Ultrasound First For Women Under 40 With Breast Lump: Doctors

Women under age 40 who feel a lump are better off first getting an ultrasound rather than a mammogram, new research suggests

Women under age 40 who have breast lumps are better off first getting an ultrasound rather than a mammogram, according to a new study.

"From our study, ultrasound is the best imaging tool for women under age 40 with a palpable lump," says Dr. Constance Lehman, vice chair of radiology at the University of Washington and director of imaging at the Seattle Cancer Care Alliance.

She is talking only about younger women, under age 40, and only if they have a lump.

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She bases that advice on a study in which she compared the sensitivity of ultrasound and mammography in 954 women being examined because they had breast lumps.

Ultrasound identified those who actually had breast cancer nearly 96% of the time, while mammography identified them correctly less than 61% of the time.

Most of the lumps, 98%, turned out to be benign.

The study is published in the American Journal of Roentgenology.

Right now, Lehman tells TakePart, most doctors order both a mammogram and ultrasound in this group, following criteria suggested by the American College of Radiology. Going by the criteria, the mammogram is done first.

However, based on her study findings, Lehman now says they should consider the ultrasound first.

Eventually, Lehman says, it may become standard practice to perform only the ultrasound in this group of women.

"It is better at distinguishing or separating out those lumps that need a biopsy from those that can be safely followed," she says, talking only about women under 40 with lumps.

Women under 40 with a lump they can feel could consider asking t heir doctor to do the ultrasound first, Lehman says.

For women over 40 with no symptoms, regular screening mammograms is still the way to go, she says.

The new study findings may results in doctors changing their workup pattern for younger women with breast lumps, says Dr. Barbara Monsees, professor of radiology at Washington University in St. Louis and chair of the American College of Radiology Breast Imaging Commission.

She reviewed the findings but wasn't involved in the study. "Many will [now] start with ultrasound rather than mammograms," she predicts, talking only about women under 40 with lumps. "If the ultrasound does not answer the clinical concern, then mammography would be utilized. But mammography will not be needed in every case."

The college is currently updating their criteria for what to do in cases of breast masses in women under age 40, she says. The new version, due out soon,  will probably reflect the new research, she says.

Breast cancer in women under age 40 is rare, accounting for about 5% of all cases, research suggests.

Even so, Lehman says,  it does occur.  "Some women think if they don't have a family history of breast cancer and they are young they can't get breast cancer," she says.

Not true, she tells them. "Most women with breast cancer don't have a family history."

And women of any age who feel a breast lump need medical attention, experts say.

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