Early detection is the breast cancer community's best friend when it comes to combating this disease. Among the many screening and diagnostic tests options, mammograms and ultrasounds of the breast are two of the most popular. While both imaging tests are vital to breast imaging, they operate in very different ways. Knowing how they differ, when one should use each, and what the results will be like can help women make educated choices about the health of their breasts.
The blog discusses the primary differences between mammograms and ultrasounds, their advantages and limitations, cost comparisons in India, and how they support one another for efficient detection of breast cancer.
Read Also: Mammography Test in Mumbai, India: Procedure, Costs, and What to Expect
What Is a Mammogram?
A mammogram is a radiologic imaging procedure that employs low-dose X-rays to visualize the internal breast structures. It is the gold standard for breast cancer screening, especially for early stage, small tumors which are not yet palpable.Types of Mammograms
Screening Mammogram
Screening mammograms are done on women with no symptoms or abnormalities of the breast. The goal is detection early, frequently before a lump is detectable on a self-exam or clinical exam. Annual or biennial screening mammograms beginning at age 40 for women with an average risk is recommended in most health guidelines.Diagnostic Mammogram
When symptoms such as a lump, discharge from the nipple, or abnormal findings on a screening mammogram are present, a diagnostic mammogram is used. Diagnostic mammograms emphasize specific areas of concern and include additional X-ray views from various angles to give precise visualization.What Mammograms Detect
Mammograms may detect:- Microcalcifications (small calcium deposits that could be evidence of early breast cancer)
- Tumors or masses
- Breast tissue changes over time
- Abnormalities too small to be seen by the naked eye
3D Mammography (Tomosynthesis)
3D mammography, or digital breast tomosynthesis, is a more advanced form of the standard mammogram. It takes several images of the breast from various directions and stacks them to create a three-dimensional image. This minimizes the overlap of breast tissues, especially helpful for women with dense breasts.Advantages of 3D mammography:
- Enhanced cancer detection rates
- Lower false positives
- Improved visibility of dense breast tissue
What Is a Breast Ultrasound?
A breast ultrasound is a non-invasive medical imaging procedure that employs high-frequency sound waves to produce real-time pictures of the inside of the breast. It is not performed with radiation like mammography. It is very useful for assessing lumps or abnormalities discovered on a mammogram or physical exam.Ultrasound Uses
- To differentiate between solid tumors and fluid-filled cysts
- To assess abnormalities identified on a mammogram
- For imaging younger women, who often have denser breast tissue
- As a guidance tool for biopsies
Mammogram vs Breast Ultrasound: Key Differences
| Aspect | Mammogram | Breast Ultrasound |
| Technology | Low-dose X-rays | High-frequency sound waves |
| Primary Use | Screening and early detection | Diagnostic follow-up and lesion analysis |
| Radiation Exposure | Yes (low dose) | No |
| Comfort | Requires breast compression | No compression, generally painless |
| Detection | Best for microcalcifications and small cancers | Best for cysts and distinguishing tissue types |
| Age Group | Recommended for women 40+ for screening | Preferred for younger women or pregnant women |
| View Coverage | Entire breast | Targeted areas only |
Which Is Better: Mammogram or Ultrasound?
The response hinges on the reason for the imaging.- For early detection: Mammograms are superior since they can pick up microcalcifications and small tumors that are not palpable.
- For dense breasts: Ultrasound is sometimes employed in addition to mammograms, since dense breast tissue will hide tumors on X-rays.
- For younger women or in pregnancy: Ultrasound is utilized since there is no radiation.
- To describe lumps: Ultrasound is good at differentiating between cysts and solid lumps.
Dense Breast Tissue and the Challenges it Presents
Dense breast tissue contains a higher percentage of fibrous and glandular tissue than fatty tissue. Dense tissue and tumors both show up as white on a mammogram, so it is harder to detect them.Why Density Matters:
- Dense breasts can decrease the sensitivity of mammograms.
- Slightly higher risk of breast cancer in women with dense breasts.
- 3D mammography (tomosynthesis): Decreases the problem of overlapping tissue.
- Supplemental ultrasound: May catch cancers that mammograms do not.
