Dense breast?


Dense breast?

ultrasound + mammogram = peace of mind

Observer writer

Sunday, January 03, 2021

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After enduring the discomfort of a mammogram and anxiously waiting more than a month for the results, 56-year-old Alison (not her real name) was told she needed to do an ultrasound. Her breast tissue was too dense for an accurate reading from the mammogram, the doctors explained.

“If they felt something [during the physical exam before they ordered the mammogram why not] just send me to do the ultrasound? I would expect them to use the best method and don't put people through the stress and expense,” she told the Jamaica Observer, obviously frustrated.

Mammograms at private facilities can run between $10,000 and $15,000 while ultrasounds are about $10,000.

The ultrasound eventually showed Alison had nothing to worry about but she is debating whether, as someone with dense breasts, she should skip the mammogram next year and go straight to an ultrasound. Medical professionals advise against this, especially in older women like Alison. The recommendation is that women 35 years old and over still do a mammogram and follow up with an ultrasound if so advised. This is a bit counter-intuitive as ultrasounds are typically recommended for younger patients.

“The mammogram has a better pick up rate as persons grow older,” said consultant general surgeon at the Kingston Public Hospital, Dr Hugh Roberts. “For younger women [under 35], many radiologists are reluctant to use a mammogram for screening because the pick-up rate is going to be extremely low. The primary modality in that age group is probably an ultrasound.”

Mammograms are more effective when breast tissue is fatty, not dense. The fat content tends to increase with age. The challenge is when older women have dense breasts.

“When you do a mammogram, it can differentiate fat from anything else and when you have dense breasts it is sometimes difficult to see exactly what is going on in the breasts even though there are techniques that the radiologists can use,” said Dr Roberts.

He explained that an ultrasound is used in conjunction with a mammogram to provide more information which helps radiologists in making a diagnosis.

“It is not only about diagnosing breast cancer, but it is also about picking up [other issues], and that will help the person who is actually managing the patient, which is most likely a surgeon that determines what kind of biopsy to do,” he said.

Dr Roberts also suggested that patients with dense breasts are considered for other medical screenings, especially if they have factors such as family history or previous history of breast cancer, genetic predispositions and pre-exposure to radiation which would increase the risk for developing breast cancer.

“When something is not showing clearly on the ultrasound, there are other investigations that can be used such as the MRI or a computerised axial tomography (CAT) scan but those should be selectively used because of their availability and cost,” he said.

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