Clinical trials are now looking at the benefits and risks of adding breast ultrasound screening to mammogram screening for women with dense breasts who are at a higher risk of breast cancer.

"There was research that came out [in early June of this year] indicating that women at higher risk - especially younger women who tend to have denser breast tissue - would benefit from mammography coupled with ultrasound screening. The study indicated that there was a three-times higher breast cancer detection rate when both tests were used, meaning that something that wasn't seen on the mammogram was seen on the ultrasound," Schmitt says. "There was a higher capture. That is not policy, but it was a huge study so it will have some impact on how screening will be done for higher risk women."


Along with the higher cancer detection comes a lower specificity. "When we recommend biopsy for an abnormality seen on a mammogram we find cancer in around 20-25 percent of women," says Schroeder. "When we biopsy something seen in an ultrasound we find cancer less than 10 percent of the time."

When you talk about high risk women, you are talking mainly about women who have first degree or multiple second degree family members with breast cancer. The other high risk category is the prior existence of breast cancer in one breast.

CT is making a strong case for itself

There are some who believe that using CT is the best modality when it comes to breast imaging for diagnostic purposes, and there are plenty of studies going on today that are trying to prove this theory.

A breast CT scanner takes images of virtual "slices" of the breast-about 300 images per breast. Computers then assemble these images into highly detailed, three-dimensional pictures that provide a more unobstructed view of breast tissues than can be seen on mammography.

Schroeder has invested in CT because he believes it takes a good modality and makes it better. "I'm looking at this and saying, X-rays work now, so a better X-ray seems to be the most logical next step," he says. He admits, however, he has no way of knowing how popular CT mammo will become. "A breast CT with a contrast agent will provide at least as much information as MRI, if not more - but that's not definitively known yet, because it has not yet been fully studied."




De Paredes says there is some new research using high resolution CT that is promising, and that breast cancer screening using new CT imaging devices may be more accurate than standard mammograms, and much less painful.

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