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Does it matter where I get my mammogram done?
Oct. 12, 2011
As long as your facility utilizes digital mammography, and most do, it does not matter. Tomosynthesis (tomo) (3D) mammography is the most recent upgrade in mammography. Not all facilities have 3D. Women with significantly dense breasts or a history of breast cancer benefit the most from this technology. Instead of having two views done of each breast, the 3D is able to take digital picture "slices" of the breast, better visualizing through dense breast tissue. 3D takes just a few seconds longer to do than 2D. Medicare and Medicaid have been covering the 3D additional cost, some commercial insurers are paying, but not all. The extra cost is approximately $50-$100, many women feel this money is a good investment in their healthcare.

How long does it take to get a biopsy report?
Oct. 12, 2011
Approximately three working days for tissue (core & stereotactic) biopsy and up to two days for fine needle aspirates.

I was called back for more testing after my mammogram, does this mean I have cancer, what is happening?
Oct. 12, 2011
No, sometimes the initial mammogram views will show an area that isn't completely clear to the radiologist. Further mammogram views, often magnified are taken. Ultrasound is sometimes recommended as well.

If I get an annual mammogram, why do I need to do self breast exam and see my healthcare provider?
Oct. 12, 2011
The best surveillance for breast cancer is a combination of monthly self breast exam, annual mammograms as recommended and a clinician (Dr, PA, ARNP) exam once a year.

If I have breast cancer – what happens next?
Oct. 12, 2011 by Breast Care Center, IA
One of our RN Nurse Navigators will work closely with you to coordinate further testing as indicated and provide education for you and your family. You will be provided with educational booklets for your review. The nurse will spend time with you and your family providing instruction, explanations and education as your journey progresses. When ready to schedule surgery, your nurse will coordinate all pre-op and post-op appointments needed for you. This includes any pre-surgery testing, your history and physical with your primary care physician, and fitting for a post-op compression bra if indicated.

If I need a biopsy – how long do I have to wait for the procedure?
Oct. 12, 2011
Your ultrasound guided biopsy here at the Breast Care Center can often be performed the same day as your initial visit if desired. If you are recommended to have a biopsy guided by mammogram, that will need to be scheduled at another time.

Isn't the radiation from the mammogram dangerous?
Oct. 12, 2011 by Breast Care Center, IA
Mammograms expose the patient to a low dose of radiation. Studies have found no significant increased risk for breast cancer in women who start and have their annual mammogram at age 40 and above.

My breasts are very “lumpy” and I wouldn't know if I was feeling something I should be concerned about. So I avoid self breast exam, is that okay?
Oct. 12, 2011
We recommend women get to know their own breasts, lumpy or not. Examine them approximately the same time each month and feel for anything that was not present previously. The best time for exam in women still menstruating is the week after their period. The breasts are usually much less tender than just prior to her period. You are the best examiner of your breasts. Another examination tip is to only press down about one-half to one inch deep with the pads of your fingers.

What are microcalcifications?
Oct. 12, 2011
These are very tiny deposits of calcium within the breast, they appear as very tiny white dots on the mammogram. In about only 15% of microcalcifications, an early cancer, usually ductal carcinoma in situ (DCIS) is present. Not all deposits of calcium are a problem in fact, 85% are not cancer. The radiologist compares past mammograms to check for any changes from the previous mammograms. When there are changes, a stereotactic biopsy is often indicated. Microcalcifications can typically not be seen with ultrasound, we rely on mammography to visual these.

What are the different types of breast cancer?
Oct. 12, 2011 by Breast Care Center, IA
There are several types of breast cancer. The greatest majority start within a breast duct (DCIS - Ductal Carcinoma In Situ), if left unchecked, these may then break out of the duct – when this occurs the cancer is described as invasive. Some cancers start in the lobules of the breast (where breast milk is generated), this too can be contained within the lobule (LCIS), but may also break out to be classified as invasive lobular breast cancer. Some patients have a combination of In Situ and Invasive cancer.

What happens after the diagnosis of breast cancer is made?
Oct. 12, 2011
We ask our patients to come in and meet with their surgeon and discuss the pathology report findings. There are many types of breast cancer and bringing the patient into the office for the pathology report allows for appropriate education and planning from that point on. Every patient has a different level of readiness for more information, each patient is treated individually and their consultations with their Breast Care Navigator are tailored to the patient.

