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Our Breast Care Services Team recommends the ABC's of Breast Health:

"A" - Annual mammogram—starting at age 40 and continuing as long as you are in good health;

"B" - Breast self-exam monthly—become familiar with your breasts so that you will notice any changes and report them without delay;

"C" - Clinical breast exam—have one every year by your doctor if over age 20.

Breast Health - What every woman should know:

• Breast cancer is the most common cancer that you may have to face in your lifetime; one out of eight women will develop breast cancer in her lifetime.
• Breast cancer can occur at any age, but it is much more likely to occur after age 40.
• When found and treated in its earliest stage, the chance for successful treatment is greatest.
• A mammogram can find cancer when it's very small, often several years before a woman or her doctor would be able to find it.
• Most breast lumps are NOT cancer. More than 80 percent of biopsied abnormalities are proven benign. New, less invasive needle biopsy procedures permit evaluation of these abnormalities without surgery.

What is a mammogram?

A mammogram is a low-dose x-ray of the internal structures of the breasts. The procedure involves compressing the breasts with a mammography machine paddle to flatten the breast tissue, which gives a more accurate picture while using the lowest amount of radiation possible. A radiation technologist will position your breast carefully under the paddle and take two views, one from the side and one from the top of the breast. Compression of the breast will last only a few seconds and may be slightly uncomfortable, but should not be painful.

mammo A routine or screening mammogram requires two views of each breast. A healthcare provider may order a diagnostic mammogram if a change has been detected in your breasts or if some type of abnormality is seen on a screening mammogram. Problems such as a lump, thickening, swelling, pain, nipple discharge, retraction, or bulging of the skin require a diagnostic rather than a screening mammogram. The diagnostic mammogram involves additional views that focus on the suspicious area. Compression or magnification views are close-up pictures of a suspicious area. An ultrasound may be needed to clarify the findings of a mammogram to distinguish if a lesion is solid or fluid filled. A radiologist—a physician with special training in reading x-rays—will interpret your mammogram and send a written report to your physician.

Remember, mammograms are needed for two reasons:

1. To check apparently normal breasts for abnormality.
2. To help diagnose a change, discharge, thickening or lump in the breast.

Preparing for your mammogram

It is best to schedule your mammogram at the end of your monthly period when the breasts are least filled with fluid and are not tender. Compression will be less uncomfortable. If you have had a mammogram that was very uncomfortable, you may wish to cut out caffeine for several days prior to the exam.

On the day of your mammogram do not wear any deodorant, body powders or perfume. These may contain small metal particles that can appear on your films as small spots or shadows and may look like an abnormality. Take your deodorant in your purse and apply it after the exam.

It is helpful if you wear comfortable separates such as a blouse and pants instead of a dress; you will need to undress from the waist up.

During the mammogram, the technologist will instruct you to hold your breath and remain still for a few seconds. Motion, even breathing, can blur the image and make it necessary to repeat the picture. The radiologist may preview your films before you are dressed. You may be asked to have additional pictures taken because of movement or inaccurate positioning.

Results of mammogram

A radiologist, usually one that specializes in breast cancer detection, will interpret your films. The results are sent to you and your healthcare provider.

Computer Aided Detection

In addition to our skilled radiologists at DRMC reading your mammogram, we have CAD (computer aided detection) which offers an added benefit to mammography findings. This technology can identify and mark regions that contain the slightest abnormal or suspicious features and mark them for the radiologist to review. The radiologist examines the CAD output and the original mammogram to make his final interpretation. CAD is used with ALL screening mammograms performed at Breast Care Services.

MammoPad

DRMC is certified as a Softer Mammogram Provider®. This means we provide a soft foam cushion, called MammoPad®, for each woman's personal use during every screening mammogram.

As a Softer Mammogram Provider, we make it a top priority to ensure your mammogram is warm and comfortable. It's one way we provide the tender loving care you deserve.

The MammoPad breast cushion was designed for women by a female breast surgeon. It is FDA-cleared, does not impair image quality and makes it easier for you to be relaxed, warm and comfortable during your exam. That helps our highly skilled mammography technologists achieve the best possible mammogram.

Implants and Mammography

Many women have had their breasts augmented with breast implants. Some women have implants after surgery for breast cancer. The common questions are: Do I still get a mammogram? How do they take pictures? Is it safe?

