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Women at high risk for breast cancer, including women with a BRCA mutation, women with a family history of breast cancer, and women with dense breast tissue, have several supplemental screening options beyond standard mammography. These include 3-D mammography (also sometimes called "breast tomosynthesis"), Automated Breast Ultrasound (ABUS), Breast-Specific Gamma Imaging (BSGI), and Breast MRI. This article, presented in Q&A format, focuses on Automated Breast Ultrasound (ABUS).
How is ABUS different than regular ultrasound?
We'll focus on the somo-v ABUS system from U-Systems (Sunnyvale, CA). Both use sound waves to detect abnormal structures in the breast that could be tumors. With regular ultrasound (hand-held ultrasound, or HHUS) either a radiologist or a highly-trained technician called a sonographer moves a kind of wand ("transducer") over the surface of the breast. Think of the wand like a flashlight. As she moves the wand, she looks at the image on a monitor in real-time, trying to see possible tumors. Images can also be captured for later viewing. With ABUS, a much larger transducer is configured over the breast (it isn't manually moved over the breast), automatically taking different ultrasound images from different angles. These are then processed by a computer to construct a 3-D image.
What are the main advantages of ABUS?
First, the 3-D image gives a more complete picture of the entire breast than HHUS. Second, the images can be compared from year to year, or between visits, so any changes in the breast are easier to detect. Finally, the method does not require a diagnostic medical sonographer to perform. The imaging is automated, similar to mammography. So you don’t have to worry about whether or not the technician might be less experienced. Most ultrasound sonographers are trained and accredited. But their level of experience can also matter with HHUS.
What systems are out there?
The main system on the market is called the somo-v INSIGHT Automated Breast Ultrasound (ABUS) system. It was developed by U-Systems, a company in California that pioneered the field. A similar competing system called the ACUSON S2000 Automated Breast Volume Scanner (ABVS) is marketed by the large German company Seimens AG.
Can Automated Breast Ultrasound be used for screening?
The simple answer is "Yes, and it increasingly is." But realize that breast ultrasound, automated or not, is usually performed as a diagnostic procedure to further characterize a suspicious mammogram or MRI result. It's also commonly used to help surgeons guide needles when they perform biopsies. Ultrasound is not traditionally used for screening to assess women with no suspicion of disease. However, given the growing concerns about mammography and women with dense breast tissue, ultrasound is increasingly used as a second, supplemental screening method for that subgroup of women. Generally, screening methods need to be more automated and require less technical skill than diagnostic methods, simply because more tests have to be performed more rapidly. This is part of the appeal of the ABUS system. But read on...
Is ABUS approved for screening in the United States?
No. It's approved for diagnosis, but not for screening. That doesn't keep physicians from using it as a screening method. It does keep U-Systems from marketing it for screening. U-systems is conducting a large study (20,000 women with dense breasts) in the United States to gain approval for screening. The study is looking at whether screening with mammography plus ABUS outperforms mammography alone. Here we're talking about traditional 2-D mammography and not 3-D mammography (tomosynthesis). Enrollment continues, but the company already feels the data are strong and so they submitted an application to the FDA in April 2011. The FDA could decide at any time.
Is ABUS approved for screening outside the US?
Yes, in Canada and in Europe. It was approved as a screening method by the Canadian regulatory agency Health Canada just last month (Aug 2011). It was granted European Union marketing approval a year ago (Sept 2010).
Is there a way that I can see how it works?
The somo-v system was recently featured on Dr. Oz. You can search for it on YouTube. Their site has three videos of that episode, which is all about supplemental breast screening. Watch all three if you have time. If you just want to see the somo-v system, just watch part 2. Once you get there, you'll see the links to parts 1 and 3. Sorry but they're going to subject you to some commercials...
How much does it cost?
That depends on the facility providing the service, but typically about $250-300.
Will it be covered by insurance?
That also depends on the judgment and policy of the facility you use, but often it's reimbursed.
How can I find a doctor that performs ABUS in my area?
First, you might check to see if you can get access through U-Systems' clinical study. Data from the trial have already been submitted, but they might still be recruiting. Outside of the clinical trial, it might take you a lot of time to call breast centers on your own. I'd probably just call the company (1-866-364-6777). Legally, remember, they can't talk about the system for screening. So just ask where there's a system installed in your area and hold the screening questions for the facility.
Where can I find more information on ABUS?
Go to the somo-v Automated Breast Ultrasound page on LATESTBreastCancer.com. There you'll find all the most recent web links to high-quality news articles and medical journal abstracts about every new medical option.
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