Despite Katie Couric’s advice, doctors say breast ultrasounds can be done

When Katie Couric shared the news of her breast cancer diagnosis, the former NBC Today show host said she saw this new health challenge as a time to encourage people to get screened for cancer.

“Please get your annual mammogram,” she wrote on her website last month. “But just as important, find out if you need additional testing.”

In the article, Couric, 65, explained that because she has dense breasts, she gets an ultrasound every year in addition to her mammogram to check for breast cancer. A breast ultrasound, also called a sonogram, uses sound waves to take pictures of breast tissue.

It can sometimes detect malignant tumors that are difficult to detect on mammograms in women with dense breasts, meaning a high proportion of fibrous tissue and glands and less fatty tissue.

Couric, who performed a colonoscopy live on television after her first husband died of colon cancer, and who lost a sister to pancreatic cancer, has long advocated for better screening options.

Breast cancer experts applauded Couric for drawing attention to breast density as a cancer risk factor. But they disagree with his defense of complementary testing.

“We have no evidence that incidental screening reduces breast cancer mortality or improves quality of life,” said Dr. Carol Mangione, a UCLA professor of medicine and public health who chairs the US Preventive Services Task Force. Recommendations about preventive services after a group of medical experts weighed the benefits and harms.

Couric did not respond to a request for comment.

In addition to annual mammograms, some women with dense breasts have an ultrasound or MRI to try to detect cancer cells that cannot be detected on a mammogram. On a mammogram, dense fibrous tissue appears white and makes it difficult to see a cancer, which also appears white. Fatty breast tissue, which appears dark on mammography, does not hide breast cancer.

As digital breast tomosynthesis, or 3D mammography, becomes more widespread, an increasing number of women are opting for this screening test instead of the standard 2D mammogram.

3D mammography reduces the number of false positives and appears to detect more cancers in some women with dense breasts, although the effect on mortality is unknown.

The task force gives ultrasound an “I” grade for women with dense breasts whose mammogram results do not indicate a problem. This means that the current evidence is insufficient to assess whether the benefits outweigh the harms of further testing.

One of the main adverse effects researchers worry about is false positives.

Complementary imaging in women who are not at high risk for breast cancer can identify potential problem spots, which can lead to follow-up tests, such as biopsies, which are invasive and often increase patients’ fear of cancer. But studies have shown that often these results turn out to be false alarms.

If 1,000 women with dense breasts were given an ultrasound after a negative mammogram, the ultrasound would detect two to three cancers, according to the study. But the additional images will also identify 117 potential problems that lead to follow-up visits and tests, but are ultimately determined to be false positives.

“On the one hand, we want to do everything we can to improve screening,” said Dr. Sharon Maas, an obstetrician-gynecologist in Morristown, New Jersey, and past president of the New Jersey chapter of the American College of Obstetricians and Gynecologists. . “But on the other hand, a lot of cost and emotional distress” is associated with false-positive results.

The professional group does not recommend supplemental screening for women with dense breasts who have no additional risk factors for cancer.

Many other professional groups have similar positions.

“We recommend a conversation with a health care provider, and for patients to understand if their breasts are dense,” Mass said. “But we don’t recommend that everyone get tested.”

In particular, for the roughly 8% of women whose breasts are extremely dense, further screening is worth a conversation with a doctor, Maas says.

Similarly, for women with dense breasts who have additional risk factors for breast cancer, such as a family history of the disease or a personal history of breast biopsy to check for suspected cancer, ultrasound may make sense, he said.

Dense breasts are relatively common. In the United States, approximately 43% of women over the age of 40 have breasts that are considered dense or very dense. In addition to making mammograms difficult to interpret, women with dense breasts are twice as likely to develop breast cancer as women with average density breasts, according to research.

Studies have shown that mammograms reduce breast cancer mortality. However, while it seems intuitive that more screening improves the chances of missing cancer, research has not shown that women are less likely to die from breast cancer if they have a follow-up ultrasound or MRI result. Mammogram is negative.

Thirty-eight states and the District of Columbia have laws that require patients to be informed of breast density after a mammogram, although not all mandate that women be informed of their own situation. Some states require insurance companies to cover supplemental tests.

In 2019, the Food and Drug Administration (FDA) proposed that information about breast density be included in the letters patients receive after a mammogram. The rule has not yet been finalized, but the agency has told lawmakers it expects to issue it in early 2023.

Complementary imaging tests can be expensive if your health plan doesn’t cover them. An ultrasound can cost $250, while an MRI can run $1,084 if you pay out of pocket, according to the Bram Foundation to Beat Breast Cancer.

Rep. Rosa DeLauro (Democrat of Connecticut) tweeted that Working on a bill With Couric that will cover MRI and ultrasound for women with dense breasts.

Some doctors recommend other measures that may be more effective than additional testing for women with dense breasts who want to reduce their risk of breast cancer.

“If you really want to help yourself, lose weight,” says Dr. Karla Kerlikoske, professor of medicine and epidemiology/biostatistics at the University of California-San Francisco, who has developed calculators to help people determine their cancer risk. From Mom “Moderate your alcohol intake and avoid long-term hormone replacement. These are things you can control.”

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