- MRI: For women at very high risk, but not generally used for regular screening because it's expensive and has a high rate of false positives.
Screening vs Diagnostic Mammogram
Screening Mammogram:
- Utilized as a preventive process.
- Concerned with finding cancer at an early stage, even if there are no symptoms.
- Typically done every year or two starting at age 40.
Diagnostic Mammogram:
- Performed when there are certain symptoms like a lump or abnormal findings on a screening mammogram.
- Includes extra views and more magnification to closely examine the area of concern.
Ultrasound as a Diagnostic Tool
Breast ultrasound is not typically employed for screening but is crucial in cases where mammogram findings are unclear or more definition is necessary.Strengths of Ultrasound:
- Safe for people of all ages, including pregnant women.
- Differentiated between tumors and cysts.
- Offers real-time images, which is beneficial for procedures such as biopsies.
Disadvantages of Ultrasound:
- Will not pick up microcalcifications.
- Will miss some cancers at an early stage.
- Dependent on the operator, so it may be less accurate.
When to Opt for Ultrasound Instead:
- For women under 30: Ultrasound is usually the first option because of the density of their breast tissue.
- For pregnant or lactating women: It does not expose them to X-rays.
- For palpable lumps: Ultrasound can easily diagnose whether a lump is a cyst.
- For supplemental screening: In dense breasts, ultrasound is utilized in addition to mammograms to scan.
Accuracy and Effectiveness
Mammogram Accuracy:
Mammography has been shown to lower the rate of death from breast cancer by catching cancers early. Mammography is not flawless, though, and can occasionally lead to false positives (indicated cancer when there is none) or false negatives (missing cancer).Ultrasound Accuracy:
Ultrasound works well for assessing particular lumps or abnormalities but is not as effective as a screening method to start with since it can miss early cancer that is not visible as masses.Cost of Breast Imaging in India
Breast ultrasound and mammogram cost is significantly less in India compared to Western nations, and these procedures can be accessed by a broader population due to this reason.- Screening Mammogram: ₹1,500 – ₹3,000
- Diagnostic Mammogram: ₹2,500 – ₹5,000
- 3D Mammogram: ₹3,000 – ₹6,000
- Breast Ultrasound: ₹1,000 – ₹2,000 per breast
- Mammogram + Ultrasound Packages combined: ₹2,500 – ₹5,000 based on location and hospital
Breast Imaging Tests Comparison
Following is a brief overview of when each imaging test is advisable:| Test | Primary Purpose | Best For |
| Mammogram | Route screening and early detection | Women over 40 years, early cancers |
| 3D Mammogram | Faster detection, fewer false alarms | Women with dense breasts |
| Ultrasound | Follow-up diagnostic, cyst versus solid lump evaluation | Young women with dense breasts |
| MRI | High-risk screening for genetic risk factors | - |
Benefits vs Drawbacks
Mammogram Benefits:
- Catches cancers early, usually before symptoms occur.
- Decreases breast cancer deaths.
- Catches microcalcifications that sonography cannot.
Mammogram Drawbacks:
- Brief discomfort because of breast compression.
- Exposure to low-dose radiation.
- Potentially decreased accuracy in dense breasts.
Ultrasound Benefits:
- No radiation.
- Good at telling solid from fluid-filled lumps.
- Best for pregnant women or women under the age of 30.
Ultrasound Drawbacks:
- Less effective in detecting cancer early.
- May produce false-positive results and cause unnecessary biopsies.
Recommended Screening Approach
- Aged 40 and older: Every year, 2D or 3D mammograms, with ultrasound if necessary.
- Women under 30 or pregnant: Ultrasound is the preferred option.
- High-risk women (genetic mutations or family history): MRI and combination with mammography and ultrasound.
- Dense breasts: Mammography combined with ultrasound for better detection.
Last Takeaways
A mammogram is more suitable for routine screening and early cancer detection, particularly for the identification of microcalcifications.A breast ultrasound is a valuable added-value tool, especially in younger women, dense breasts, and lumps differentiation.
Together, mammography and ultrasound tend to yield the best results. Both are inexpensive and readily available in India and thus early detection is possible.
