Setting the Record Straight: Why Mammograms Remain the Gold Standard in Breast Cancer Detection If there is only one thing you take away from reading this blog, here it is: in the fight against breast cancer, mammograms are the standard diagnostic tool – known to detect even the smallest cancers more than five years before they can be felt.  Women over 40 are encouraged to be tested yearly.  Period. A recent article in The Atlantic reported that, for women with dense breasts, mammograms aren’t as effective, only detecting cancer 40 to 50 percent of the time and that breast ultrasound (US) should be added as a diagnostic tool.  One of our experts disagrees and cites the fact that this recommendation is based on a single study.  “This article shows a lack of understanding regarding the details of the ACRIN 6666 trial: this study focused on women who had dense breasts and who were already considered ‘high-risk’ for breast cancer,” explained Haydee Ojeda-Fournier, MD, assistant professor of clinical radiology and medical director of breast imaging. “ACRIN 6666 also showed an unacceptable number of false negative biopsies which were expensive, had associated complications, and that ultrasound is more expensive and time consuming than a mammogram. On average, ultrasound took 40 minutes per case whereas a typical mammogram takes eight minutes.” We asked Dr. Ojeda-Fournier three questions about sonograms, dense breasts and why mammograms remain the standard diagnostic tool for detecting breast cancers. Question: Why should women over 40 have yearly mammograms? Answer: Eight large, randomized clinical trials have shown mortality due to breast cancer decreases as much as 30 percent as a result of mammographic screening.  It’s important to note that these studies cannot be repeated because it would be unethical to deprive woman from this life saving study and it would be expensive and untimely (women have been followed for 30 years on these clinical trials).  We also know that digital mammograms, which were not available prior to 2005, are more sensitive in detecting cancer in women with dense breasts.  UC San Diego Health System is fully digital. Q: What defines a dense breast and, if a woman has dense breasts, should she request a sonogram or US each time she has a mammogram? A: We cannot truly classify breast density because we do not perform volumetric imaging of the breast.  Rather, we look at an image and then decide if it is fatty, scattered, dense or extremely dense, depending on how much ‘white’ we see.  The white areas indicate the glandular tissue; dark gray being fatty tissue. Q: Are their drawbacks to adding US as another diagnostic tool? A: ACRIN 6666, which showed whole breast ultrasound to be detrimental in screening evaluation of the breast, lead to too many unnecessary biopsies, and this study targeted high-risk woman with dense breasts (i.e. the highest risk women).  For now, the role of ultrasound in breast cancer is in differentiating cysts versus solids lesions and/or to guide biopsies.
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Setting the Record Straight: Why Mammograms Remain the Gold Standard in Breast Cancer Detection

If there is only one thing you take away from reading this blog, here it is: in the fight against breast cancer, mammograms are the standard diagnostic tool – known to detect even the smallest cancers more than five years before they can be felt.  Women over 40 are encouraged to be tested yearly.  Period.

A recent article in The Atlantic reported that, for women with dense breasts, mammograms aren’t as effective, only detecting cancer 40 to 50 percent of the time and that breast ultrasound (US) should be added as a diagnostic tool. 

One of our experts disagrees and cites the fact that this recommendation is based on a single study. 

“This article shows a lack of understanding regarding the details of the ACRIN 6666 trial: this study focused on women who had dense breasts and who were already considered ‘high-risk’ for breast cancer,” explained Haydee Ojeda-Fournier, MD, assistant professor of clinical radiology and medical director of breast imaging. “ACRIN 6666 also showed an unacceptable number of false negative biopsies which were expensive, had associated complications, and that ultrasound is more expensive and time consuming than a mammogram. On average, ultrasound took 40 minutes per case whereas a typical mammogram takes eight minutes.”

We asked Dr. Ojeda-Fournier three questions about sonograms, dense breasts and why mammograms remain the standard diagnostic tool for detecting breast cancers.

Question: Why should women over 40 have yearly mammograms?

Answer: Eight large, randomized clinical trials have shown mortality due to breast cancer decreases as much as 30 percent as a result of mammographic screening.  It’s important to note that these studies cannot be repeated because it would be unethical to deprive woman from this life saving study and it would be expensive and untimely (women have been followed for 30 years on these clinical trials). 
We also know that digital mammograms, which were not available prior to 2005, are more sensitive in detecting cancer in women with dense breasts.  UC San Diego Health System is fully digital.

Q: What defines a dense breast and, if a woman has dense breasts, should she request a sonogram or US each time she has a mammogram?

A: We cannot truly classify breast density because we do not perform volumetric imaging of the breast.  Rather, we look at an image and then decide if it is fatty, scattered, dense or extremely dense, depending on how much ‘white’ we see.  The white areas indicate the glandular tissue; dark gray being fatty tissue.

Q: Are their drawbacks to adding US as another diagnostic tool?

A: ACRIN 6666, which showed whole breast ultrasound to be detrimental in screening evaluation of the breast, lead to too many unnecessary biopsies, and this study targeted high-risk woman with dense breasts (i.e. the highest risk women).  For now, the role of ultrasound in breast cancer is in differentiating cysts versus solids lesions and/or to guide biopsies.

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