Mammography involves a method in which high-quality X-ray radiation at a very low dose is used on the breast to detect breast cancer or other breast diseases, while breast ultrasound is a technique that uses ultrasound waves to perform scans.
Especially for women under 40, ultrasound is recommended as an initial diagnostic test, and sometimes for women over this age in addition to mammography. After the age of 40, mammography is recommended, as it is more accurate for detecting breast cancer. It should be noted that the risk of developing breast cancer increases with age. Since the incidence of breast cancer increases with age, individuals aged 40 and above should take greater care and participate regularly in breast screening. Breast cancer screening is recommended every two years for individuals over 50 and annually for those aged 40 to 49. Typically, mammography and ultrasound are used for breast cancer detection.

In summary, in mammography:

• It involves the use of X-rays.

• It is performed while standing with a device called a mammogram, which requires moderate compression of the breast.
• No special preparation is needed for the test, but the mammogram should be done a week after your period.

In summary, in the ultrasound:

• A gel-coated probe is used to facilitate movement.
• Ultrasound waves are used instead of X-rays, which are reflected from the area under examination, particularly the breast, and converted into images.
• The result depends on the operator to perform the work accurately and obtain the images well. However, one advantage is that there is no need to compress the breast.
• No prior preparation is needed for a breast ultrasound.

Which is better for diagnosing breast cancer, ultrasound or mammography?

Currently, most mammography devices are digital, which have the advantage of providing better X-ray imaging with a lower dose of radiation. Some devices are now being offered with new three-dimensional technology or tomosynthesis, which provides tomographic images of the breast that help distinguish specific issues and accurately determine their location. Depending on breast density, lighter or darker areas can be seen in a mammogram.
It’s usually not the case that a mammogram is better than an ultrasound or vice versa. There are many factors that determine whether ultrasound or mammography is the more suitable method for each individual.
In general, mammography is the primary screening tool for breast cancer, but ultrasound is not used as a standalone breast cancer screening test; rather, it is prescribed when a lump is detected or when an abnormality is identified in a diagnostic device. Therefore, in this regard, both methods work together in the detection of breast cancer.
Women often ask whether they can skip mammography and opt for ultrasound instead, as the latter is less painful. However, numerous studies have shown that mammography is the most effective screening tool for the early detection of breast cancer and for reducing mortality rates.

The main differences between mammography and ultrasound

Mammography is a screening tool that uses low-dose X-rays to examine the breasts. It works by compressing the breasts between two plates, and often during this process, the individual feels pressure. Some women may even feel discomfort due to this compression, but this technique is essential for obtaining clear images to detect small abnormalities or microcalcifications, which are tiny calcium deposits found in early breast cancer.
Then the images are analyzed by radiologists. If the findings indicate the presence of a mass or appear unclear, the individual may be asked to undergo further tests such as an ultrasound. Typically, about 5 to 10 percent of women are called back for further testing, but fortunately, more than 90 percent of these cases are non-cancerous.

However, ultrasound uses high-frequency sound waves to assess the tissues inside the body and convert them into images. Unlike mammography, there is no radiation in ultrasound, which makes it safe for pregnant women. A small probe moves across the breast to determine if there are any lumps, including solid lumps that indicate conditions such as fibroadenomas or cancer, or fluid-filled lumps that resemble cysts. Therefore, ultrasound provides additional information that cannot be obtained through mammography.

Why shouldn’t one go directly for an ultrasound?

While ultrasound appears to be more efficient and cost-effective, mammography should always be the first choice for breast cancer screening, as ultrasound has specific limitations that make it an unsuitable screening test.These limitations are as follows:
•Inability to take a photo of the entire breast at the same time.
Ultrasound uses a handheld probe to focus on abnormal areas around the breast, which is prone to errors and operator-dependent.
•Inability to examine the deep areas inside the breast.
While ultrasound is very useful for evaluating superficial masses, mammography is better for detecting deeper abnormalities in breast tissue.
•Not showing microcalcifications.
Microcalcifications are small clusters of calcium around a tumor and are often detected in mammography. Although calcifications may be natural, if they appear in specific patterns or clusters, it can be the first sign of cancer.

When is ultrasound more useful than mammography?

With all that has been said in the previous section, it does not mean that ultrasound is not useful. There are several cases where ultrasound may be a more suitable option, such as the following:
• You feel a palpable lump, but the mammogram shows no abnormalities.
• You have breast problems and you are in your 20s or 30s.
You have breast problems and you are pregnant.
• You have a cyst that needs to be drained.
There are also cases where women with dense breast tissue need both mammography and ultrasound.
It is important to always take breast cancer detection seriously and participate in regular screenings, which for most women begins with a mammogram.