Diagnostic Mammogram or Ultrasound

You should have the diagnostic mammo as well as the ultrasound.

Mammograms and ultrasounds "see" different things. And even with extremely dense breast tissue (which is not at all uncommon for pre-menopausal women), mammograms can still spot some things that ultrasounds can't. The best example of this is calcifications. Calcs are very common and usually benign, but they can be a sign of DCIS or a very early stage invasive breast cancer. Most often, ultrasounds don't show calcifications at all. In my case, even with extremely dense breast tissue, my diagnostic mammogram spotted the calcifications that led to my diagnosis; my ultrasound was completely clear and showed nothing. Another example would be architectural distortion. While a mass might not be seen by a mammogram because of dense breast tissue, the presence of a mass might cause the breast tissue to appear distorted or uneven. That would provide a target area for the tech to focus in on with a diagnostic mammogram, which provides a close-up magnified view and therefore might see something that the screening mammogram missed. The tech would also focus more closely on that area with an ultrasound, which might miss a small mass if the tech didn't know specifically where to look.

But just to be clear, there is no screening modality that can diagnosis breast cancer and if something is present, most often screening alone cannot rule out breast cancer. All that screening does is look into the breast to see if something unusual or abnormal is present. Depending on how the lesion appears, in some cases - with simple cysts (completely round and fluid filled) or with benign calcifications (larger and coarse, for example) - the Radiologist can be quite certain that the lesion is benign. But often, even if something looks quite benign or looks highly suspicious, follow-up is required to confirm this. With something that looks quite benign, the follow-up might be another screening in 6 months to ensure stability. Or a biopsy might be recommended - anything with a 2% or greater risk of being cancer is recommended for biopsy. With something that looks highly suspicious, a biopsy is required to confirm a diagnosis. There are some benign lesions that mimic the appearance of cancer, so even some highly suspicious lesions do turn out to be benign. It is helpful to the Radiologist's assessment to have more than one modality of imaging, because those two different views can sometimes help define what the lesion might be.

I have very dense tissues and on my non cancer side they did a 3D mamo and they read mine right away for me because of my history. Then had me take some additional films and then do an ultra sound as well to be extra sure after that due to a an area. You can end up with both and my insurance covered it all as a result.

Super!

that’s great news! I would have asked for both. I have extremely dense tissue.

Glad all is well

Ahhh... so this answers the question I asked you in a different thread. I'm in my upper 50's now and have had "extremely dense breasts" ever since I've been getting mammograms in my early 40's. Just began getting 3D mammo's a few years or so ago. I'm not sure I've heard of anyone getting a callback for dense breasts only with no other suspicious findings.... so I can't really help you with that. I've had many callbacks though that was due to microcalcifications, etc. they saw; otherwise no callback.

I think it can go either way on a call back. I have extreme dense tissue. My situation was different tho cause I felt my tumor. Then went for Diag mammo which didn’t see my tumor but since they felt tumor too they then did ultrasound which saw tumor and blood source to tumor.

Please keep us posted on how all goes for you. We are here to support you! Hope all is benign.