Background: Recent imaging modality named automated breast ultrasound was encountered for mammographic substitution. Our study aims to compare ABUS and mammography as screening modalities with special concern to dense breasts. Method: Eighty participants from our breast screening program were examined with mammography and ABUS. The patient's mean age is about 46 years ranging from 32 to 67 years. The study was carried out during the period from September 2020 to October 2021. Results: The percentage of lesions detection in BIRAD II and BIRAD III in mammograms was 31.25% and 12.5%, however, in ABUS, it was 32.5% and 11.25%, respectively. Also, in BIRAD IV and BIRAD V lesions were detected in mammogram in 20% and 11.25% of cases, and there is an increase using ABUS to about 22.5% and 12.5%, respectively; thus, ABUS is a valuable tool in detecting benign, probably benign and malignant lesions in comparison to the mammogram. Also, it was noted that in participants with dense and extremely dense breasts, ABUS has significantly more added value over mammography in picking breast lesions with a statistically significant difference. ABUS was about 100% sensitive meaning that ABUS can detect all cases found in the mammogram study without significant change, but it was about 85% specific. Conclusions: ABUS is a scientific improvement in breast radiology with the advantage of innovative diagnostic precision of breast pathologies in terms of initial recognition, better classification, and meticulous evaluation. It is operator independent, saves time, and permits whole breast assessment with no radiation hazard, improved picking of few millimeters' pathologies, particularly in dense breast parenchyma. ABUS plus mammography will be augmented in the future breast screening program.