When is a breast ultrasound exam appropriate?

In most instances, you will know whether or not a breast ultrasound might benefit you upon the completion of your mammogram. If it is determined by the radiologist that you might benefit, the breast ultrasound may be available to you on the same day.

The two procedures - mammography and breast ultrasound - provide clinical information about the health of your breasts, because they each produce different pictures of the tissues in the breast. The X-rays used in a mammogram travel through human tissue differently than the sound waves used in a breast ultrasound exam.

Mammograms that demonstrate dense breast tissue can potentially hide small abnormalities. In these cases, supplementary breast ultrasound screening tests may be required to improve detection of early breast cancer. Breast ultrasound does not replace mammography; mammograms continue to be the only imaging modality that has proven to reduce mortality from breast cancer, according to the American College of Radiology (ACR).

Who benefits most from breast ultrasound?

• Women who have "dense" breasts. The composition of a "dense" breast may make it more difficult to interpret a mammogram image. Dense breasts are more common in younger, pre-menopausal women. Post-menopausal women taking some form of hormonal replacement therapy, such as estrogen, are also more likely to have "dense" breasts.
• Pregnant women who need breast exams. Ultrasound is an excellent alternative for pregnant women because it does not use the ionizing radiation that is used in mammograms.
• Women who have cysts or other breast masses. A breast ultrasound may be a quick and accurate method for determining whether the mass, as detected by mammography or physical examination, is a harmless cyst or a solid mass, which could be cancerous.
• Women with breast implants. Breast ultrasound can provide critical information, after mammography, for women with breast implants.
• Women whose mammogram shows indeterminate results. Ultrasound may serve as a secondary test that provides new information about the health of your breasts.

What does it mean if you have "dense" breasts?

"Dense breast" or "dense breast tissue" means that you have more connective tissue (i.e. glandular, ductal and fibrous tissues) and less fatty tissue in your breast. "Dense breast" is simply a characteristic of the breast, just like eye color, skin color, hair color or height. A mammogram is the only way to determine if you have dense breast tissue. Younger women are more likely than older women to have dense breast tissue. The factors that affect dense breast tissue include weight, age, menstruation, hormone levels and fluid retention.

If it is reported by the radiologist that you have Category 3 or Category 4 dense breast tissue, you might benefit from a breast ultrasound exam. This is because a breast ultrasound exam can detect small abnormalities inside dense breast tissue better than a mammogram by itself.

Unlike your annual mammogram, which is most often paid for by your health insurance plan, a screening breast ultrasound exam may have to be paid for in part or in full by the patient. This may cost up to $150, depending upon your health insurance plan. To better determine if your plan does or does not pay for this cost, please contact your health insurance provider.

What happens in a breast ultrasound exam?

A breast ultrasound exam is a painless procedure that usually takes about 10 to 20 minutes and does not involve uncomfortable compression of the breast tissue. The exam is usually performed with the patient lying on her back, with one hand behind her head.

A physician or sonographer will apply a clear gel to the breast. This gel allows the sound waves to travel from the ultrasound machine through the skin, down to the tissues that are the target of the study. The resulting sound wave pattern is displayed on the monitor of the ultrasound machine. This image shows the inside of the patient’s breast, including any possible areas of concern. The results of an ultrasound breast exam are usually available to your physician on the same day as the exam.

What should one look for in a quality breast ultrasound exam?

• A provider that is accredited by the American College of Radiology (ACR) for breast ultrasound
• A physician of radiology who is board certified, knowledgeable and skilled in the use of breast ultrasound with mammography
• A sonographer who is certified in breast ultrasound by a nationally recognized certifying agency, such as the American Registry for Diagnostic Medical Sonography (ARDMS)
• Newer equipment that produces high quality ultrasound breast images, and is designed for breast ultrasound