NEW YORK—There is a role for ultrasound in breast cancer screening and diagnosis, but many physicians do not seem to know what it is, according to Annette Brown, MD, a radiologist in the Mammography Division of Long Island College Hospital in Brooklyn. At the “Breast Cancer in Women of Color” meeting, Dr. Brown expressed her frustration or “gripes” as she put it.
She called ultrasound the first line of defense for women under 40 who have a mass, in order to spare them exams involving radiation. “My gripe with any physician who is here,” she said, “is when you send a patient for a sonogram, you can’t just say ‘bilateral ultrasound’ or ‘ultrasound right breast’ and leave it at that. You have to say what you are looking for. Is there a mass in the breast? Where is it? Other than that, we’re on a fishing expedition, and we may or may not find it.”
Dr. Brown told ONI that she gets requests for bilateral ultrasounds every day. “You have to waste your time calling them. ‘Excuse me, doctor, where is it?’ Otherwise you are roaming around seeing what you bump into. If you cannot say for sure that a mass is a simple cyst, then you have to do something about it and not say you didn’t see it.”
There are patients for whom such a “fishing expedition” makes sense, she said, eg, a young patient with dense breasts and a strong family history of breast cancer. “Because she has dense breasts, you are probably not going to see anything on the mammogram. She deserves a second look with anything you have. I think in a patient like that, you have to go roaming around the breast and make sure there is nothing there. The problem, of course, is that such aggressive screening can lead to more unnecessary biopsies.”
Women with dense breasts who have had breast cancer also deserve screening sonograms; even those without dense breasts deserve that second look, she said. ‘Of course, I explain the drawbacks to the patient and the fact that we may not always find an existing mass.”
Although Dr. Brown feels ultrasound is not ready for prime time as a breast screening tool in the general population, still “it’s a wonderful exam,” she said. “It gives us a lot of information and can distinguish between a cyst and a solid mass. However, since it is done with a hand-held transducer, if the technologist doesn’t put the transducer where the problem is, we’re not going to have a picture of it.”
She further noted that ultrasound will not find very small lesions in the breast or show lesions that have the same cystic properties as the surrounding tissues of the breast. “The other problem is fatty breasts. I sometimes get a request for an ultrasound, and find that the woman has fatty breasts. Ultrasound doesn’t like fat,” Dr. Brown said.