Breast Pain and CAT Scan

CT is not sensitive enough to evaluate the breasts. Mammo has better spatial resolution and can see things in the breast far smaller than a CT.

A mammogram will show things not visible on an US and vice versa. Complete evaluation of the breasts includes both Mammo and US.

Rrobin0200

US is better at evaluating masses, and can find small masses that are obscured by dense tissue. On the other hand the calcifications that develop in DCIS are well seen on mammogram but not on US. If DCIS is present but has not yet developed calcifications it may not be seen on either Mammo or US but could be demonstrated on MRI.

Currently a screening exam consists of a mammogram only, and only in patients 40 and over who are asymptomatic. Studies have shown that a screening "whole breast" ultrasound can significantly improve the odds of finding a non-palapable cancer when combined with a mammogram but not all facilities offer screening US exams. HERE is a very good article on the subject.

Not sure where ins companies stand on screening US at this point in time. If you have had a cancer and you are looking for a recurrence, I assume ins companies would reimburse for whole breast US as it would technically be a diagnostic study but I am not certain of this.

Jons_girl

Complicated issue(s).

DCIS. Technically not cancer. May or may not progress to cancer, no way to know without biopsy/lumpectomy. Some are pushing to rename it without the word carcinoma as they did/are doing with LCIS (now lobular neoplasia). Surgeons accuse radiologists of "overdiagnosis" when calling small areas of DCIS on a mammogram (as if we could unsee an abnormality) and some accuse them of "overtreatment" in retaliation. Now many are recommending watchful waiting or similar verbiage. Presents as calcifications with no associated mass on mammogram but it only calcifies when the cells begin to die in the ducts so its been there for a while and basically invisible for quite a while but then again it cant kill you. There are recognized findings for DCIS on US that have been published but you need the right machine, the right tech and the right rad for these subtle findings. Hard to find all three of these at once in a general radiology practice. Not all exams are equal in all locations at all times.

Studies have shown US is valuable as a screening modality (see this article) but it will not replace screening mammo until it can be proven it can stand alone with both high true positives and true negatives, as well as an impact on survival which would require long term studies of patients over a period of years. There is then the issue of personnel. Who will do the scan? The average general US tech may not be qualified to do whole breast US to find an 8mm patch of DCIS. The rad may be qualified but in the time it would take to do a thorough hand held real time bilateral whole breast US, they could have read 25-50 screening exams which is a more efficient use of their time (google "relative value units" or RVUs). There are automated whole breast US units made for screening that anyone could use to scan the breasts with a little training. These are then processed and put on PACS for the rads to batch read like screening mammos. These images can be reconstructed in any plane which is a plus for interpretation.You will still need to be recalled if something abnormal is found.

Bottom line is there are two schools of thought that have not yet been reconciled. One is "we must find every breast cancer out there" and the other is "its ok to miss DCIS now and then, and treatments these days are so good you can miss an IDC now and then too and besides 6 mo follow up exams stress people out". I am part of the first group along with the American College of Radiology and the Society of Breast Imaging. The USPSTF is the founding body of the second group (google USPSTF Guidelines 2009). Group 1 wants a mammo every year starting at 40 til your dead, or any time you feel a new lump on your monthly self exam. Group 2 recommends starting screening mammo at 50, and then only every two years, and please do not examine yourself. Kinda like "don't ask, don't tell".

Mammo has been the gold standard for years, well tested and followed up for many years and clains to decrease mortality by 30% (google any Swedish breast cancer study by Dr. Lazlo Tabar) and it has improved over the years. US may be the modality of choice for screening at some time in the future, but not until proven by well constructed long term studies. Science in general, and insurance companies are very particular about that. MRI is the best technology we have right now and is extremely valuable if read by the right rad. It won't be used for general screening unit the scan takes 10 minutes and cost $50.00.

djmammo:

Thank you SO much for yr response I’m so sorry my reply was so delayed! Life has been crazy busy😊

So with all you stated above, if you were a woman and had extremely dense tissue would you still be pro mammo??

My mammo didn’t see my tumor. My tissue is very white. Dense. I got a copy of the cd. So I don’t trust mammos for finding anything in my breast tissue. They keep pushing them on me as the diagnostic of choice. But they know too that the mammo missed my cancer

I am going to start having automated ultrasounds. I agree with you that the technology still has to be proven with studies to show ultrasound is a great option especially for those of us with dense tissue.

Thank you so much for yr answer above! Really appreciate that!

djmammo:

Thank you for that information. I really appreciate you taking the time to explain stuff.

I’m not trying to be difficult. I did go to a breast center after finding my lump myself. The 3D mammo they did missed my small tumor completely. So if they missed my tumor the likelihood of them actually catching precancerous mass forming is probably not high. I had I believe the lead rad dr reading it too. So my trust in Mammos isn’t high at all. I know mammo is the gold standard. Basically the go to for breast cancer detection. But it didn’t work for me.

My thought is that if my tumor was obviously seen on ultrasound then I would think any other tumors that have formed probably would be found that way as well. I felt my tumor. So ultimately I caught it first. I have a lead tech who does my ultrasounds. I have the same tech do the ultrasounds for continuity. I also go to a place that is a specialized center for diagnostics. Not just a hospital. The same radiologist can read them too. So more continuity.

If I chose to do mammos each year and it caught Dcis I would not choose to have dcis cut out anyway. I’d have it watched. My doc would be fine with that I’m sure. My tumor also was very slow growing. Low prolif rate. My thought is mammos did nothing for me regarding catching anything early. So if it’s only going to catch dcis....? I’m not sold on mammos.

My doc would order mammos yearly I’m sure if I asked for that. But I won’t go without ultrasound. That’s what saw my tumor very very clearly!! Showed blood source and everything very obviously.

Sorry....not trying to be a pain in the backside 😊. I’m just not sold on mammos. Even if they can see calcifications. My mammoreports have often talked about my dense tissue over the years. And stated nothing seen. I had to have had calcification prior to my tumor. But it’s not on previous report.

dmammo:

Yes I understand and appreciate your answering my questions. I definitely agree having someone read my ultrasound who really sees a lot of breast ultrasounds is important especially with extreme dense breast tissue.

I have a question for you. It appears throughout my young adult life and up til now I’ve had varying degrees of density. It appears to be getting more dense not less as I am getting older. Do you know why that is? Any theories that doctors have stated about that? A nurse at a breast center told me yr breasts can have different density throughout the month. But my density hasn’t changed a lot just gotten more dense. So I’m not sure that nurse was correct.

Thanks again for your answers. Appreciate your knowledge

Thanks for all the great information djmammo!