Breast Imaging

It’s essential for women over 40 years old to have a screening mammogram each year. After a screening procedure, some women receive a recommendation to get a diagnostic mammogram. The difference between the two – and the purpose for each – can be confusing. Let’s discuss what each exam means.

A Screening Mammogram

Screening mammograms simply look for signs of cancer. These procedures are x-ray exams of the breasts done yearly in women who have no breast symptoms or changes in their breast exam.

The goal of a screening mammogram is to detect breast cancer as early as possible – when it’s too small to be felt by a woman or her doctor. Detecting breast cancer early greatly improves a woman’s chance for successful treatment and increases her treatment options.

A screening mammogram usually takes two pictures of each breast. Some women, such as those with large breasts, may need to have more pictures in order to image all the breast tissue. After obtaining these standard views, the patient is done and the exam is then read by the radiologist. All screening mammograms are read by board certified radiologists.

A Diagnostic Mammogram

When something is abnormal or difficult to determine, a woman may be referred for a diagnostic mammogram. For example, a woman with a breast problem a lump, breast pain or nipple discharge or an abnormal area found on a routine screening mammogram would get a diagnostic mammogram.

Diagnostic mammograms are also done in women who need short interval, follow-ups exams as a result of a prior diagnostic exam. Also, women that were previously treated for breast cancer may get a diagnostic exam.

During a diagnostic mammogram, the breast images are reviewed by one of our breast imaging radiologists almost immediately. It’s important to do this review while the patient is there so that additional pictures can be taken if additional images are needed. In some cases, special images known as spot views or magnification views are used to further evaluate a specific area of concern. Breast ultrasound may also be performed in addition to the mammogram images, depending on the type of problem and the findings seen on the patient’s mammogram.

A diagnostic mammogram is usually interpreted in one of three ways:

• It may reveal that an area that looked abnormal on a screening mammogram is actually normal. When this happens, the woman may return routine yearly screening.
• It could show that an area of concern probably is not cancer, but the radiologist may want to watch the area closely. When this happens, it’s common to ask the woman to return to be re-checked in four to six months.
• The results could also suggest that a biopsy is needed to find out if the abnormal area is cancer. If your doctor recommends a biopsy, it does not mean that you have cancer.

A mammogram is a specific type of imaging that uses a low-dose x-ray system for examination of the breasts. Most medical experts agree that successful treatment of breast cancer often is linked to early diagnosis, primarily through the use of mammograms. Screening mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.

At Southtowns Radiology we are proud to offer Genius 3D Mammography (tomosynthesis). Genius 3D mammography detects 41% more invasive breast cancers and reduces false positives by up to 40%. This means one simple thing: early detection. Genius 3D mammography is the first and only clinically superior 3D mammography approved by the FDA. Genius 3D mammography allows doctors to see masses and distortions associated with cancers and precancerous cells significantly more clearly than conventional 2D mammography. Instead of viewing all of the complexities of your breast tissue in a flat image, as with traditional 2D mammography, fine details are more visible and no longer hidden by the tissue above or below.

No. Since the introduction of 3D mammography technology, multiple studies have shown that it detects 41% more invasive cancers in women with dense breast tissue and with fatty breast tissue. That means the scan is beneficial for women of all breast tissue types.

At Southtwowns Radiology we offer 3D mammography to every woman having their screening mammogram with us.

For women with dense breasts and those with certain risk factors, breast ultrasound is a tool for additional breast cancer screening. Along with a mammogram, the two scans together can give a radiologist a more complete picture of the breast in order to diagnosis disease. An ultrasound uses no radiation, which is an important consideration for patients, especially women of childbearing age.

MRI of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool that has many important uses, including:

• Screening in women at high risk for breast cancer
  For women at high risk for breast cancer, typically because of a strong family history, MRI may be an appropriate tool to screen for breast cancer in conjunction with mammography and ultrasound. A strong family history is usually a mother or sister who has had breast cancer before age 50. It can also be aunts or cousins, including those on your father’s side. Relatives who have had ovarian cancer also increase your risk. Your radiologist or primary care doctor can look at your family history and determine if screening MRI may be appropriate for you. Depending on your family history, genetic counseling may also be recommended.
• Determining the extent of cancer after a new diagnosis of breast cancer
  After being diagnosed with breast cancer, a breast MRI may be performed to determine:
  • how large the cancer is and whether it involves the underlying muscle.
  • if there are other cancers in the same breast and whether there is an unsuspected cancer in the opposite breast.
  • if there are any abnormally large lymph nodes in the armpit, which can be a sign the cancer has spread to that site.
• Further evaluating hard-to-assess abnormalities seen on mammography
  Sometimes an abnormality seen on a mammogram cannot be adequately evaluated by additional mammography and ultrasound alone. In these rare cases, MRI can be used to definitively determine if the abnormality needs biopsy or can safely be left alone.
• Evaluating lumpectomy sites in the years following breast cancer treatment
  Scarring and recurrent cancer can look identical on mammography and ultrasound. If a change in a lumpectomy scar is detected by either mammography or a physical exam, MRI can help determine whether the change is normal maturation of the scar or a recurrence of the cancer.
• Following chemotherapy treatment in patients receiving neoadjuvant chemotherapy
  In some cases, breast cancer will be treated with chemotherapy before it has been removed by surgery. This is called neoadjuvant chemotherapy. In these cases, MRI is often used to monitor how well the chemotherapy is working and to reevaluate the amount of tumor still present before the surgery is performed.
• Evaluating breast implants
  MRI is the best test for determining whether silicone implants have ruptured.

