Oncology

BREAST ULTRASOUND

37 year old Michelle Michaels is taking every precaution to protect herself against breast cancer. “My mother had inflammatory breast cancer three years ago, and my grandmother had breast cancer at 38, so I’m considered high, high risk,” says Michelle.

Women at risk of breast cancer would do well to get a breast ultrasound done.

37 year old Michelle Michaels is taking every precaution to protect herself against breast cancer. “My mother had inflammatory breast cancer three years ago, and my grandmother had breast cancer at 38, so I’m considered high, high risk,” says Michelle.

Last year she had her first mammogram and in addition she also had a breast ultrasound. Although her results were negative, Michelle is contemplating mastectomy because of her strong family history. “It’s kind of like the ticking time bombs, let’s get rid of them, the big decision is then what do I want to do, a kind of reconstruction,” says Michelle.

The decision is daunting and it’s a decision millions of women who are at high risk face. Breast cancer specialists at Allegheny General Hospital and 21 other medical centers across the country have now embarked upon a landmark clinical trial to evaluate the role of ultrasound as a supplemental screening tool for women at high-risk for breast cancer.
According to Allegheny’s director of breast imaging, Dr. William Poller,
“If a woman has a dense breast there is a chance that the breast cancer can be hidden in that dense breast. So, the question is what can we do to up our positive predictive value of finding a breast cancer in the woman with dense breast.”

Around one-third of breast cancers are found in women under the age of 50, but it’s in these women that the breast tissue is more likely to be dense and thus it’s in this population that a mammogram is more likely to miss a breast cancer.

Mammography works best in women with fatty breasts, detecting as high as 98% of cancers before they’re large enough to be felt. “As you reach menopause the breast tissue becomes less dense and is replaced by some fatty tissue,” says Dr. Poller.
Ultrasound uses high frequency sound waves to image the body. Unlike mammography, the technology is capable of identifying abnormalities in dense tissue, which makes it valuable in these young, high risk women. “If we do ultrasound in these women and mammography, the early studies show that perhaps you’re picking up 4-5% more breast cancer which is great and you’re picking up small breast lesions which is even better. The smaller the lesion, hopefully no nodes, no metastasize, no lumpectomy, not a mastectomy, with a great chance of survival,” says Dr. Poller.

Researchers found that among women with dense breasts, in New York and other cities, a mammogram detected just 48% of the smallest tumors, while combining mammography with ultrasound raised the detection rate to 94%.

As a mother of 2 young daughters, Michelle is happy she has the ultrasound to add to her arsenal of screening tools. And she remains hopeful that her daughters will benefit from advancements of science. “Since we’ve made great strides in the past 20 years, hopefully 20 years from now when they’re old enough, they’ll be able to be cure it,” says Michelle.
According to Dr. Poller, insurance companies do not pay for screening ultrasounds. And that’s why he says their study is so crucial.

If these medical centers across the country, involved in the trial, can prove the benefit of having an ultrasound in addition to mammography, then there’s a fighting chance for reimbursement.

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