Ultrasounds provide additional screening for those with dense breast tissue
Although they live many miles apart, Patti Beyer of Glenview and her youngest sister, Susan Larkin, share a love of fishing, blueberry picking and making jam. They also share the trait of dense breast tissue.
One day as they were talking - as sisters are prone to do - Larkin told Beyer, 66, that in addition to her mammogram, she has an ultrasound of her breasts because of her dense tissue. Larkin encouraged Beyer to ask for one, too.
So, in March 2016, in addition to her mammogram, Beyer took the extra step and went to The NorthShore Center for Breast Health at Glenbrook Hospital to have an Automated Whole Breast Ultrasound, also known as ABUS.
ABUS is an FDA-approved, noninvasive, radiation-free, painless procedure that uses sound waves to create 3-D images of the breast. The procedure takes about 15 minutes. The 3-D images are reviewed by a radiologist and patients receive their results within a few days.
"The mammogram was normal; the ABUS ultrasound showed a lesion," Beyer said.
As a follow-up to her ABUS report, Beyer had three more mammograms done the next day - all came back normal. The radiologist did a targeted ultrasound and then Beyer had a needle biopsy, which showed invasive breast cancer. Luckily, it was discovered early, Beyer said.
"Because the lesion was caught so early, the malignancy was under 1 cm," Beyer said. "My lymph nodes were cancer-free. I required no chemotherapy and the radiation I had following a lumpectomy was a short-term treatment."
Dr. Georgia Spear, chief of the Department of Breast Imaging at NorthShore University HealthSystem, said such early detection is why ABUS is an important tool.
"The implications of finding the tumor at this stage is exactly what we want the supplemental screening exam to provide: the ability to detect breast cancer early when it's manageable and treatable," Spear said.
Beyer says if it wasn't for the ultrasound, her breast cancer likely would have remained undetected longer and would have had a chance to grow and spread.
Unfortunately, Beyer is not alone when it comes to a correlation between dense breasts and breast cancer. More than 70 percent of breast cancers occur in women with dense breasts, and research has shown nearly one in two cancers is missed on standard mammography in extremely dense breasts.
"Knowing whether you have dense breast tissue is important because dense breast tissue can mask cancer from being detected on your mammogram," Spear said.
She encourages women to look at their mammogram reports and talk with their doctor to become more informed about their breast density and decide if alternative testing is warranted.
Breast density notification laws are in effect in 30 states. The purpose of these laws is to inform women who have undergone mammography of their inclusion in two of the four categories of breast density.
Illinois does not have such a law and Beyer is out to change that.
"The thing that keeps me awake at night is when you hear stories of women who had lumps for years and who had mammograms, but it wasn't detected because of high density," Beyer said.
"The difference between a stage 1 and a stage 3 or 4," she says, her voice catching. "When it goes into those further stages; a woman's life is changed forever."
Beyer credits her sister, who lives in California - a state with a breast density inform law - with raising her awareness about having an ultrasound in addition to a mammogram because of her breast density. And, Beyer thinks all Illinois women should have that information.
So she is writing to state legislators to urge them to enact a breast density inform law in Illinois that would require doctors to send a letter to patients informing them of their high-density breast tissue. The American College of Radiology even offers sample letters for facilities to use, with language that includes notification, supplemental screenings available in addition to a mammogram, and the importance of having a conversation with their doctor about their breast cancer risk factors.
Some facilities and doctors in Illinois are voluntarily sending out such information to patients, but not all.
"You cannot depend on your doctor to tell you. Advocate for yourself," Beyer said. "You need to ask: 'What's on my lab report?'"
Spear says it's important for women to know that ultrasound is a supplemental test to a mammogram, not a replacement. Some early breast cancers are present with breast calcifications that can only be detected by mammography, she said, so having a mammogram is still important for women with dense breast tissue.
Insurance coverage can be variable for ABUS. If a provider does not cover the procedure, out-of-pocket costs are estimated at $400 to $500. For more information about ABUS offered through NorthShore at Glenbrook Hospital, Highland Park Hospital, Skokie Hospital and Evanston Hospital, visit www.northshore.org/radiology/procedures/breast-imaging/automated-whole-breast-ultrasound.
Beyer says she is doing fine now. She focuses on a healthy lifestyle, is careful with her diet, limits alcohol consumption to no more than 2-3 drinks per week, has her vitamin D levels checked, keeps her weight down and exercises regularly - all lifestyle changes that can reduce a woman's risk of getting breast cancer. She also said women should give careful consideration about the risk factors of hormone replacement therapy if they have dense breast tissue.
To learn more about breast density, visit densebreast-info.org.