What is the difference between mammogram and ultrasound when it comes to breast cancer?

One of the early signs of breast cancer are certain types of microcalcifications. Microcalcifications are tiny deposits of calcium….about the size of a grain of salt. These can be seen fairly well on mammograms, but cannot be seen at all with ultrasound. If the only sign of breast cancer are these microcalcifications, an ultrasound will not see it.

Also, a mammogram provides a good image of the entire breast, where as an ultrasound of the breast is highly directed. I mean, ultrasound is very good if the patient can feel a lump, and the ultrasound technologist can place the transducer (or camera) right over that area. It is also good when we find something suspicious on a mammogram, and we can see what area of the breast to direct our ultrasound images. But, it is not a good screening tool. Finding a small breast cancer, with ultrasound, without these positioning “clues” can be like finding a needle in a haystack.

Mammograms should not be painful. They can be uncomfortable for some women, and other women aren’t at all bothered by the exam. If you are tender breasted, you might feel more discomfort. Make your appointment for after you have started your menstrual period, when the breasts are the least tender. Caffeine also makes tender breasts more tender for many women, so consider limiting your intake (coffee, tea, chocolate) for a few days prior to a mammogram. I do not recommend avoiding caffeine if you are prone to headaches when you go without.

Size of the breasts have nothing to do with the level of discomfort. Both small and large breasts can be tender. We don’t compress the breasts to a magical number. A large breast might be compressed until the breast measures 6 cm thick. A small breast could be compressed until it measures 3 cm. So, in this case, size does not matter!

Now, lets assume that mammographic exams are VERY painful, for arguments sake. A routine, screening mammogram consists of 4 images….2 views on each breast. The total time of compression for those 4 images is about 45 seconds. I can do anything for 45 seconds, especially if those 45 seconds can greatly impact my future and my quality of life. Sounds like a small price to pay, doesn’t it?

I get very upset with women who spread the misconception that mammograms are so extremely painful. They are scaring other women badly enough that some women are not having mammograms. I had a patient a few years ago, who came in for her first mammogram because she had a huge lump in her breast. You could tell, without the mammograms, that she had an advanced breast cancer. Her skin was red and nipple was inverted….her breast looked angry. She had known about this lump for over two years, but never went for a mammogram, because her “friends” had told her how painful they were. A day later, we did a CT scan of her head, chest, abdomen and pelvis, and her breast cancer had spread to her liver and brain. She was dead within a couple of weeks. I guarantee that pain was nothing what is experienced with a mammogram. With friends like that, who needs enemies, right?