Introduction: With technological advancement sonographers work with increasing independence and expertise, forming intimate relationships and engaging in extended communication during breast ultrasound. However the nature and extent of any current communication is unknown. This study set out to examine sonographer’s attitudes, beliefs, fears and the constraints that determined the communication of differential diagnosis. Method: A survey was sent to a purposive sample of sonographers. Questions relating to demographics, experience and employment were included. Comments on communication, nonverbal cues, restraints, communication skills and fears of disclosure were asked. Following collation descriptive statistics were developed.Results: 82% of the surveys were returned. 89% of sonographers agreed patients were aware of non-verbal cues. 83% communicated normal and abnormal findings to the patient. 32% reported using cryptic language to answer patient’s questions. 65% worked in practices that placed no constraints on what or how much information was communicated. Fear of medico-legal issues and loss of credibility with medical practitioners rated highly as an influence in the decision to impart a differential diagnosis. Conclusion: The study demonstrated varied approaches to the provision of differential diagnosis during breast ultrasound. This study has provided evidence for the development of specific guidelines for sonographers wanting to impart differential diagnosis. The provisionof communication skills workshops to guide and provide strategies to deal with the emotional needs of the patient and sonographer when ‘‘bad news’’ is to be given is also recommended.