It’s recommended that women screen for breast cancer annually with screening mammograms, beginning at age 40, but some patients worry that getting a mammogram every year is risky and request breast ultrasounds instead.
Is there reason for concern? Are the two options interchangeable?
Are Annual Mammograms Safe?
Charissa Etrheim, MD, Avera family medicine provider and breast expert at the High Risk Breast Clinic in Mitchell, SD, 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,” said Etrheim.
A study published in the Annals of Internal Medicine found that annual screening of 100,000 women aged 40 to 74 years was projected to induce 125 breast cancer cases leading to 16 deaths, relative to 968 breast cancer deaths averted by early detection from screening.
“It’s well studied and controlled to make sure we use the least amount of radiation possible,” said Etrheim.
If fear of radiation still makes a woman hesitant to have annual mammograms, Etrheim suggests she talk with a provider about the possibility of adjusting her 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 only be considered an additional test — not as a replacement for mammograms.
“As a breast cancer screening tool, ultrasound alone is not recommended,” said Etrheim. “However, 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.”
How Much Does a Breast Ultrasound Cost?
Breast ultrasounds are not covered 100% as a screening tool by insurance because they are a diagnostic tool (used to rule out or confirm a specific condition). Depending on a person’s insurance plan, an ultrasound is subject to 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.
Are Ultrasounds Best for Dense Breast Tissue?
For those who have dense breast tissue, breast cancer can be harder to find.
“We know mammograms are not as sensitive for people who have denser tissue and can make it harder to see a breast cancer on mammogram, but getting regular yearly mammograms is still beneficial. Cancer is something that changes and grows. It will tend to poke its head out in a mammogram at some point,” said Etrheim.
Currently, there is a lot of discussion among experts about what other tests, if any, should be done in addition to mammograms in women with dense breast tissue. If you have questions about your breast cancer screening or a desire to pursue additional imaging, start by talking with your primary care provider.
The breast risk questionnaire completed at Avera mammography appointments takes breast tissue density into account to estimate a woman’s lifetime risk of breast cancer.
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% or more lifetime risk of developing breast cancer, you’re considered high risk, Etrheim said. Typically, you would then 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?
Etrheim stressed the importance of self-exams — knowing what’s normal for you and being proactive when you notice changes.
“People can catch a new lump or other breast change through a self-exam that ends up being breast cancer,” said Etrheim. “Mammograms are our best tool, and doing self-exams can help support that.”
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 Lokender Bommisetty, MD.
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