October 2013

NCH's Automated Whole Breast Ultrasound screening

Dear Physician,
We have recently launched a breast density awareness program which informed screening mammography patients of their breast density, promote a patient-centric approach to breast cancer screening and offer supplemental screening using Automated Whole Breast Ultrasound (ABUS).

As you may know, women with dense breast tissue are at 4-6 times higher risk of developing breast cancer than women without dense tissue1. Additionally, in the dense breasted population, mammography screening alone misses more than one third of breast cancers2. Breast density is determined by the radiologist who reads the mammogram. Clearly, there is a need for women to be properly informed of their risk and screening options. Many states have now proposed and/or passed legislation mandating all screening mammography patients demonstrating greater than 50% breast density be informed of their density and the limitations of screening with mammography alone. Illinois law, Public Act 95-1045, mandates insurance coverage for whole breast ultrasound screening as an adjunct to mammography when determined to be medically necessary by a physician.

A growing number of studies, including ACRIN 6666,, 4 have shown a significant improvement in breast cancer detection in dense breast tissue with the use of screening ultrasonography as an adjunct to screening mammography. The most recent data shows that ABUS will detect cancer at a rate similar to mammography in this population, and the cancers tend toward small invasive lesions.

We are pleased to be the first in the Chicagoland area to offer such cutting-edge technology as ABUS. However, it should be noted that ABUS is a screening exam and differs from diagnostic ultrasound that specifically addresses an area of concern.

Acceptable coding for ultrasound breast screening is ICD-9 code 793.82 which states inconclusive mammography due to dense breast tissue.

If you would like to read further about breast density and ABUS, please refer to the following link

Lastly, I want to thank you for your support and would like to reiterate our continued commitment to providing state-of-the-art, quality care. Please do not hesitate to call with any questions you may have regarding our services.

Allan Malmed, MD

  1. Boyd NF, et al. Mammographic density and the risk and detection of breast cancer. New Eng J Med. 2007 Jan 18; 356(3): 227- 36.
  2. Mandelson MT, Oestreicher N, Porter PL, et al. Breast density as a predictor of mammographic detection: comparison of interval-and screen-detected cancers. J Nal Cancer Inst 2000; 92:1081-87
  3. Berg WA, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008; 299 (18): 2151-63
  4. Berg WA, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307 (13): 1394-1404