms seemed useless for me, I wondered why they kept telling me they are still necessary....No one ever mentioned getting an MRI instead.

[Mrs Mungo]

Thanks, ladies, that helps some.  I do have small breasts so just doing an ultrasound might be a good option for me:

I had an initial mammogram last year.  Small, very dense breasts.  The images looked like snow--solid white.  They couldn't see anything, so did another mammogram.  Still could not tell so did an ultrasound after that.  I had to have a cyst biopsied and the doctor, who had been practicing for years and years could barely get the needle in.  Finally, on the third try, he was able to get the biopsy.  So, since the mammograms seemed useless for me, I wondered why they kept telling me they are still necessary....No one ever mentioned getting an MRI instead.

 

Are you in a high risk category? I had an MRI because I have an aunt who was diagnosed with breast cancer at 42 and a sister who was diagnosed at 29. Insurance generally only pays for MRIs for high risk patients. 

[nevergiveup]

Grandma's sister on my dad's side had "something" that we suspected as did my other grandmother's sister (mother's side).  No one ever talked about it to us kids and everyone who would know is dead.  I had a lump they were checking out and I am over 50.  I just thought it odd they did two mammos in the first place and keep telling me to go back for more in the future.

[Joker]

I've only had two mammograms but they've done an ultrasound as well both times. I thought that was normal, but I'm only in my 30s and both times have been because there was something to look at. I have to go back for a repeat as soon as I can afford it and they want to do both again.

[ChiMomNP]

Have you tried the 3D mammogram? That is what I have to have. My insurance will not cover it, but it is much better at seeing through dense breast tissue. It takes 3D slice images of the breasts. You might want to look into who in your area does them. They charge me about $150.00 which is way better then undergoing repeated mammos, u/s and uneeded biopsies. 

 

I have not needed a u/s since I started having the 3D mammos done.

[Slartibartfast]

I had an ultrasound but only because I was breastfeeding. Once my youngest was weaned for about six months they had me do a mammogram instead.

[Lanny]

We knew 2 women whose doctors did not think the problems they found in their breasts required a mammogram examination. Both of their doctors were wrong. Both women had Breast Cancer and their treatment was delayed, because of their doctors not ordering a mammogram exam. My wife's best friend passed away, during November 2012...  Her Cancer spread to other areas of her body...

 

I have a page on our family web site about this. We believe, very strongly, that any woman who finds something in a breast should DEMAND a mammogram examination.

 

I don't think Ultrasound is normally used for this. Women should have a "benchmark" mammogram exam done in their early 40s.

[Mrs Mungo]

We knew 2 women whose doctors did not think the problems they found in their breasts required a mammogram examination. Both of their doctors were wrong. Both women had Breast Cancer and their treatment was delayed, because of their doctors not ordering a mammogram exam. My wife's best friend passed away, during November 2012...  Her Cancer spread to other areas of her body...

 

I have a page on our family web site about this. We believe, very strongly, that any woman who finds something in a breast should DEMAND a mammogram examination.

 

I don't think Ultrasound is normally used for this. Women should have a "benchmark" mammogram exam done in their early 40s.

 

Just a point of clarification-women in high risk categories should begin mammograms well before then.

 

And to put it another way-It is true that looking for lumps on mammograms in young women are like trying to see a snowball in a snowstorm. BUT, they CAN be used to show changes in the breast over time-it is the comparison that is useful. 

[Melissa in Australia]

I am going to be having both a mammogram and an ultrasound next Monday. I have very small breasts.

[Mrs Mungo]

I don't think the size makes a difference. I'm 40. I have fairly big breasts for my size and my tissue is still very dense. It's the density of the breast tissue that creates the issue. But, like I said, the mammograms are still useful for detecting changes.

[nevergiveup]

Thanks, Mrs. Mungo--I think you have answered my question the best:  for dense breast tissue, the mammogram may be useful to detect changes over time.  When I had asked the technician, they said they couldn't see anything due to the image being so white and like a snow storm, but they insisted mammograms were "useful" without saying why.  I don't know if they did a 3D (no one mentioned of what sort was the second mammogram).

Still, considering how my images were so unreadable, I would like to minimize exposure to radiation and just have the ultrasound...I don't guess that is an option.

[Laurie4b]

I don't think the size makes a difference. I'm 40. I have fairly big breasts for my size and my tissue is still very dense. It's the density of the breast tissue that creates the issue. But, like I said, the mammograms are still useful for detecting changes.

 

The reason I mentioned size wasn't regarding density, but for the ultrasound question. Ultrasound isn't used for screening ie scanning for problems because it focuses on a small area. I supposed (theoretically) that with very small breasts, it could be done, but would take forever with larger breasts. Plus, you are paying the radiologist to stand there the whole time. It would be way too expensive as a screening method for most women.

[Laurie4b]

OP, if your breast tissue is dense, you are at higher risk, something like 7x normal risk. Having needed a breast biopsy also places you in a somewhat higher risk category. If you had children later in life, had an early onset period, etc, you could likely build a very good case for an MRI . It is  not unreasonable to ask for an MRI instead in any case. My understanding is that there is no radiation. And perhaps in your case, with very small breasts, they could do u/s as screening.  There is obviously some radiation emitted by mammograms but it's considered worth the risk in light of the benefits in most cases. I  would encourage you to keep asking questions and evaluating what the best screening method is for YOU and your particular breasts.