The online magazine AuntMinnie.com has just published a review article by Emily Hayes entitled “Ultrasound jostles for bigger role in screening dense breasts.” With the FDA contemplating an update to their guidelines for reporting breast density, Hayes commented that “ultrasound is poised to play a greater role as an adjunct to mammography in screening, along with other imaging modalities.” In addition to citing recently published papers, she also interviewed some of North America’s leading breast imaging specialists.
Among the benefits of hand-held ultrasound (HHUS) are that it is relatively inexpensive, easy to perform, does not require injection of a contrast agent, and women are not exposed to ionising radiation. When HHUS is applied as an adjunct to mammography, an extra 2 to 3 cancers are detected per 1,000 women screened. In addition, the vast majority of these cancers are early-stage and invasive. Dr Liane Philpotts of Yale said, “From a screening point of view, ultrasound makes a lot of sense [and] once you start doing it, there’s no going back.”
Dr Paula Gordon in Vancouver advocates performing both mammography and ultrasound on the same day. “Being able to do additional tests – including needle biopsy – on the same day has huge value,” she said. In fact, Gordon strongly believes that all women with breasts that are mammographically dense should be offered supplemental screening such as automated breast ultrasound (ABUS) seen at left. “Anything less than that is rationing – and dangerous rationing,” Gordon commented.
HHUS has the disadvantage that it is time-consuming and highly dependent on operator skill and that is why ABUS has emerged as an important screening modality in the past few years. Dr Habib Rahbar of Seattle suggested that the extra 3 to 4 cancers detected by ultrasound was “modest” and he advocated contrast-enhanced MRI as an adjunctive screening modality. Although MRI detects an extra 7 to 10 cancers per 1,000 women, the high cost and need for an injected contrast agent will limit its widespread adoption for screening. Both Gordon and Dr Wendie Berg of Pittsburgh contested the “modest” benefits of ultrasound.
Emily Hayes (seen right) is a creative editor who has extensive experience with a portfolio that includes magazine features, market commentaries and government reports. Her journalistic specialities encompass cancer immunotherapy, drug development, precision medicine, and diagnostic imaging. Hayes is also a professional singer, specialising in jazz, blues and country. She once sang at a conference on breast imaging hosted by Dr László Tabár, a Swedish pioneer who demonstrated the benefits of mammographic screening, and has recently promoted the use of adjunctive ABUS. Ultrasound to the fore!