Breast Ultrasound in Ajax: Why It Sometimes Follows a Mammogram

The phone call or letter usually arrives a few days after a routine mammogram. The message is short: the images have been reviewed, and you are being asked to come back for more imaging, often including a breast ultrasound. For many women, the hours after that message are filled with questions, and the internet is rarely a calm place to look for answers.

This guide is meant to fill that gap. It explains why ultrasound is so often the next step after a mammogram, what each test is good at, what a breast ultrasound appointment actually involves, and how to look after yourself while you wait for answers. It is written for patients in Ajax, Pickering, Whitby and the rest of Durham Region, but the basics apply wherever you have your imaging done.

One point is worth making right at the start: being asked for more pictures is a common part of breast imaging. It means someone wants a clearer look at something. It is not, on its own, a diagnosis of anything.

Two tests that see the breast differently

It helps to understand why one test so often leads to the other. Mammography and ultrasound are not competing tools; they answer different kinds of questions.

What a mammogram does well

A mammogram is a low-dose X-ray picture of the breast. It shows the whole breast at once and is particularly good at showing tiny calcium deposits, changes in the overall pattern of the tissue, and differences between one year’s images and the next. That broad, comparable view is why it is the standard screening test in Ontario.

What a mammogram cannot always do is tell exactly what a particular shape is made of. A rounded area on a mammogram could be a fluid-filled cyst, a solid lump, or simply normal tissue overlapping in a way that looks like something more.

What ultrasound adds

Ultrasound uses sound waves rather than X-rays. Instead of photographing the whole breast in one view, the sonographer moves a small handheld transducer over a specific area and watches the tissue in real time. This makes ultrasound very good at a few things a mammogram finds harder:

• Telling fluid from solid. Sound passes through fluid differently from how it passes through solid tissue, so a simple cyst usually looks quite distinctive on ultrasound.
• Measuring and describing a specific spot. The sonographer can look at an area from several angles, measure it and note its edges and shape.
• Looking at blood flow. Many machines can show whether there is blood flow in or around an area, which can add useful detail for the radiologist.
• Examining dense tissue. In breasts with a lot of glandular tissue, ultrasound can sometimes show an area more clearly. Our earlier article on breast density and your mammogram report covers density in more detail, so we will not repeat it here.

Put simply, the mammogram is the wide-angle lens, and the ultrasound is the close-up.

Common reasons ultrasound follows a mammogram

Every situation is different, and only the radiologist and your health-care provider can say why a particular scan was recommended for you. That said, these are some of the everyday reasons a breast ultrasound is requested after a mammogram.

1. A rounded or oval area was seen. Ultrasound can often show whether it is a cyst or something solid.
2. An asymmetry was noted. Sometimes one breast looks slightly different from the other in a single area. Extra imaging can show whether this is just overlapping tissue.
3. A change compared with previous years. If something looks new or different from older images, a closer look is a reasonable next step.
4. You have a symptom. If you or your provider can feel a lump, or you have noticed a localized change, ultrasound lets the sonographer look directly at that spot.
5. The tissue is dense. In some cases, ultrasound is added because dense tissue limited what the mammogram could show.

Some of these recalls involve additional mammogram views as well as ultrasound. Others go straight to ultrasound. The combination depends on what was seen and on the recommendation in the report.

Screening, diagnostic and “follow-up”: the words you may hear

The language around breast imaging can be confusing, and it changes depending on who is speaking. A few terms are worth knowing.

Screening imaging

Screening is imaging for people who have no symptoms. A routine mammogram through the Ontario Breast Screening Program is a screening test. If you are between 40 and 74, you can book a routine screening mammogram yourself; our guide to booking an OBSP mammogram explains how that works.

Diagnostic imaging

Diagnostic imaging is done to look into something specific: a finding on a screening mammogram, a lump, or another symptom. A breast ultrasound after a recall is diagnostic. It is focused, it is tailored to a particular question, and it is arranged through your health-care provider or through the screening program’s follow-up process.

