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Posted by Betsy Mullen on 8/12/2000 from 152.163.204.29:

In reply to: Breast MRI vs. Ultrasound? posted by Susan on 8/12/2000 from 166.62.77.11:

Dear Susan:

This is a complicated question. One key factor to take into consideration is your age. Premenopausal women particularly women in their 20's and 30's tend to have dense breast tissue which is why traditionally, baseline mammograms begin between the ages of 40-50. So...if you are younger, this might be an option.

Another key question is whether or not you have breast implants. There are some schools of thought that recommend an occasional breast screening with magnetic resonance imaging (MRI) for women with a breast implant(s). MRI does not involve any exposure to radiation, although it is important to keep in mind that such exposure is minimal with mammograms.

It is important for you to know that many states and communities have great low and no-cost breast cancer screening programs. Qualifications are based on age and financial/insurance status. California, for example, will cover screening and detection services all the way up to an excisional (surgical) biopsy for women at or below 200% of the federal poverty level. We are fortunate in California, that we also have a breast cancer treatment fund for medically underserved patients. I have included a link (below) to WIN ABC’s on-line Resources Section that can link you to low/no-cost screening services.

If you need assistance in finding a screening program in your area, please feel free to call or e-mail our staff – we will be pleased to help you in any way that we can. You are more than welcome to call us at (626) 332-2255. If it is a long distance call for you, just ask us to call you right back so that the call is "on our dime."

You are also welcome to fill out the special form (blue link at the top of this page) with your specific information and with requests for some of the information and resources I have outlined here. Your e-mailed form will remain confidential.

MRI is gaining recognition as a very effective method to detect a ruptured or leaking breast implant and as a breast screening method that may be more effective than mammography for women who have implants. It takes a skilled MRI technician/expert to detect an area of concern in a breast MRI because when a dye is used w/ MRI, (used to help with the reading of tumor tissue) both the breast tissue and the dye appear bright so a trained eye needs to analyze the images. (Source: The Complete Book of Breast Care by Niels H. Lauerson, MD, PhD and Eileen Stukane)

WIN Against Breast Cancer has several resources that I think will be very helpful to you. We have trained information specialists in our offices that can speak with you one on one to determine the best materials to send you (all free of charge). WIN ABC has an in-depth resource guide with additional resources and suggested reading; a series of audiotapes with a booklet produced by the NCCS entitled "Finding ways to Pay for Care"; and much, much more.

AN IMPORTANT REMINDER: It is very difficult to render an opinion without knowing all the facts of any one particular case. But one strong recommendation we would like to make is that you pursue your question(s) with your own physicians. You should feel fully empowered to obtain a satisfactory answer and feel free to seek a second, third or even fourth opinion. We have some great tips on partnering with your health care team and key questions to ask your doctors, communication tips and informed decision-making tips to help you get the information you need.


Here is some additional information that I hope you find helpful:

Excerpts from: Breast Imaging Questions

Source: Richard L. Ellis, M.D.
Memorial Medical Center, Department of Radiology
Division of Breast Imaging. Springfield, Illinois 62794


Q: Why is ultrasound performed in addition to mammography?

Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography.

A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas.


Q: What other diagnostic procedures are performed in mammography?

Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special X-ray maneuvers and magnification of the abnormality in question as mentioned previously.

Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and is not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (X-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance.

Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment.

Nuclear Medicine Imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions.


Richard L. Ellis, M.D.
Memorial Medical Center
Department of Radiology
Division of Breast Imaging
Springfield, Illinois 62794


Susan, I am holding you in my thoughts and look forward to hearing from you with an update on how you are doing.

My best regards,
Betsy Mullen
Founder, President/CEO
WIN Against Breast Cancer
(626) 332-2255

• Low and No-cost Breast Cancer Screening Services

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