Breast Diagnostic Center - Your Breast Exam

Survival

Mammography is a low-dose x-ray study of the breasts. The key role of mammography is in identifying a site of breast cancer early in its development when it is very small and often a year or two before it is large enough to be felt as a lump. These small cancers have a much better response to treatment and often require much less surgical or drug treatment. Mammography detects approximately 2-3 times as many "early" breast cancers as physical examination, and is the best method for screening for breast cancer.

Modern technology has classified mammography as state-of-the-art both in its safety and diagnostic accuracy. Twenty years ago, the medical community and its patients were concerned about the radiation level delivered during the test.

Today, only 1/40 of that amount of radiation is used with the new very low dose, film screen mammogram.

Even though mammography is the best screening examination available today, some cancers, approximately 10%, will not be identified by mammography at a stage when they can be felt as lumps. For this reason, breast self-examination and examination by your doctor at intervals are integral components of breast cancer detection.

Having A Mammogram
A typical mammogram consists of two views of each breast in which they are pressed firmly between two plates. The best time for breast examination is 5 to 7 days after cessation of menses, when the morphologic influences of hormones are minimal.

Women with implants require two additional views to visualize tissue -- using the Eklund Technique (implants are pushed back and breast tissue is pulled forward).

The complete procedure takes only a few minutes. It will be performed by a trained technologist under the supervision of our qualified Radiologists. The physician will analyze the x-rays, looking for specific abnormalities or changes related to cancer. A written report will then be sent to your doctor. On occasion, the doctor may order additional views or other techniques such as ultrasound.

To prepare for a mammogram, you should dress comfortably as you would for any upper-body x-ray . . . in a two-piece outfit. (You will need to undress from the neck to the waist.) Also refrain from using any types of powders, deodorants or creams on your underarms or breasts since these can interfere with a clear x-ray.

Ultrasound
Ultrasound uses harmless and painless sound waves to produce a visual picture of the breast. It is most frequently used to determine whether a lump in the breast is a cystic (fluid-filled) lump or a solid one. Ultrasound is also helpful in examining younger women with very dense breasts, where it can complement the findings of mammography.

Other Methods
At the present time, there are no other comparable screening techniques for breast cancer.

... An important part of every physical exam

A breast exam is an important part of every women's physical exam. As with the breast self-exam that you do at home, a breast exam by your doctor consists of a visual exam and a manual exam: visually checking for dimplings or puckerings of the skin, secretions from the nipples, changes in the breast contour, and other abnormalities; manually checking the breasts and underarms for any lumps or thickenings. If your doctor does not perform a breast exam during your physical exam, be sure to ask for one.

If You Have A Problem

Needle localization	If your doctor discovers a suspicious area, calcification, lump or other change in your breast -- or if you do -- then diagnostic tools may be used to analyze the condition. A needle localization precisely locates an abnormality in the breast for an excisional biopsy.
Needle aspiration	A needle aspiration allows the extraction of the fluid from the abnormal area for analysis.
Biopsy	A biopsy identifies the true nature of a persistent lump or other breast change through a surgical removal of the area.

Stereotactic Core Needle Breast Biopsy
Stereotactic core needle biopsy is a diagnostic procedure used to remove a small amount of tissue with no incision or minimal incision. Ultrasound and computerized imaging equipment are used to locate the abnormal area in your breast. Small samples of your breast are removed by a needle during this procedure to help the pathologist provide a diagnosis. The procedure involves only mild discomfort with very few side effects.

But don't forget … if you do have a breast lump, the chances are three out of four that it's benign.

The radiologist requires high technical quality in each study in order for his report to be most accurate. We approach every patient with the idea "What would I do if this were a member of my family?" Interpreting mammograms takes considerable training and experience with each study being a supreme test for the examining radiologist.

Every exam is interpreted as either:

1. No abnormalities identified.

2. Most likely normal, but a subtle area is questioned which should be closely followed.

3. Areas of greater concern which require biopsy in order to make a definitive diagnosis.

If you should be among the patients asked to return in six months for a special view of an area, you fall into Category 2. This means that we think your examination is negative, but there is a subtle area that we are questioning that we would appreciate re-examining in six months to insure its stability. Please do not panic. The odds are 90-plus percent that this is not a significant finding. However, it is only by being extremely careful and cautious with every subtle finding that we will find the early preclinical and curable abnormalities for which we are constantly searching.

If we request a six month study, a letter will generally be sent to your referring physician explaining the reason for our request and again explaining that the likelihood is extremely high that this is not a significant finding. A reminder will be sent personally to you at the time of the requested repeat study. Only a limited study of the area in question will be performed at that time.

What Do We Mean by the Term "Tailored Mammogram"?
Every patient is different with different problems, different needs, and different types of breast tissue. For this reason at the Breast Diagnostic Centers we "tailor" the mammogram to each patient, as opposed to the standard views taken at most breast valuation sites. Generally we do a standard four-view study. The techniques vary according to the density and type of breast tissue which we find. Special views are added of any area which needs better definition and occasionally we will add "spot compressed views" to better define a specific area. On occasion an ultrasound study will be added of a specific area, or both breasts, to better define special areas.

Our staff is highly trained and experienced in making decisions on how to best demonstrate your breast tissue for thorough evaluation by the examining radiologist. Do not be alarmed when special views are added in the course of your study. This is part of our "completeness" and "tailoring" of each study to the individual patient.

Why Compression?
When your breasts are compressed the tissue is "spread out" and brought closer to the film allowing for a more sharply defined study. This is necessary in order to find the subtle underlying changes (or rule them out) necessary for a complete study. We do not want to hurt you. We will demonstrate to you before the study, visual examples of breasts examined with and without proper compression. On each study we want to have the "highest quality" study possible.

You are in charge! The technologist will ask when the compression is reaching the point of discomfort. Please remember that generally the greater the compression, the more diagnostic the study.