Often, there is more information and testing that needs to be obtained prior to the patient deciding on their treatment/surgical options. A breast MRI is often helpful, particularly in patients who are considering breast conservation surgery (lumpectomy or partial mastectomy). The MRI is very sensitive, providing information as to the involvement of the known affected breast, the opposite breast and the axillary (armpit) lymph nodes on both sides.

The biopsy specimen is also tested for hormone receptor status. The tests are frequently called Tumor Markers, these provide more information about the tumor and helps direct future treatment.
The ER/PR (estrogen and progesterone receptor) reports, are usually available the business day after the pathology report is received. The patient will be contacted with this report. When appropriate the Her2neu (another tumor marker) test is done, these results take 10-14 days from biopsy. Again the patient is contacted with the report.

What if I want a second opinion?
Oct. 12, 2011
Second opinions are encouraged, welcomed and your right. It is not an insult to our physicians if a patient seeks another opinion. Often, the second opinion reassures the patient, and helps clarify understanding of the proposed treatment plan.

What is an ultrasound?
Oct. 12, 2011
Breast ultrasound is a form of imaging that uses sound waves to differentiate between normal breast tissue and abnormalities. Your doctor will use an ultrasound transducer and go over your breast(s) as needed. Gel is used to allow sound waves to evaluate your breast tissue. Measurements of abnormalities are often done during the exam and photos printed for your medical record.

What is DCIS (ductal carcinoma in situ)?
Oct. 12, 2011 by Breast Care Center, IA
In Situ translates to “in place” - meaning the cancer cells is confined to inside the duct. This changes over to an invasive description when those cells break outside the duct wall.

What is the difference between a mammogram and an ultrasound?
Oct. 12, 2011
Mammograms use a small amount of radiation to image the breast tissue. Your breast is compressed from top to bottom and side to side – usually two pictures for each breast. Ultrasound utilizes sound waves with no radiation. Both tests can be helpful, they provide images of the breast tissue in different ways.

What kind of biopsies are available at the Breast Care Center?
Oct. 12, 2011
• Fine Needle Aspirate (FNA) – this is a sampling of cells through a thin needle, often under ultrasound guidance. The sampling is placed on microscope slides and submitted to the lab.
• Core Biopsy – this is where small samples of the breast tissue are taken. This is done with local anesthetic (numbing injection), a special instrument and uses ultrasound for guidance. These both are done in our exam rooms.
• Stereotactic Biopsy – this is where small samples of breast tissue are taken, done with local anesthetic, but using mammography for guidance. Stereotactic biopsies are done with special equipment in the mammography suite.
Other biopsies may be done, such as skin biopsies – all procedures will be explained prior to the start of the procedure.

What will occur at my first appointment?
Oct. 12, 2011
You will be asked to complete a general health and breast specific questionnaire. A nurse will bring you to an exam room. Your spouse, significant other or other family member is welcome to join you. The nurse may have more questions to clarify your history. You will be given a gown and asked to undress from the waist up. You may leave on your slacks, pants, skirts, socks, shoes, etc.
The physician will do a physical exam of your breasts and depending on the need, may do an ultrasound as well.

When should I start having mammograms?
Oct. 12, 2011
In general, an initial, baseline screening mammogram between the ages of 35 and 40 is recommended. Then you should have a mammogram annually starting at age 40. Variances to this guide are affected by personal and family history. If there are any questions, please consult with your primary care physician.

Why not have mammograms on all women at any age?
Oct. 12, 2011
Mammograms are generally not helpful in younger women, as they typically have very dense breast tissue. Dense breast tissue shows up as white on the mammogram and masses also show up as white, making it difficult to determine the difference. Ultrasound is often used for younger women, as ultrasound views the tissue differently than mammogram, helping to assess the tissue.

Will I have to have chemotherapy?
Oct. 12, 2011
We cannot predict this accurately in many patients. The final pathology report from the surgical procedure will provide more information for the medical oncologists (cancer doctors), such as degree of lymph node involvement, size of the tumor and any other microscopic findings. There are also specified tests (Mammaprint or Oncotype) that can be done on the surgical tissue that helps determine if chemotherapy is indicated.

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