From the Director NewsNew Patients Refering PhysiciansStaff BiographiesClinic LocationPreventionGeneral Information RisksGeneticsScreeningDiagnosisTreatment Options Support GroupY-Me Salon One Woman's Story W.I.S.E.RDenim & DiamondsHome Page |
Screenings
Mammography Q: At what age should a women have her first screening mammogram and how often thereafter? The American Cancer Society guidelines for the detection of breast cancer in asymptomatic women are:
It is very important to remember than approximately 90% of all breast cancers can be detected by mammography. Therefore, monthly self-breast examinations and yearly health care professional examinations are very important for detection of cancer not visible with mammography. When yearly mammography, monthly self-breast examination, and yearly health professional examination are utilized in combination as recommended, potential detection of cancer at its earliest stage is possible. Also, a new policy that became effective January 1, 1998, allows one screening mammogram per year for women with Medicare insurance beginning at age 40. Q: What is the difference between a screening and a diagnostic mammogram? A screening mammogram is an examination using low dose X-rays to evaluate the breast for potential abnormalities and provides a general overview of the breasts. A screening mammogram is not intended to diagnose cancer but rather screen out patients who will require additional evaluation in the search for potential breast cancer. If a questionable abnormality is detected on the screening examination, then a more detail diagnostic mammogram is required. The diagnostic mammogram is performed using special X-ray views (i.e., magnification, spot compression, etc.) which allow a detailed evaluation of the region of interest. Approximately 10% will be recalled after the screening mammogram for additional diagnostic evaluation. Q: Are the recommendations different for women who have a positive family history of breast cancer? For women with a positive family history of breast cancer in a premenopausal first-degree relative (mother, sister, or daughter diagnosed before age 50), screening is suggested to begin ten years before the earliest breast cancer occurrence in the family, but not before age 25. Example: If a mother is diagnosed with cancer at age 45, then all daughters and younger sisters should start screening mammography at age 35. Currently, there is no information to suggest that screening intervals shorter than one year are beneficial, even in women who have a strong family history of breast cancer. Q: What is the appropriate exam for a patient under the age of 30 with a palpable lump? With breast pain or tenderness? In general, young, pregnant, or lactating women with abnormal breast lumps should be evaluated with breast ultrasound as the first imaging study. Mammography is reserved for young patients when the ultrasound examination is inconclusive or suggests the presence of breast cancer. However, in young women with fatty breasts or who have several children, mammography can frequently provide valuable information since dense breast tissue is no longer a limiting factor. What is important to understand is that although the examination sequence to evaluate patients younger that age 30 may be different, the same diagnostic process to arrive at the diagnosis is still used. This individualized workup requires a highly trained mammography specialist well trained in breast disease. Patients with diffuse breast pain or tenderness usually require reassurance, without the need for breast imaging studies. Localized breast pain, which the patient repeatedly pinpoints the region of pain, is rarely associated with breast cancer. However, when present and persistent, such cases merit a diagnostic evaluation with ultrasound and/or mammography. If a young patient presents with secondary signs of breast cancer (skin thickening, retraction, bloody nipple discharge, large mass, etc.), the initial examination is usually mammography, supplemented by additional examination and biopsy, if needed. Q: Why is ultrasound performed in addition to mammography? Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography. A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas. Q: What other diagnostic procedures are performed in mammography? Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special x-ray maneuvers and magnification of the abnormality in question as mentioned previously. Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (x-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance. Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment. Nuclear Medicine imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions. MRI Magnetic Resonance Imaging (MRI) has recently been used more and more frequently to evaluate breast tissue. MRI is valuable in the following conditions:
|
