Understanding Mammograms, Ultrasounds and Breast Density

All breasts are not the same, and the makeup of your breast tissue can help determine if supplemental screening is right for you.

Like any other body part on different people, not all breasts are the same.  Some are fatty, some are dense, and some are a mix.  What does this mean and why does this matter?

Breast Basics: Fat and Tissue

Breasts are made of fat and breast tissue.  Some women have more fat than breast tissue while others have more breast tissue and less fat.  When there is more breast tissue, the breast is considered “dense.”

“There are four types of breast density for screening purposes,” explained Dr. Rita Krane, a breast radiologist and Medical Director of The Breast Center at Community Memorial Hospital.  “Fatty and scattered fibroglandular are non-dense types.  The other two are heterogeneously dense and extremely dense, both of which are dense tissue types.”

The makeup of the breast is important because on an X-ray mammogram, dense tissue looks white.  Since masses or lumps also appear white on a mammogram, a suspicious lump may be masked by the dense breast tissue and harder to see.  Therefor, with mammography, a cancer can easily hide in the background of dense breast tissue since they both appear white.  Alternatively, in fatty tissue, which is black, a white mass (cancer) stands out more and can be seen more easily.

What You Need to Know About Breast Density

Breast density can only be determined by evaluating a mammogram.  A radiologist performs a breast density assessment when interpreting the image from the mammogram.

Breast density can only be determined by evaluating a mammogram.

Having dense breast tissue is common!  Forty percent of women have dense breast tissue.  It’s a feature of the body just like any other feature, and it can’t be changed.

However, dense breast tissue is linked with an increase in the risk of developing breast cancer, and it may be harder to detect at an early stage on a mammogram.  “So, for women with dense breasts, a regular mammogram alone may bot be the best or only way to detect cancer,” said Dr. Krane.  “Since mammography has limited visibility in women with dense breast tissue, screening dense breasts with whole breast ultrasound, in addition to mammography, can improve the likelihood of finding cancer.”

When to Get a Mammogram

“Mammography is still the gold standard for finding breast cancer,” Dr. Krane said.  “Supplemental imaging is meant to compliment mammography, not replace it.  The whole breast ultrasound should be used as supplemental screening.”  Regular mammography is vital even with dense breast tissue, because certain cancers, such as those that contain calcifications or cause tissue distortion, can only be detected on mammogram.

There are different recommendations about when to get a mammogram and how often.  Dr. Krane noted that the American College of Radiology, the Society of Breast Imaging, and many practicing breast radiologists recommend that patients of average risk for breast cancer begin having mammograms at age 40 and get one every year.  It’s important to discuss your personal risks with your primary care doctor or gynecologist.

Supplemental Breast Screening: Invenia Automated Breast Ultrasound System (ABUS)

The GE Invenia ABUS helps physicians look differently at dense breast tissue and get a clearer picture than a mammogram alone.

Women with very dense breasts are good candidates for a supplemental type of screening that can help doctors get a better picture of the breast.  An advanced type of screening using the Invenia Automated Breast Ultrasound System (ABUS) helps physicians look differently at dense breast tissue and get a clearer picture than a mammogram alone can offer.

Made by GE, the Invenia ABUS uses 3D ultrasound technology to comfortably and quickly image women with dense breast tissue.  “ABUS finds cancers that are smaller and can find them earlier than a mammogram alone,” said Dr. Krane, who also noted that this type of supplemental screening has many advantages.

“It’s painless, there is no radiation, and it only takes about 15 minutes,” she said.  “The advantage of this over a hand-held screening ultrasound is that it’s not dependent on the operator to cover the entire breast, so it ensures complete coverage of the entire breast.”

These supplemental ultrasounds are frequently covered by insurance (The Breast Center staff will check in advance the status of a patient’s insurance coverage).  Dr. Krane emphasized that more and more insurances are starting to cover supplemental screening, or a portion of it, for women with the two dense breast categories, as supplemental ultrasound is rapidly becoming the standard of care for these women.

As always, women should be proactive about their breast health and talk to their doctor about what is best for them.  And if you are 40 or older, remember to get that mammogram every year!