Follow-up recommendations

After the extra imaging, the report may recommend different things. Very often it concludes that the area is benign or simply normal tissue, and you return to routine screening. Sometimes it suggests repeating an ultrasound after a period of time to confirm that nothing has changed. Less often, it recommends a biopsy so that a small tissue sample can be examined. Your provider will explain which applies to you and what it means.

What happens at a breast ultrasound appointment

If you have had an abdominal or pregnancy ultrasound before, much of this will feel familiar. If not, the general walk-through in what to expect at your first ultrasound is a good companion to this section. Here we focus on what is specific to the breast.

Before you arrive

Breast ultrasound typically does not require fasting or a full bladder, but always follow the instructions you are given when you book. A two-piece outfit makes things easier, since you will only need to undress from the waist up. Bring your health card and your requisition, and if your previous mammogram was done somewhere else, tell the clinic when you book so your provider can arrange for the earlier images or report to be available if needed.

Positioning

You will usually lie on your back, sometimes rolled slightly onto one side, with the arm on the side being examined raised above your head. This position spreads the breast tissue more evenly across the chest wall, which makes it easier to scan. Pillows or wedges can help you stay comfortable.

The scan itself

The sonographer applies warm gel and moves the transducer over the area of interest, pressing gently. You may feel some pressure, but the exam is generally not painful, and unlike a mammogram there is no compression plate. The sonographer may also look at the armpit, where lymph nodes sit, because that is part of a complete breast assessment.

If a symptom brought you in, it is helpful to point to the exact spot. Lumps that are easy to feel standing up can sometimes be harder to find lying down, and your guidance saves time.

How long it takes

The length depends on how many areas need to be examined and whether both breasts are included. It is usually a fairly short appointment, but allow extra time in case the sonographer needs additional views.

Why the sonographer may not give you an answer on the day

This is one of the hardest parts for many patients, in Ajax or anywhere else. You are lying there, the images are on the screen, and the person scanning you has clearly seen something worth measuring. Why can they not just tell you?

The sonographer’s role is to capture the best possible images and document what they see. The interpretation is done by a radiologist, who compares the ultrasound with your mammogram and any older studies, and then writes a report. That report goes to the health-care provider who ordered the exam, and they discuss it with you in the context of your full history. Our article on how imaging results reach your doctor walks through that journey step by step.

It is completely reasonable to ask the sonographer practical questions, such as whether they have the images they need. Questions about what a finding means are best saved for your provider.

Coping with the wait

There is no tidy way to make waiting easier, but some patients find these approaches help:

• Write down your questions as they come up. Having them on paper means you will not forget them at the follow-up appointment, and it can quiet the mind a little.
• Limit late-night searching. Online forums tend to collect the most dramatic stories. Your situation is your own.
• Bring someone with you. A friend or family member can drive, listen, and help you remember what was said.
• Ask your provider how you will be contacted. Knowing whether to expect a call, a portal message or an appointment can reduce the feeling of waiting for the phone to ring.
• Keep your routine screening. If the result is benign, returning to regular screening is usually the next step. A single recall does not mean every future mammogram will lead to one.

If you notice any new breast change while you are waiting, such as a lump that is growing quickly, skin changes, or nipple discharge, contact your health-care provider rather than waiting for the report.

Questions worth asking your provider

When you sit down to discuss the results, these questions can help you leave with a clear picture:

• What did the ultrasound show, and how does it relate to what was seen on the mammogram?
• Is this area considered benign, uncertain, or in need of further testing?
• Do I need a follow-up scan, and if so, roughly when?
• Does this change how often I should have screening mammograms?
• Should I be doing anything differently at home, such as checking a particular area?

Breast ultrasound close to home

Rossland Diagnostic Clinic offers both mammography and ultrasound at Unit 102, 300 Rossland Road East in Ajax, with free parking and ground-floor access. Patients come to us from across Ajax, Pickering, Whitby and nearby communities, and we are open on weekdays from 9:00am to 5:00pm and on Saturdays from 8:00am to 3:30pm.

If your provider has asked for a breast ultrasound, call us at 905-426-3111 with your requisition in hand, or request an appointment online. We will confirm any preparation and help you find a time that works.