The Debate on Mammography: Mammograms or Breast Ultrasound

Recently, there has been a plethora of discussion and debate regarding the US Preventive Services Task Force (USPSTF) latest recommendations concerning screening mammograms.
The USPSTF changed the timing for initial baseline screening from 40 to 50 years old and then recommended only biennial screening. Screening would stop at age 75. The task force also advised that self breast exam (SBE) no longer be taught as it did not result in any advantages in mortality. It was decided that the possible negative consequences of over- diagnosis, anxiety and biopsy were not worth the effort. These recommendations were made after survey of the literature and decision of risk versus benefit ratios.

These new recommendations lead to a communal cry from women and doctors who felt that lives had been saved by early detection of a breast cancer through yearly screening mammography.
However, there are many women who refuse to have mammography done because of the concern of cumulative radiation effects to breast tissue. There is reason for concern because compared to a chest x-ray, which delivers 1 millirad to tissue, a typical mammogram may deliver up to 340 millirads to each breast and maybe even more when breast tissue is dense, as it is in many cases. Since radiation effect is also cumulative, yearly mammograms continue to contribute to the radiation effect on sensitive breast tissue.

Deciphering mammographic images can also be tricky. That is why screening mammograms have high degrees of false negatives and false positives. The rates can be as high as 10 -20%. This inaccuracy is higher in denser breast tissue and leads to more films being taken and higher radiation effects. The procedure of the mammogram is also painful, squeezing breast tissue to be as flat as possible and theoretically disseminating cells from the breast into ducts and blood vessels.

Digital mammography and breast MRI have not been used as primary screening tools in the general population and even though reserved for higher risk women, still have significant high false positive rates leading to unnecessary and invasive procedures.

What has been largely ignored throughout the breast screening debate is the use of high resolution breast ultrasound (HRBU). This is an imaging technique utilizing non-ionizing sound waves rather than x-rays. It is generally utilized when there needs to a distinction made between a cyst and a solid nodule. The HRBU can “see through” dense breast with more sensitivity than other imaging techniques. When used with Doppler it can evaluate resistivity index, or how much blood is flowing to an area of concern. Malignant tumors are known to attract more blood supply enabling growth. In 3-D mode HRBU can discern whether a lesion lies within or outside of a milk duct. The only advantage that mammography has over HRBU is that it can identify micro-calcifications. Micro-calcifications in the breast can be benign or malignant depending on their distribution patterns. They are likely an attempt of the body to isolate and contain proteins of inflammation. When present they may indicate the presence of a ductal carcinoma in situ (DCIS), a very early and slow growing malignancy. Mammograms can be done biennially to follow these if present. HRBU performed every 6-12 months, depending on risk factors, will uncover rapidly growing breast cancers.

I also promote SBE. This is not done with the energy of “looking for lumps”. Instead, women are instructed to massage healing essential oils such as lavender and frankincense into the breast tissue while visualizing healthy cells (could be flowers opening or smiley faces) and bringing healing energy into the breasts from wherever their faith lies. They are to pay attention to thoughts, memories and ideas that come up related to fourth chakra issues of love, nurturing, judgment and criticism. Journaling has been shown to be a successful way of ridding the body of the clutter of stored emotional energy.

This more integrative, holistic approach to maintaining and supporting healthy breasts empowers women to develop their own intuitive healing energy. Unfortunately there are no head to head studies on screening mammography versus HRBU. However, the USPSTF also suggested that the final decisions are between physician and patient. We as physicians need to listen to our patients concerns and be open to change and innovation. The USPSTF recommendations allow us to consider protocols on an individual basis. The integrative, holistic approach works well here.

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