Arrow-right Camera
The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

‘Dense tissue can hide cancers’: New clinic to offer imaging technology to detect small breast cancer mass

Angela Barnes always felt uneasy that her mammograms wouldn’t detect cancer. Because she had an earlier breast augmentation, Barnes signed a waiver each time acknowledging that her implant might obscure a cancer tumor.

She discovered another issue after a friend, Natalie Ziegler, found a lump in her breast weeks after a mammogram had indicated an all-clear result. Because of that, Ziegler at first dismissed it but eventually had a follow-up – discovering Stage 2 breast cancer – missed earlier because of dense breast tissue. Despite treatment, Ziegler’s cancer worsened to Stage 4 by 2019, which sent Barnes into a deep research dive.

That’s how Barnes in early 2020 found out about the SonoCiné Automated Whole Breast Ultrasound imaging system, which uses ultrasound and other technology to detect cancers down to 3 millimeters, including in patients with dense breast tissue and augmentations. She’s now the owner of Kvinna Breast Care, set to open Feb. 8 in Liberty Lake as the fifth U.S. clinic using SonoCiné.

“It was so shocking when Natalie had gone in for her mammogram, got the little letter in the mail saying everything was fine and then it was just a matter of weeks later when she felt a lump,” said Barnes, 48, a Liberty Lake resident.

“It wasn’t until later we figured out that the reason the cancer had gone undetected in the mammogram was because of the density of her breast tissue. As I started to research that more, I came to find out that 50% of women actually fall into that category.”

Barnes then read how cancer tumors might be overlooked in mammograms among those women.

The Centers for Disease Control and Prevention backs her concerns. Women fall into four categories, ranging from having almost entirely fatty tissue (10%) to denser tissue that comprise about 50% of women, the CDC says, including “breasts are evenly dense throughout” (about 40%) and “breasts are extremely dense” (about 10%). In 2019, a federal law was passed for a minimum standard in mammography reports to list breast density information.

“Dense tissue can hide cancers,” says the CDC, reporting that fibrous and glandular tissue look white on a mammogram and “so does a possible tumor. Because it’s hard to tell the difference between a tumor and dense breast tissue on a mammogram, a small tumor may be missed.”

After reading about SonoCiné, Barnes said she called every imaging center she could find statewide and found none had the technology. SonoCiné uses an automated, computer-controlled arm to guide a transducer over breast tissue, as well as higher on the chest wall and at the underarms.

The word “sono” is for sonography and “cine” for cinema, Barnes said, because the software for the ultrasound captures up to 5,000 images and stitches them together into a video that a radiologist reads to detect cancer tumors often by Stage 1, which for many women means noninvasive treatment. Sonography uses high-frequency sound waves, often called ultrasound, to produce the images.

Barnes turned to SonoCiné developer Dr. Kevin Kelly, a radiologist in Pasadena, Calif. After several phone calls with him, she traveled in June to meet him and have a screening. Although she doesn’t have a medical background, the trip cemented her decision to bring the technology here. Her husband and friends, some as investors, backed her.

A Kvinna screening is $375, and patients can make an appointment via its website The fee includes any further diagnostic exam if needed by a radiologist, Barnes said. The clinic will have ultrasound technicians and administrative workers, while an Arizona-based radiologist will read the screenings.

Barnes said Kvinna will assist patients with referrals if any cancer is detected and provide documents, a superbill and medical report for women who want to submit them to an insurance company for possible reimbursement.

“Most women have luck getting if not a full reimbursement, at least partial reimbursement, especially if they have dense breast tissue or breast augmentation,” Barnes said. “We have the ability to take HSA or FSA cards.”

She also has a goal to add a nonprofit component over time to offset or cover the cost for women who can’t afford it.

SonoCiné doesn’t use radiation, so it’s considered a safe supplemental breast screening, Barnes said. A mammogram is an X-ray picture of the breast. However, SonoCiné isn’t intended to replace mammograms but rather be another tool for higher-risk women.

“I was not educated before on some of the risk categories that women fall into where a mammogram alone isn’t always enough,” Barnes said.

Her SonoCiné session with Dr. Kelly came back clear, bringing unexpected relief that Barnes said she wants to bring to other women.

The American Cancer Society says experts don’t agree yet on what other tests should be done in addition to mammograms in women with dense breasts, but it cites that studies have shown breast ultrasound and magnetic resonance imaging (MRI) can help find some cancers not seen on mammograms. It cautions occasionally these might show findings that aren’t cancer with unnecessary follow-ups.

It also says digital breast tomosynthesis (3D mammography) can find some cancers not seen on regular mammograms. Federal guidelines recommend women at average risk of breast cancer get a mammography every 1 to 2 years beginning at age 40.

Barnes thinks some of her customers will be younger women with a family history of breast cancer who want an earlier baseline.

The SonoCiné system is sophisticated and shows a cancer tumor as black on white, Barnes said, even when small. She said it likely would have made a difference for her friend.

“It’s interesting because going back to my friend Natalie, even once they found the lump and they biopsied it and knew exactly what it was and where it was, they went back and did a follow-up mammogram, and they could not see it; that’s how obscured it was. She showed me her mammogram, and she said, ‘That’s where my cancer is, and you can’t see it.’ It just looks like a big white spot.”

Barnes chose the name Kvinna, a Swedish word for women.

“Federal law passed two years ago for doctors to start notifying women when they have a mammogram and it’s noticed that they have dense breast tissue,” she said. “It might be in itty bitty fine print at the bottom of mammography results, so a woman would really have to look for it unless the doctor makes you aware of it.”

“My main goal is to educate women because you have to know to ask the questions of the doctor, pay more attention to mammogram results and look at the fine print.”

More information

What: Kvinna Breast Care + Imaging, which offers ultrasound technology for supplemental breast imaging; Where: 1334 N. Whitman Lane, Suite 202, Liberty Lake; Website:; Email:; Phone: (509) 960-5550.