Mammography is still needed for women who have implants. The risk for having breast cancer has not changed. Most centers have technologists who are trained to perform mammograms on women with implants. Silicone implants are dense on x-rays and can block the view of tissues behind them. The breast needs to be positioned in certain ways to detect any abnormalities. Special techniques or positioning allow the tissues to be visualized without damaging the implants.

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Breast Ultrasound

Ultrasound, a sonogram, is the use of sound waves to obtain a medical image or picture of various organs and tissues in the body. It is a painless and safe procedure. A breast ultrasound provides much of the same information as mammogram without radiation. It can detect diseased or damages tissues, locate abnormal growths and identify a wide variety of changing conditions, which enable your doctor to make a quick and accurate diagnosis.

What will the exam be like?

The person performing the ultrasound study is known as a sonographer. This technologist is highly skilled and educated and works under close supervision with the radiologist. The radiologist is a physician who specializes in the study of various imaging tests such as: x-ray, ultrasound, mammography, CT and nuclear medicine.

The technologist will assist you onto an examination table. At this time, a transmission gel will be applied to the breast to be examined. A transducer, a small hand-held device, will be moved slowly over the body part being imaged. The transducer sends a signal to an on-board computer which processes the data and produces the ultrasound image. It is from this image that the diagnosis is made.

You won't feel a thing except for the slight pressure and movement of the transducer over the breast. It is important that you remain still and relaxed during the procedure. The ultrasound images will appear on a monitor similar to a TV screen and are recorded either on paper or film for a detailed study.

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MRI

What is an MRI?

MRI, or magnetic resonance imaging, is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

Using a powerful magnetic field, radio frequency pulses and a computer, detailed pictures of organs, soft tissues, bone and virtually all other internal body structures are produced.

Detailed MR images allow physicians to better evaluate parts of the body and certain diseases that may not be assessed adequately with other imaging methods.

The FDA approved breast MRI in 1991 as another test to help diagnose breast cancer. Radiologists often use an MRI to further investigate breast concerns first detected with mammography or during a physical exam to clarify abnormalities. MRI is also an excellent breast cancer screening tool for women who have implants for enlargement because it can show breast tissues surrounding the implant, which might be obscured with mammography. MRI also helps to determine what stage the breast cancer is by imaging the nodes between the ribs and below the collarbone.

Advantages of MRI:

- No compression of the breasts, as in a mammogram;
- Evaluates breast implants for ruptures or leaks and images the breast tissues behind the implants;
- Effective in imaging dense breasts and young high-risk women's breasts;
- Evaluates inverted nipples for evidence of cancer;
- Evaluates to determine if lumpectomy or mastectomy is the best surgical choice;
- May detect areas not seen by mammography or ultrasound;
- Evaluates for recurrence of breast lumps in lumpectomy breast;
- Effective in locating primary tumors not seen on mammography if positive lymph nodes are present.

Disadvantages of MRI:

- Costs much more than mammography;
- Takes approximately four times longer to image the breasts;
- Cannot identify microcalcifications (small calcium deposits in breasts);
- Requires injection of contrast agent into a vein before exam.

Preparation for the exam:

- Inform your physician if you have problems lying on your stomach or if you have any allergies;
- Tell your physician about any prescription or over-the-counter medications you are taking to evaluate the potential to increase bleeding;
- Inform your physician if you have a fear of small places.

Day of exam:

- You will have an IV inserted into your arm;
- You will lie on your stomach on a table. The breasts are allowed to fall through a cushioned opening, where they are encircled by a part of the machine;
- You will then receive a contrast material (Gadolinium DTPA) through your IV to improve the quality of contrast between the tissues;
- You will enter into a cylinder-shaped machine where you will hear tapping sounds as the images are being taken;
- Your images will be evaluated by a physician;
- You will be informed when and how you will receive your MRI report.

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Minimally Invasive Breast Biopsy

Image-guided needle biopsies are one of the most common procedures performed on women for diagnosing breast disease. Please remember that the majority of breast biopsies do not reveal cancer. By being diagnosed early, women have more options and a better chance of recovery. These biopsies take approximately one hour to perform and offer an alternative to standard, open surgical biopsy. These procedures are less invasive, less painful and less costly than traditional surgical biopsy.

The three types of Minimally Invasive Breast Biopsies are:

1) Fine Needle Aspiration (FNA)

Fine needle aspiration is a biopsy procedure that is performed on lumps that can be felt or identified on mammography. If the physician can feel the area, this procedure can be performed in an office setting.

