Forbes/ Pharma & Healthcare | Elaine Schattner | FEB 16, 2015 @ 07:00 AM

It’s hard to understand opposition to screening middle-aged women for breast cancer. Mammography finds tumors early in over 80 percent of cases. The question is how to make the process safer, more accurate and efficient.

The optimal screening program should include ultrasound for women with dense breasts. The sound-wave test is good for detecting invasive cancers that are otherwise hard-to-spot in cloudy mammograms of dense breasts. The procedure should be covered by insurance and provided by expert radiologists who specialize in breast imaging.

The latest fuss about breast cancer screening has to do with this very issue. Some radiologists suggest it’s inadvisable or impractical to inform all women with dense breasts that an ultrasound might help clarify their cancer status, to know if they’re clear. Just last week, a perspective in a prestigious medical journal came down on legislation that would assure women have this information. The physician authors emphasize the role of “grassroots organizations and laypeople” in the push for women’s access to information about their breasts and supplemental studies.

The benefits of breast ultrasound – compared to other methods of breast cancer screening – are several. First, there’s no radiation. Zip. The sound-wave test is like an echocardiogram (to image the heart) or a sonogram many have while pregnant to check the fetus’s beating heart and developing limbs. In itself, ultrasound is safe and essentially harmless (without a biopsy, see below). And it’s inexpensive, especially as things go in radiology.

Courtesy of GE Healthcare: In the left panel, an ultrasound image obtained with GE’s Automated Breast Ultrasound (ABUS) system reveals a dark spot in the lower left breast (where thin blue and green “crosshair” lines meet) consistent with an invasive malignancy. In the right panel, a standard mammographic image of the same breast shows dense tissue with non-specific calcifications.

Low cost may be part of ultrasound’s problem – why some radiologists don’t favor mandatory notification. Today CMS pays in the range of $108 to $200 for bilateral breast ultrasound including fees for the doctor’s interpretation. Rates vary, depending on where the procedure is done. Typical reimbursement is around $150. The same government service pays around $540 for bilateral breast MRIs with interpretation.