By: Eva Keller
Most people assume that a newer or more comfortable scan must be a better one. In breast imaging, that assumption is now driving a mistake that Dr. Ryan Polselli sees accelerating across his patient population. Women with dense breast tissue are being told to add an ultrasound to their annual mammogram. A growing number are skipping the mammogram entirely and going straight to the ultrasound instead. Polselli, a fellowship-trained breast radiologist and founder of Mammolink, which operates five mobile imaging units across Florida, says that is the opposite of what the evidence supports.
What Each Scan Is Actually Built to Do
Polselli describes a mammogram as a portrait. Every region of breast tissue is captured in full. It sees everything, including small areas of tissue that an ultrasound cannot reliably detect, and including cancers that a technologist scanning in real time might miss entirely.
An ultrasound is technologist-dependent in a way mammography is not. What gets captured depends on who is holding the probe and where they point it.
More importantly, the two scans fail in different directions. A mammogram is the test that catches ductal carcinoma in situ through microcalcifications, the earliest detectable stage of breast cancer. “Can you theoretically see calcifications on ultrasound? In some cases, yes,” Polselli says. “The small ones, no. You’ll never see them. So you’re going to be missing those.”
Certain tumor types disappear on ultrasound entirely. Mucinous carcinoma, Polselli explains, blends into surrounding background tissue on an ultrasound image while remaining visible on a mammogram.
The supplemental ultrasound recommendation exists precisely because dense breast tissue reduces mammogram sensitivity. The solution to that gap is adding a second test, not replacing the first one.
Where the Substitution Idea Is Coming From
Polselli points to a specific market dynamic. Screening ultrasound is not regulated by the FDA the way mammography is. That regulatory gap has attracted private equity investment into standalone ultrasound companies, and those companies can advertise freely on comfort: no radiation, no compression, no pain.
“They advertise no radiation, no compression, comfortable,” he says. “Then in fine print at the very bottom, where nobody sees it, they put: not a substitute for mammography.”
The testimonials fill in the rest. A patient reports that her mammogram found nothing and her ultrasound found the tumor. The story is accurate. The context, her breast density, what a supplemental scan is designed to catch, and what the mammogram was and wasn’t built to see in that tissue type, is missing. That missing context is what makes the conclusion dangerous.
The Radiation Argument
The belief that mammograms cause cancer appears constantly in Polselli’s work, including in the comments on Mammolink’s own location announcements. His response is direct: “Being alive causes cancer. Mammograms detect it so you can live longer.”
His clinical reasoning is straightforward. If mammographic radiation were producing breast cancer at any meaningful rate, the disease would not be appearing in 35-year-olds and 60-year-olds arriving for a first-ever baseline scan having never been imaged before.
What Skipping Actually Costs
Polselli is specific about what delayed detection produces. Even skipping a single year results in tumors that are bigger, later stage, more likely to be node positive, and more likely to be metastatic by the time they are found.
The system makes skipping easy. Most facilities require a physician’s script, prior images from another location, and a scheduling window that can stretch weeks out. Polselli built Mammolink specifically because he believes that friction is the cause of the compliance problem, not patient reluctance. “The easier it is, the more people get screened. The harder it is, the less they get screened. Period. End of story.”
One Thing to Do
Polselli’s practical advice is simple. Pick a date you will not forget and make the mammogram non-negotiable. The patients he sees with unbroken annual screening records are usually the ones who tied the appointment to their birthday.
The ultrasound, if your density warrants it, goes alongside that appointment. Not instead of it.
Disclaimer: This article is for general informational purposes only and should not be considered medical advice. Readers should consult a qualified healthcare professional regarding their individual circumstances before making healthcare decisions.
