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Melanie Cole: UAB Med Cast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please visit UABmedicine.org/medcast and complete the episodes post-test.

Introduction: Welcome to UAB Med Cast continuing education podcast from medical professionals bringing knowledge to your world. Here's Melanie Cole.

Melanie Cole: Welcome to UAB Med Cast. I'm Melanie Cole. Today we're talking about ABUS technology. Joining me is Dr. Stefanie Woodard. She's an Assistant Program Director in Diagnostic Radiology Residency Program at UAB Medicine. Dr. Woodard, it's a pleasure to have you join us today. First, let's start about the issue to discuss dense breast tissue and conventional mammogram and what's been the case over the years.

Dr. Woodard: The issue with mammography in dense breast tissue is that we know that even though mammography is great and does detect a lot of cancers and has helped to decrease the death rate of cancer due to finding early cancers, it misses cancers when breast tissue is dense. Which is in about 40% of our population, so we've known that for awhile, but really there wasn't a good answer as to what we could do to combat that. And there have been some different suggestions, different ideas, more recently, whole breast screening ultrasound has been investigated. It actually has been going on for quite some time, but in the last several years, the technology of an automated system has become available. That's what we're talking about today. The whole breast ultrasound or ABUS, which is automated breast ultrasound. And it's allowed for detection of really small cancers that are clinically significant, which are those that are invasive could potentially shorten someone's life expectancy.

It's been a great exam because it's reproducible. Having an automated exam, people used to do this handheld and still do where the automated system's not available, but this allows a reproducible exam fairly easy for a technologist or anybody really to do because it doesn't require a high level of skill to perform the exam and it's fairly accepted by patients, doesn't require the kind of compression that mammography does. It's fairly short, about 15 to 20 minutes is kind of the standard amount of time that it takes for a patient to have an exam. And no radiation, which is fantastic, which we all love.

Host: Well. That is certainly really encouraging for women and for other providers to hear so that they can be recommending this. Why not skip to MRI if density is an issue?

Dr. Woodard: Well MRI's a fantastic study and I don't want to discount anything. The MRI's is wonderful and does add a ton of information. The issue with MRI one, it does require an IV. It requires the use of IV dye for the examination and the other issue is fairly uncomfortable. The patient does have to lay on their stomach, currently that's the standard positioning, and they have to be put into the MRI machine. Which can be an issue if patients are claustrophobic, can be an issue because some patients just can't fit into the machine. Some patients can't have an MRI because of certain implants in their body that may not allow them to have an MRI. And the other issue with MRI is it's very, very sensitive. And what that word means is just basically it picks up a lot of stuff and that stuff may not end up being anything important.

And there's a lot of extra workup that comes from MRI that is unnecessary. And MRI does habits uses. And we do MRI for high risk patients and certain patient populations that definitely need that type of a scan. But not everybody needs that. It's also very expensive, which is a big difference between ABUS and an MRI. So the cost, and it varies based on where the location, insurance coverage for these exams. But MRI, we're talking in the thousands, where ABUS, we're talking lower hundreds. So even coverage I think has been up to about a hundred dollars is out of pocket for some places, and again that all depends, but it's vastly different as far as the cost. So all those things are reasons why, you know, not every patient needs to have that kind of an exam. And it certainly would be really overkill for screening in the general population, just not feasible.

Host: Well, then for the women that do qualify, and I'd like you to speak to that for a minute, but for the women that do qualify, is this an adjunct to tomosynthesis or standard mammography, which not that many people are using any more, but 3D are we doing this together? How often should this be done? Are they done in conjunction with each other kind of at the same time? Tell us a little bit about that and patient selection.

Dr. Woodard: It is an adjunct to mammography, so definitely not a substitution for mammography. In fact, whenever a patient comes in for an ABUS exam, we typically will check and make sure that the patient has had a mammogram within the past year. And if not, we'll have the patient go ahead and have the mammogram the same time that they're having their ABUS exam. Some providers have alternating exams, so they'll do them every six months. Again, that's not a hard recommendation and that's just a preference. A lot of patients like to come in and have their screening exam done the same day. So tomosynthesis, as you said, is kind of the preferred screening modality as opposed to just 2D mammography now and if it's available, tomosynthesis is recommended. Especially in dense breasts population. But ABUS would be the adjunct that they would have. At the same time, we do only recommend typically a yearly ABUS exam, so they wouldn't need to have more than one ABUS exam per year. And if an abnormality is seen on the ABUS exam, they may be called back for a targeted ultrasound to look at a specific area of breast tissue to do a further evaluation. But again, it would just be the standard evaluation. It's just a yearly ABUS with their yearly mammography exam.

Host: So you mentioned insurance a little bit before. Where does insurance stand as to this screening? And I mean, why aren't hospitals all over the country using this right now? They're calling it ABUS studies right now. Is this not nationwide yet? And if so, why not?

Dr. Woodard: No, not completely nationwide yet. Now there are more and more States that, for instance, some States like Connecticut and a lot of the Northeastern States have density reporting walls, so we have to actually report if a patient has dense breast tissue, we have to notify the patient. Some States actually require insurance coverage for additional dense breast tissue, and most insurance providers will cover it just because it is common knowledge, there've been multiple studies that have shown that dense breast tissue patients have a higher risk of developing breast cancer just due to the fact that they have dense breasts. For that reason, it is covered by a lot of insurance companies, but it's dependent on which particular insurance they have. If you go onto the different websites for the ABUS exams, most of the time we can look at the CPT code with that particular insurance company and see if it's covered ahead of time if the patients are concerned about that. But it all depends. It varies from state to state and from insurance company. So that's something that it's really good to let patients know about so they can check that out before they have the exam and see what they want to do.

Host: Really important information. Wrap it up for us. What would you like other radiologists and healthcare providers to know about ABUS? Any new clinical research that you can mention? Anything you'd like them to know to take forward to their patients?

Dr. Woodard: I really would like everyone to, especially providers that are sending patients for screening. If you have sent your patient for a mammogram and you see that it is reported that she does have dense breast tissue, please look into whole breast screening ultrasound and if it's possible in your area, this is a great supplemental tool for patients. They should be aware that they may be called back for something additional. We do know that that's a possibility. However, most of the time those are completely benign things that end up being found and the ability of ABUS to find small cancers is fantastic when patients have dense breast tissue. So I would recommend that if you do see that after you've referred a patient for a mammogram and you get that report to any of the providers, look into the supplemental screening available in your area for your patient. And you can have that discussion or the radiologists that are in the area, usually more than happy to have that discussion with the patient about the ABUS exam to tell them what it's like, what to expect. And don't hesitate to contact a radiologist in your area because it's really a fantastic exam, no radiation and overall decreased costs of other screening modalities as far as MRI and other ways to screen patients with dense breast tissue.

Host: Thank you so much Dr. Woodard for joining us today. And a community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. And that concludes this episode of UAB Med Cast. For more information on resources available at UAB Medicine, please visit our website at UABmedicine.org/physician. Please remember to subscribe, rate, and review this podcast and all the other UAB podcasts. I'm Melanie Cole.