Can I get a breast ultrasound instead of a mammogram?

The two tests are not interchangeable, because they answer different questions. Ultrasound is very good at telling whether a lump you can feel is a fluid-filled cyst or a solid mass, at taking a closer look at something a mammogram has already flagged, and at guiding the needle during a biopsy. It is usually the second step, not the first one.

At what age should I start mammograms, and how often?

The U.S. Preventive Services Task Force, the American Cancer Society, the American College of Radiology and the Society of Breast Imaging all support starting screening at age 40. Where they differ is frequency: the American College of Radiology and the Society of Breast Imaging recommend every year, while the Task Force recommends every two years. Your own history, including family history and prior biopsies, affects which schedule fits you.

Do dense breasts mean I need extra screening?

Not automatically. Whether you need anything beyond your regular mammogram depends on your overall risk, not on density alone. Additional ultrasound is sometimes added for women with dense tissue depending on their overall risk. Bring the report with you and talk it through with your doctor or other healthcare provider.

Mammogram or Ultrasound? What Each Test Actually Sees

Q: What does a mammogram see that an ultrasound does not?

Microcalcifications. These are tiny flecks of calcium in the breast tissue, far too small to feel, and they are often the very first sign of ductal carcinoma in situ (DCIS), a very early breast cancer. A mammogram picks them up. An ultrasound usually does not, especially when the flecks are small and there is no lump to find.

Q: Is thermography a safe alternative to a mammogram?

No. The FDA has been direct about this: a thermogram is not a substitute for a mammogram, and the agency has warned against unapproved thermography devices sold as screening tools. Thermography measures heat patterns at the skin surface. It does not find microcalcifications, and it has never been shown to reduce breast cancer deaths.

G. DeAn Strobel, MD, FACOG

4 days ago

4 min read

If you have spent any time online lately, you have probably seen someone explain why you should skip your mammogram. Get a thermogram instead. Ask for an ultrasound. Wait until you are 50. Do not bother at all.

Some of that advice is well meant. Some of it is half-remembering something real. Very little of it comes from someone who has sat with a woman while she waited on a biopsy result.

Here is what each test actually does, where the experts genuinely disagree, and how to think about what is right for you.

What does a mammogram see that an ultrasound does not?

This is the question underneath most of the confusion, and it has a specific answer: microcalcifications.

Microcalcifications are tiny flecks of calcium in the breast tissue. They are far too small to feel, and they are often the very first sign of ductal carcinoma in situ (DCIS), a very early breast cancer. A mammogram picks them up. An ultrasound usually does not - especially when the flecks are small and there is no lump to find.

Side-by-side mammogram comparison: a normal mammogram on the left, and on the right a mammogram showing a cluster of white microcalcifications marked with an arrow. — Microcalcifications found on mammogram.

That single difference is the whole answer to "can I just get an ultrasound instead?" The two tests are not interchangeable. They answer different questions.

So when is an ultrasound the right test?

Often - just not instead of a mammogram.

Ultrasound is very good at telling whether a lump you can feel is a fluid-filled cyst or a solid mass. It is used to take a closer look at something a mammogram has already flagged. It guides the needle during a biopsy. And it is sometimes added for women with dense breast tissue, depending on their overall risk.

In other words, ultrasound is usually the second step, not the first one.

The same area of breast tissue on two tests: a mammogram showing a circled cluster of microcalcifications and a breast ultrasound where no definite calcifications are visible. — Breast ultrasound can miss small microcalcifications.

Why do the guidelines disagree about when to start?

Because they genuinely do. You are not imagining the confusion.

All four - the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Radiology and the Society of Breast Imaging - support starting screening at 40. Where they differ is how often. The American College of Radiology and the Society of Breast Imaging recommend every year. The Task Force recommends every two years.

In 2026, the American College of Physicians published guidance recommending screening every two years from 50 to 74, with a shared decision between 40 and 50. The American College of Radiology and the Society of Breast Imaging responded jointly that the guidance "will cause continued confusion among women."

So when you hear that the experts now say wait until 50, that is half-quoting something real. What gets left out is that most of the major bodies disagree with it.

What about thermography?

The FDA has been direct about this one: a thermogram is not a substitute for a mammogram. The agency has also warned against unapproved thermography devices sold as screening tools.

Thermography measures heat patterns at the skin surface. It does not find microcalcifications, and it has never been shown to reduce breast cancer deaths.

Why does so much of this advice come from social media?

A 2026 study in the journal Clinical Imaging scored 75 TikTok videos about breast screening using DISCERN, a standard tool for rating the quality of health information.

Videos from physicians scored 3.12 out of 5. Videos from clinics scored 3.07. Videos from non-physicians scored 2.29.

That is the difficult part. Personal stories are the most compelling and the most shared, and they are also the least reliable. A woman telling you what happened to her is telling the truth about her own experience. She is not telling you what will happen to you.

What if my report says I have dense breasts?

Since 2024, federal rules require every mammogram report to tell you whether your breasts are dense. A great many women are reading that language for the first time with no explanation attached to it.

Dense breasts mean more glandular and fibrous tissue and less fat. It is common, and it is normal. It matters for two reasons: dense tissue makes a mammogram harder to read, and it carries a modestly higher risk of breast cancer.

Whether you need anything beyond your regular mammogram depends on your overall risk, not on density alone. Bring the report with you and talk it through with your doctor or other healthcare provider.

So what should you actually do?

Have the conversation with someone who knows your history.

Screening is not one decision that fits every woman. It depends on your family history, whether you have had a breast biopsy, your breast density, and how you feel about uncertainty. The American College of Radiology recommends that every woman have a formal risk assessment by age 25 - long before most women think about any of this.

What you should not do is let a video make the decision for you.

How we handle breast care

At G. DeAn Strobel, MD, PA, a clinical breast exam is part of your well-woman visit. We order your screening mammogram, go over the results with you, assess your personal risk, and arrange genetic testing when your history calls for it.

We do not take the images in our office. We order them, refer you to imaging close to home, and stay with you through whatever the results show.

We are glad to serve Sherman, Grayson County and the Texoma community, with bilingual support available. Text or call us at 903-957-0275, and we will take it from there - with confidence and care.

This article is for education and is not a substitute for medical advice. Talk with your doctor or other healthcare provider about what is right for you.