Terri Mallioux felt uneasy despite receiving a clean mammogram last year.
Mallioux is one of the 40 percent of U.S. women the National Cancer Institute estimates have dense breast tissue, and she understands the difficulty it can cause.
"A mammogram is a fabulous test, but it is not the only test for everyone," she said. "I knew over time it was very difficult to read my mammograms."
Dense breasts have a high amount of glandular and connective tissue compared to less-dense breasts, which contain a high amount of fatty tissue. Radiologists score a breast's density on a scale of 1 to 4, from least to most dense.
Mallioux is among the 10 percent of U.S. women who have the densest ranking, so she decided to have an additional screening.
A mammogram is an X-ray of the breast. A traditional screening mammogram typically takes X-rays of each breast from two different angles. Cancer in a dense breast can be hard to see on a mammogram because a tumor or mass can blend into the tissue.
Insurance covers screening mammograms as part of required preventative care, but often does not cover the cost of additional or enhanced screenings based solely on breast density.
Mallioux decided to pay to have a whole-breast ultrasound at the Breast Center of Northwest Arkansas with a machine called SonoCine.
"It was the best $275 I've ever spent," Mallioux said.
Mallioux's second screening spotted a small tumor, which doctors said probably would have gone undiagnosed for a couple of years. She was 47 years old when diagnosed June 12. She had a lumpectomy and 20 radiation sessions and avoided chemotherapy.
Mallioux is a proponent of legislation that would require screening centers to inform women if they have dense breast tissue and suggest they discuss additional screening with their doctor.
"Screening is always the key. The highest survival chances are if we catch cancer early," said Lauren Marquette, director of mission services for the Ozark Affiliate of Susan G. Komen for the Cure. "We have all these new screening tools that can paint a more complete picture. We are all for more and better screenings."
Not everyone agrees.
A report released in the Annals of Internal Medicine in December concludes that supplemental ultrasound screening for women with dense breasts would substantially increase costs with little improvement in overall lifespans.
Brian Sprague, lead study researcher from the University of Vermont Cancer Center, stated in the study that ultrasound screenings caught a few cancers but caused a substantial increase in biopsies and costs for women with dense breasts. He said more research is needed to find the best approach to screening women with dense breasts.
The study estimated that four breast cancer deaths would be prevented for every 10,000 women between the ages of 50 and 74 with dense breasts who received ultrasound screening exams after a normal mammogram. The screening would also cause an additional 3,500 biopsies in women who did not have breast cancer. The study used computer modeling.
The study was paid for by the National Cancer Institute and conducted by Sprague and colleagues within the national Breast Cancer Surveillance Consortium and the Cancer Intervention and Surveillance Modelling Network.
Several studies by various medical groups determined that most tumors detected by ultrasound would eventually be caught by mammogram.
Dr. Steven Harms of the Breast Center rebutted the findings, pointing to the eight cancers the SonoCine has caught since the machine was installed in 2012.
"Breast cancer is better treated the earlier you catch it," he said. "You can't tell people they don't have cancer with a negative mammogram if they have dense breasts."
The Breast Center has done about 1,500 whole-breast ultrasounds at its Fayetteville and Bentonville clinics since 2012. The clinic started performing diagnostic screenings in Bentonville two years ago and added a SonoCine last fall.
Jason Wilson, Medical Associates CEO, said work began on a Bentonville center expansion in March. The project adds about 1,000 square feet of space and two exam rooms.
"It doubles our capacity due to demand," Wilson said.
Harms has been a leader in enhanced breast cancer screening for many years. He helped develop the use of magnetic resonance imaging for patients at high risk of breast cancer in 1990. The MRI also works to screen women with dense breast tissue.
"The MRI is the best test we have, but it is more expensive" than other screening techniques, Harms said.
The SonoCine is a more cost-effective option for patients who must pay out-of-pocket for additional screening.
Most insurance plans don't cover the cost of the ultrasound, but will pay for an MRI in high-risk patients. Some insurance companies are starting to cover the costs of another screening procedure, tomosynthesis, or three-dimensional mammography.
Max Greenwood, spokesman for Arkansas Blue Cross and Blue Shield, said the insurer covers breast MRIs for high-risk individuals.
"It's not automatic, but if there is something that raises a red flag, we will cover it," she said.
She said Blue Cross and Blue Shield is constantly reviewing its policies to keep up with new medical findings. The insurer's medical policy committee and internal medical directors decided not to cover whole-breast ultrasounds because there is not enough evidence the procedure saves lives, she said.
Despite the skepticism, Mallioux and others are pushing for legislation to help educate women about their screening options.
The Breast Density and Mammography Reporting Act of the 111th Congress was introduced in February and referred to the Senate Committee on Health, Education, Labor and Pensions.
The bill sets a minimum federal standard, designated by the secretary of Health and Human Services, for dense breast tissue notification and recommends women discuss with their doctors if additional screening is necessary. The bill also directs Human Services to study improved screening options for women with dense tissue.
Twenty-one states have laws requiring breast density notification, and seven more have bills introduced. No such legislation has been introduced in Arkansas.
But Harms said the Breast Center decided it did not need legislation to inform women.
"We don't see patients who want a mammogram. We see patients who want to know they don't have cancer," he said. "And you can't stop just at telling them they have dense breasts. You need to take it to the next level."
Mallioux said she hopes her story helps other women with dense breast tissue understand their options.
"I'm living proof that additional screening makes a difference," Mallioux said. "I took my diagnosis as a sign I need to educate people."
Metro on 04/26/2015