Introduction: Breast cancer is a global problem accounting for 2.5 million cases per year worldwide. The younger women have a reported lower survival rate with cancers being detected at an advanced stage, while earlier detection improves survival rates by 27% to 47%.Health of a rural women and her access to health facility is further compromised due to socio-cultural, economical, and environmental factors. Objective: Evaluation of Mammography and Ultrasound in palpable and symptomatic breast lesions, observe concordance with histopathological findings (BIRADS IV and above) and evaluate usefulness of Ultrasound breast in young women with dense breasts as an alternative screening tool in rural areas. Methods: A total of 150 patients, more than 30 years of age withpalpable breast abnormality, underwent both Mammography and Ultrasound. Imaging characteristics of lesion evaluated and categorized using BIRADS-criteria. Cases with> BIRADS IV were further evaluated using Histopathological correlation. Statistical analysis was done using SPSS software version 25.0. Significance level of p was considered 0.05 or lower. Results: Mean age was 46.7 years, 51.3% were younger than 45 years of age and 89% of these had dense breasts. Ultrasound showed a higher detection rate in mammographically dense breasts. For Mammography, Sensitivity, Specificity, Positive and Negative predictive value were 85.%, 87.8%, 91.2% and 79.6% respectively; while for Ultrasound they were 100%, 68.3% , 82.5% and 100% respectively. There was concordance between imaging and pathology reports with morphological findings from Ultrasoundshowingbetter concordance with pathology. Conclusion: Ultrasound able to detect more lesions (than mammography) in women with dense breasts. Hence, proved to be more sensitivein early detection and can be promoted as a cost-effective screening initiative where mammography is not available. Advances in knowledge: Ultrasound appears to be superior for early diagnosis of breast lesions in dense breasts of young women and likely to have more compliance hence must be promoted as a screening tool.