A breast biopsy is a minimally invasive procedure in which a small sample of tissue is collected and then sent for testing and diagnosis. Southtowns Radiology offers the following image-guided core biopsy procedures:

• Stereotactic (X-Ray) Breast Biopsy
• Ultrasound Guided Breast Biopsy
• Magnetic Resonance Imaging (MRI) Guided Breast Biopsy

Your Guide to the Breast Biopsy Procedure

Your breast biopsy procedures will be performed by a radiologist in the comfort of our Orchard Park facility. Same day appointments are often available. This is a minimally invasive procedure, so it requires no surgery and less time for preparation and recovery while still providing high quality results for diagnosis. A nurse will be by your side from the beginning to the end of the procedure.

The doctor will use image guided technology to determine the area to be biopsied. The area will then be numbed using a local anesthetic. The doctor will then insert the biopsy device to retrieve tissue samples. When the procedure is finished you will have a very small puncture wound which will be closed with a butterfly bandage. You will be sent home with an ice pack to reduce any bruising. You will also receive written instructions on any follow up care. Our nurse will call you the day after your biopsy to check on you and answer any questions.

Results of the breast biopsy come back in about 2 business days. Southtowns Radiology will notify your physician and you will be contacted by them, or we will contact you if they are unavailable.

What is breast density?
Breasts are made up of a mixture of fibrous and glandular tissue and fatty tissue. Your breasts are considered dense if you have a lot of fibrous or glandular tissue but not much fat. Having dense breast tissue is a normal variant and it may require additional imaging.

Breast density is determined by the radiologist who reads your mammogram. There are four categories of mammographic density. The radiologist assigns each mammogram to one of the categories. Your doctor should be able to tell you whether you have dense breasts based on where you fall on the density scale. (See scale below.)

Breast density in the U.S. (See pie chart)

• 10% of women have almost entirely fatty breasts
• 10% have extremely dense breasts
• 80% are classified into one of two middle categories

At Southtowns Radiology, we use Volpara software to more accurately categorize breast density into the four categories defined by the American College of Radiology. This computer algorithm calculates breast density automatically based on your mammogram scan. The advantage is that you will always get the most consistent picture of your breast density, with no possible variations from one doctor to the next. Knowing what category your breast density falls into helps determine what screening options are best for you.

3D mammography or tomosynthesis allows doctors to see masses and distortions associated with cancers and precancerous cells significantly more clearly than conventional 2D mammography. Instead of viewing all of the complexities of your breast tissue in a flat image, as with traditional 2D mammography, fine details are more visible and no longer hidden by the tissue above or below. 3D mammography is especially recommended for women with dense breasts, however multiple studies have found that it detects 41% more invasive cancers in women of all breast tissue types. Southtowns Radiology recommends that women with both dense or with fatty breast tissue consider 3D mammography for their screening exam.

Yes. A mammogram is the only medical imaging screening test proven to reduce breast cancer deaths. Many cancers are seen on mammograms even if you have dense breast tissue.

In breasts that are dense, cancer can be hard to see on a mammogram. Multiple studies have shown that 3D mammography can help find 41% more invasive cancers in women and are beneficial to all women with all types of breast density. Studies have also shown that ultrasound and magnetic resonance imaging (MRI) can help find breast cancers that can’t be seen on a mammogram. However, both MRI and ultrasound, show more findings that are not cancer, which can result in added testing and unnecessary biopsies. Also, the cost of ultrasound and MRI may not be covered by insurance.

If you have dense breasts, please talk to your doctor. Together, you can decide which, if any, additional screening exams are right for you such as having a 3D mammogram. If your breasts are not dense, other factors may still place you at increased risk for breast cancer — including a family history of the disease, previous chest radiation treatment for cancer and previous breast biopsies that show you are at high risk. Talk to your doctor and discuss your history. Even if you are at low risk, and have entirely fatty breasts, you should still get an annual mammogram starting at age 40.