Breast ultrasounds found 100 percent of suspicious cancers in women under 40 who found lumps or other suspicious areas of the breast, offering a cheaper, less-invasive alternative to surgery or biopsies, U.S. researchers said on Wednesday.
They said targeted ultrasound — which examines just the area of the breast where a lump is identified — should become the standard of care for women under 40.
The findings may address some of the concerns raised by a federal advisory panel about breast exams done by women or doctors to investigate lumps or hot spots in the breast, which most often turn out to be harmless.
In a controversial set of recommendations issued last month, the U.S. Preventive Services Task Force recommended that women not be taught to perform self breast exams because they often result in worry and expense for tests, biopsies and unnecessary surgery.
"That concerns us because while breast cancer in young women is rare, it absolutely does occur. Often, those cancers are only diagnosed because the woman noticed the lump in her breast or her doctor noticed a lump in her breast," said Dr. Constance Lehman of the University of Washington and director of imaging at the Seattle Cancer Care Alliance, who presented her findings at the Radiological Society of America meeting in Chicago.
"There are harms that follow after a woman does a self breast exam — unnecessary surgeries, unnecessary biopsies. To that point, what we're saying is if you use imaging appropriately you can avoid those harms," Lehman said in a telephone interview.
Lehman did two studies testing the effectiveness of ultrasound to distinguish between potentially cancerous lumps and harmless masses in younger women.
In one, they studied more than 1,100 ultrasound exams of women under age 30. In the second, they studied 1,500 exams in women aged 30 to 39.
In both studies, ultrasound correctly identified the cancers and all of the benign breast changes. The only cancer not found was in a region of the breast that was not identified as an area of concern. Instead, it was identified by a full breast mammogram.
"Less than 3 percent of the patients that presented in this way had cancer. But it's important for us to find those patients that did have cancer," Lehman said.
"We had 26 women whose cancers were diagnosed because they brought the lump to the attention of their doctor, or their doctor brought the lump to the attention of the breast imaging specialist," she said.
Lehman said in the United States there is no standard way of treating women under age 40 who find a lump in their breast.
"Some of them go to the operating room to have the lump removed. Others have it followed. Others have a needle biopsy and we wanted to bring some clarity to this treatment," she said.
She said ultrasound is a quick and easy test that uses sound waves to create an image of the breast. It typically costs $100 to $200 per exam.
Lehman said using ultrasound could help balance some of the harms of overtreatment with the benefits of self breast exams in women under age 40, who are too young for routine mammogram screening even under the American Cancer Society guidelines.
The task force also recommended against routine mammogram screening for women in their 40s for many of the same reasons, a change the American Cancer Society and many other breast cancer experts reject.