Whole-breast ultrasound (an ultrasound of the entire breast)  is a technology that can be used with mammography to screen the breast for breast cancers that cannot be felt on physical examination or cannot be seen with mammography.  The whole-breast ultrasound is designed to improve the detection rate of breast cancer in women with dense breasts, beyond what a mammogram alone can find. Ideally the ultrasound is done at the same appointment as the screening mammogram.

This type of ultrasound can be done in either of two ways:

• Hand-held whole-breast ultrasound—A physician or ultrasound technologist performs ultrasound of the entire breast using a hand-held ultrasound probe.
• Automated whole-breast ultrasound—A machine performs the examination with an ultrasound probe through an automated process. If any abnormalities are found, a hand-held ultrasound is then performed to further evaluate the machine’s finding.

You may be a candidate for this whole-breast ultrasound if you have dense breasts, which should be noted in your mammogram report by either of the following notations:

• “Extremely dense breasts” (or density score of 4)
• “Heterogeneously dense breasts” (or density score of 3)

Standard screening mammograms alone are less reliable at finding cancer in dense breasts; the cancer can get overshadowed by the dense tissue. Ultrasound may be able to find some cancers missed by the mammogram as the sound waves of ultrasound better penetrate the dense tissue. Whole-breast ultrasound should be done in addition to, but not replace, the screening mammogram. The mammogram may still detect findings that an ultrasound alone might miss, such as small calcium deposits called calcifications.

Like any ultrasound, whole-breast ultrasound uses sound waves to produce the image. No ionizing radiation is involved.

Insurance coverage for whole-breast ultrasound is evolving. In some states, insurance must cover screening by whole-breast ultrasound. Check with your doctor to learn about your breast density and to see if you are a candidate for whole-breast ultrasound. Before having the exam, contact your insurance company to find out whether this test is covered for you.