The area is cleansed with an antiseptic solution to destroy surface bacteria. The area may or may not be numbed with an anesthetic. Some physicians prefer not to use an anesthetic because the amount of pain is minimal, similar to having your blood withdrawn. Others will use a very small needle to deaden the tissue in the biopsy area. Your physician will inform you of the preferred method prior to the procedure. The physician inserts a needle with an empty syringe into the lump. The needle is gently and slowly moved back and forth in the mass while the syringe pulls out cells or fluid to be examined.

If the lump is a cyst, fluid ranging from light yellow to a dark yellow greenish color may be drawn, characteristic of normal breast fluid. Occasionally, there may be signs of old blood (resembling chocolate milk) or fresh blood (which will be bright red). Your physician will discuss with you any further tests or follow-up evaluations if this occurs. After the cyst is aspirated, you should not be able to feel the lump.

Cyst fluid is usually not sent for testing unless it contains blood. The cells removed from a solid lump are sent to the lab for study. The pathology report is sent to your physician stating if the results are malignant or benign. Ask when the results of this report will be available to you and how you will be notified, whether by letter, by phone or in person.

The entire procedure takes five to ten minutes. A bandage is placed on your breast and regular activities can be resumed. You may remove the bandage and shower the same day. Occasionally, a small red lump under the skin may occur if a small vessel is ruptured by the insertion of the needle. Tell your physician if this occurs so it can be recorded.

2) Stereotactic Breast Biopsy

A suspicious area that may not be felt but is very small on a mammogram, stereotactic breast biopsy may be used to biopsy the area. This biopsy procedure is performed using a mammography table or an add-on unit to the mammography machine, a biopsy needle and the guidance of a computer. This test is done without the discomfort, risk, disfigurement or the expense of surgery. The procedure takes approximately 45 minutes to perform and most patients return to their normal activities within a few hours.

The breast will be compressed with a special mammography machine while stereo x-ray pictures are taken at angles. After the suspicious area has been identified, the radiologist enters information into a computer that calculates where the needle should be injected. The area of the breast to be biopsied is deadened with a local anesthetic. An instrument moves the biopsy needle in position and, at a rapid rate of speed, removes a sample of the suspicious tissue. Because stereotactic biopsy uses a needle, damage to the nearby tissue is minimal. When the biopsy is completed, a small bandage will be placed over the biopsy site and you may return to your normal activities. You may shower the same day you have the biopsy.

The biopsy sample will be sent to the pathology lab for evaluation. The pathologist will send the referring physician a report stating if the biopsy was malignant or benign. Consult your physician regarding how and when you can expect to receive the biopsy results.

3) Ultrasound Guided Breast Biopsy

If a lump has been found that is relatively small, close to the chest wall or observed through mammography screening but cannot be felt by a physician, an ultrasound guided needle biopsy, core biopsy or vacuum assisted core biopsy will allow a physician to accurately biopsy the area. Using ultrasound to observe the area during the biopsy is necessary because a small lump may be missed. If the lump is near the chest wall, there is a danger of puncturing the lungs, and if the lump cannot be felt, the physician is unable to stabilize the area for biopsy.

This procedure is performed in the BCS sonography room. The breast area is cleansed with an antiseptic to remove surface bacteria. An anesthetic to numb the area may or may not be used. A gel substance is placed on the breast and a transducer, which resembles a microphone, is passed over the breast to obtain images or pictures of it. The ultrasound machine locates the lump. As the physician looks at the area on a monitor, the needle is inserted into the suspicious area or lump to obtain the tissue sample. The lump is a normal cyst if the fluid removed ranges from light yellow to dark yellow or green. The ultrasound picture will allow the physician to see the cyst area disappear as the fluid is withdrawn. A bloody fluid that resembles chocolate milk or fresh blood will require the physician to conduct further tests and evaluations of the area. If a biopsy is obtained from a solid lump, the physician is assured the biopsy is from the suspicious area.

The biopsy tissue is sent to the pathology lab for evaluation. Results will be sent to your doctor. You will need to ask when and how the results will be made available to you.

The procedure will take approximately 15 minutes. When it is completed a small bandage will be placed over the needle biopsy site and you can return to your regular activities. You may shower the same day. If a bruise or red lump forms after you leave the office, inform the physician so the information may be recorded on your medical chart. The area of the hematoma formation can show up on mammograms later as an area of change. Infection from biopsy is rare.

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