Mammograms versus ultrasounds for breast cancer screening, diagnosis

This piece is sponsored by Avera Health.

If you’re at the age where a yearly mammogram is recommended — starting at age 40 — you might worry that getting one every year is risky and request a breast ultrasound instead.

Is there reason for concern? Are the two options interchangeable?

Dr. Charissa Etrheim, an Avera family medicine provider and breast expert at the High Risk Breast Clinic in Mitchell, addressed the myth that radiation from yearly mammograms increases your risk of cancer.

The average risk of a woman developing breast cancer is one in eight in her lifetime, though for some, this risk is higher. In contrast, the risk posed by the small amount of radiation received from a mammogram once a year is negligible.

A person is exposed to more background radiation — natural radiation from sources like the sun — in a year than the amount of radiation they receive from a mammogram.

“Studies have looked at the risks versus benefits of mammogram screening, and we consistently find that the amount of people we help by early detection of breast cancer — thus helping us save lives — far outweighs the risk of breast cancer being caused by mammograms,” Etrheim said.

A study published in the Annals of Internal Medicine found that annual screening of 100,000 women age 40 to 74 was projected to induce 125 breast cancer cases leading to 16 deaths, relative to 968 breast cancer deaths averted by early detection from screening.

If fear of radiation still makes you hesitant to have annual mammograms, Etrheim suggests talking with a provider about the possibility of adjusting your screening schedule to every other year since getting some mammograms is preferable to avoiding them altogether.

Can I get a breast ultrasound instead of a mammogram?

Breast ultrasounds are approved as a supplemental tool, not as a stand-alone screening tool for breast cancer. This means ultrasounds should be considered as an additional test — not as a replacement for mammograms.

“If a woman has a mammogram where the findings are inconclusive, meaning it is not definitive that the tissue is ‘normal,’ then an ultrasound can be a great tool to provide further information to clarify if the findings are benign (not worrisome) or if something should be biopsied,” Etrheim said.

How much does a breast ultrasound cost?

Breast ultrasounds are not covered 100 percent as a screening tool by insurance because they are a diagnostic tool — one used to rule out or confirm a specific condition. Depending on a person’s insurance plan, an ultrasound is subject to a deductible, coinsurance or co-pay. The benefit applies regardless of a woman’s breast cancer risk level and reason for receiving the breast ultrasound, such as when the ultrasound is part of a callback. Patients should talk with their insurance providers to see how breast ultrasounds would be covered by their plan.

What if I’m at high risk for breast cancer?

At an Avera mammogram appointment, all women complete a breast risk assessment.

If you have a 20 percent or more lifetime risk of developing breast cancer, you’re considered high risk, Etrheim said. Typically, you then would be referred to a high-risk breast clinic in Sioux Falls or Mitchell.

At those appointments, providers talk about pros and cons of additional tests — like breast MRI or contrast-enhanced mammograms — and discuss plans for keeping a closer eye on patients, such as completing imaging every six months instead of every year.

How should I maintain breast health?

There is a lot of information out there, especially on social media, and it can be hard to know what is accurate. Your primary care provider is your best source when you have questions or concerns about your breast health.

Talking in office is a great time for providers to clear up any misconceptions, share research and success stories and calm patients’ nerves through education, according to diagnostic radiologist Dr. Lokender Bommisetty.

Get more wellness tips at Avera.org/Balance.