What Does Breast Cancer Look Like on an Ultrasound?

My doctor found a lump in my breast during my yearly mammogram and then brought in an ultrasound technician to follow up with an ultrasound for a closer look. Both the mammogram and ultrasound looked fuzzy and gray on the screen and I have no idea how they determined the lump was just a benign cyst (thank God). What does breast cancer look like on a mammogram?

Breast ultrasound uses sound waves to image the tissues of the breast. An instrument called a transducer sends high-frequency sound waves into the breast and captures returning echoes. By measuring echo waves, it is possible to determine an object's size, shape, and consistency. A computer creates a picture based on these waves on a monitor. While it may look like a fuzzy, spotty television screen with different shades of grey to a patient, the ultrasound technician and the radiologist use these images to diagnose masses and tumors.

Breast ultrasound can detect lumps that may not be seen on mammograms, and they can also note changes in the breasts in women with dense breast tissue. Ultrasound can tell the difference between solid masses that might be cancer versus fluid-filled cysts, which are generally not cancerous.

A variety of tests are used for the diagnosis of breast cancer.

Screening mammography has made it possible to detect many breast cancers before they produce any signs or symptoms. While there is no doubt that mammography is important, recommendations regarding frequency and age at which women should begin receiving screening mammography differ slightly between different organizations and task forces.

The American Cancer Society (ACS) recommendations for breast cancer screening were changed in October 2015, and now are considered evidence-based guidelines based on extensive review of available studies. They are as follows:

• The Clinical Breast Exam (CBE) is no longer felt to be indicated in asymptomatic, average-risk women (women with no past history of breast cancer, no family history of breast cancer, and no past history of chest wall radiation at a young age). This screening technique is no longer considered useful, based on the evidence.
• Mammograms in average-risk women are strongly recommended annually for women aged 45 to 54. Such a recommendation is made as a strong guideline and is without reservation. Women may elect to begin mammography for screening annually from age 40 to 44, but the risks as contrasted to the benefits should be discussed. This recommendation is considered "qualified" as the risk-benefit issue may be in dispute. Women over 55 also of average risk and asymptomatic can consider going to mammography every two years or yearly as they prefer. Such a recommendation is still a "qualifed" one as opposed to a strong, evidence-based recommendation.
• Finally, mammography should continue as long as the woman is in overall good health with at least a 10-year life expectancy. Again, this is only a qualified recommendation.

Mammography is generally of greater benefit in older women than in younger women, because younger women frequently have more dense breasts, and there is a higher incidence of false-positive mammography results in younger women. The addition of ultrasound examination to screening mammography can be of value in screening younger women at higher risk or who have dense breast tissue.

Because of these limitations of mammography in younger women, the U.S. Preventive Services Task Force recommends that routine yearly screening mammography begin at age 50. Women aged 40 to 49 are encouraged to discuss their situation with their health-care practitioner to decide on the appropriate time to begin screening mammography.

Breast self-examination (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health-care professional.
If a woman wishes to do BSE, the technique should be reviewed with her health-care professional. The goal is to feel comfortable with the way the woman's breasts feel and look and, therefore, the woman can detect changes in her breasts if they do not feel or look normal.

For some women at higher risk of developing breast cancer, the addition of MRI scanning is recommended as a screening tool. The American Cancer Society recommends that women at high risk for breast cancer (greater than 20% lifetime risk) receive an MRI and a mammogram every year. Women at moderately increased risk (15%-20% lifetime risk) should discuss the benefits and limitations of adding MRI screening with their health-care professional.

Women should discuss with their doctor about how often and when they should begin screening tests.