Does it matter where I get my mammogram done?

As long as your facility utilizes digital mammography, and most do, it does not matter. Tomosynthesis (tomo) (3D) mammography is the standard in mammography, but 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 can take digital picture “slices” of the breast, better visualizing through dense breast tissue. Insurance is now generally covering 3D mammography.

How long does it take to get a biopsy report?

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?

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?

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?

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?

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?

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?

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?

These are very tiny deposits of calcium within the breast, they appear as very tiny white dots on the mammogram. It is our experience that only about 25% of microcalcifications are an early cancer, usually ductal carcinoma in situ (DCIS) is present. This is a non-invasive breast cancer. Not all deposits of calcium are a problem in fact, 75% 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?

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 if I want a second opinion?

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?

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)?

In Situ translates to “in place” – meaning the cancer cells is confined to inside the duct. This may change over to an invasive description if those cells break outside the duct wall.

What kind of biopsies are available at the Breast Care Center?

• 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 is the difference between a mammogram and an ultrasound?

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 will occur at my first appointment?

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.  You will then receive an explanation of the findings and recommendations and provided with an opportunity to ask questions.

When should I start having mammograms?

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?

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 radiation treatments?

1) If you elect lumpectomy, radiation treatment is a part of your treatment plan. For lumpectomy patients, whole breast radiation is recommended. Whole breast radiation involves short treatment sessions daily, Monday through Friday for 4-6 weeks. The length of treatment is determined by the Radiation Oncologists.
2) If you elect mastectomy, radiation is often not needed unless there is cancer found in the lymph nodes or the skin has tumor cells in it.

Will I have to have chemotherapy?

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.

What should every woman know about their breasts and their individual risk?

Breast density is the first element to know.

A detailed risk assessment should be completed for all women over 25 years of age. A Tyrer-Cuzick risk assessment includes multiple elements, your current age, height, weight, age at first menses(period), age of first giving birth to a child, breast density, menopausal status, use of hormone replacement, family history – number of blood relatives with breast cancer and their age at onset, number of previous personal breast biopsies and their outcomes, and any genetic testing performed.

A Gail Score assessment uses fewer elements but is very helpful in determining risk.

The Breast Care Center uses both calculations are part of your assessment