Myths and Facts on Automated Breast Ultrasound

MYTH

Mammography causes breast cancer. 1 breast cancer is caused for every 100,000 screening mammograms.

FACT

There has never been a single documented case of breast cancer caused by mammography. This is a theoretical extrapolation of breast cancer cases seen in Hiroshima and Nagasaki after the atom bomb blasts. Those same 100,000 screens would detect 600 early stage cancers, saving lives and families. The radiation dose from current digital mammographic systems, widely available in Ontario and at TCFMI, is less than the ambient radiation we are exposed to on a daily basis.

MYTH

ABUS done at a facility with a low price means that the machine will not take as detailed images as a study done for a higher price.

FACT

The market leader for ABUS in North America is the GE Invenia. It has the largest install base in Canada, with most units in Alberta and only 3 (as of 2019) in Ontario. Only ONE model of this machine is available for sale. A study done on ANY GE Invenia ABUS has the SAME capability (because only one type of this machine is sold). The differences in quality will be determined by the personnel that operate the machine and the Radiologist that reports the study, as we have discussed in the other “Facts” in this section. ABUS, in an ideal world, should be available to all women older than 40 years with dense breasts. At the Toronto Centre for Medical Imaging (TCFMI), our motivation to purchase an ABUS unit was to make this study available to as many women with dense breasts as possible. As you are aware, ABUS will find small breast cancers that could be missed on mammography in women with dense breasts. These cancers found on ABUS are generally small and can be treated easily.

The price for this study at TCFMI is comparable to what is being charged by clinics in the US, where they have the most experience with ABUS. In order to be true to our purpose for making the test as widely available as possible, we have priced it lower than what you may have thought. This lower price also happens to be comparable to other services that our patients access annually or semi-annually, such as regular dental or eye check ups. And patients who get their ABUS at TCFMI have the added benefit of integrating the results of ABUS with traditional hand held ultrasound, mammography and biopsy, if necessary, all under one roof.

MYTH

If you have screening with ABUS, then you do not need to have regular mammograms.

FACT

This would be a huge mistake. The only imaging modality that has ever been shown to reduce mortality from breast cancer by as much as 60% is mammography. Mammography will detect cancers that ABUS will miss. This has been shown in several trials since ABUS became available. More importantly, for women with fatty breasts, cancer detection is close to 100% with mammography and extremely difficult with ABUS. This is particularly true for small cancers. If you have fatty breasts, get a mammogram, paid for by OHIP. Do not waste your money on a private pay ABUS, if you have fatty breasts.

MYTH

Screening with ABUS is completely pain free.

FACT

Screening with mammography is NOT supposed to be painful, but should be uncomfortable when done correctly. Screening with ABUS , sometimes promoted as pain free for marketing reasons, may also be a little uncomfortable if diagnostic quality images are to be obtained. In order to get the best image, there needs to be adequate contact between the probe and the skin. For this reason, the manufacturer of the ABUS unit suggests that we encourage the woman to tolerate as much compression as possible without causing pain. If you are having a pain free ABUS study, then the image quality may not be the best. More on this below.

MYTH

ABUS can be done as a stand-alone test without access to mammography or hand held ultrasound.

FACT

Since the inception of ABUS more than 10 years ago, it has always been used in conjunction with and as an addition to mammography. ABUS should not be done in isolation. While ABUS will pick up cancers in dense breasts that were missed on mammography, some small cancers that are less than 1 cm in size or very early cancers that only show up as small calcifications on mammography could be missed on ABUS.

MYTH

ABUS can be done as a stand-alone test without access to mammography or hand held ultrasound.

FACT

The vast majority of ABUS units currently in operation throughout North America are located in dedicated imaging clinics that specialize in all aspects of breast imaging, not just ABUS. The reason for this is that about 10 to 15% of patients who get an ABUS will have some abnormality that will need to be investigated further. Usually, the next test to investigate a finding on ABUS is a hand held ultrasound, preferably with a Radiologist in attendance and most importantly with easy access to ALL of the ABUS images for proper correlation. Most of these findings on ABUS will NOT be cancer but they need to be evaluated to be sure they are not. If you are getting a private pay ABUS, you should make sure that a Radiologist supervised hand held follow up ultrasound is available at the same site. And the benefit of hand held ultrasound at the same site for the patients is that the Radiologist gets to learn which lesions on ABUS are significant and which can be ignored thereby reducing the number of recalls in future without reducing cancer detection rate.

MYTH

ABUS can be done as a stand-alone test without access to mammography or hand held ultrasound.

FACT

Breast cancer has many faces. If ABUS is performed in isolation without access to correlation from mammography and ultrasound, there is a high likelihood that the unusual faces of breast cancer may not be recognized. If sufficient pressure has not been applied, the patient may feel satisfied that they had “state of the art imaging” done. However, the image quality would be such that it could potentially be worthless.

MYTH

ABUS can be done as a stand-alone test without access to mammography or hand held ultrasound. Any correlative imaging and biopsy can be done elsewhere.

FACT

There are problems with this statement. ABUS images are viewed on proprietary software only available at facilities that have ABUS. The entire image set cannot be viewed by Radiologists when presented with a possible finding on ABUS done elsewhere. Often, the finding on ABUS turns out to be a technical artefact (in other words, the ABUS machine made normal tissue look abnormal!) and the only way to tell the difference is to have the ABUS images available before and while correlation with hand held ultrasound is being done. It can create a lot of unnecessary anxiety for the patient when the discrepancy cannot be resolved.

In summary, if you are proactive enough about breast cancer screening that you are willing to pay privately for ABUS we suggest the following:

  • If you are 40 get an annual screening mammogram, paid for by OHIP.
  • If you are 40 and do not have dense breasts on mammography, make sure you go back for a mammogram in one year and do that till your life expectancy is less than 10 years. Save the money you would have spent on ABUS for your retirement, a trip, a gift for someone you care about, a charity that is dear to you.
  • If you are 40 and over and you have dense breasts on mammography, definitely consider getting an ABUS. It may pick up additional cancers that could be missed on mammography (but ABUS alone will also miss cancers that could be picked up on mammography, so you need to do both – they complement each other).
  • If you are going to get an ABUS, it is in your best interests to have it done at a dedicated breast imaging facility where correlation with mammography, hand held ultrasound and biopsy are available with a Radiologist on site.