Services Available at the Breast Health Center
- Stereotactic and ultrasound-guided breast biopsies
- Risk assessment
- BRCA 1 and 2 genetics testing
- Digital mammography
- Dexa scan
- Benign and malignant breast concerns
- Second opinion consultation
Breast Patient Navigator
Breast Patient Navigator provides individual support and education for patients and their families. She coordinates your care starting with the diagnostic evaluation and remains a part of your support system throughout the treatment process.
Breast Examination Descriptions
This technology uses sound waves to examine the breast. No radiation is used. The ultrasound produces sound waves that are “beamed” into the body. These waves bounce off the underlying tissues and based on the time taken for the waves to return and other factors, the computer calculates the depth and allows us to "visualize" structures beneath the skin. The ability to measure these different waves that are reflected from the underlying tissues allows a shadow picture to be constructed. The technology is especially accurate at distinguishing between a solid and a fluid filled space. The total time to complete this examination is typically less than 30 minutes. The examination is typically painless and no injections are used. If repeat or extra views are necessary, it do not necessarily mean that the radiologist has found something of concern.
What is Mammography?
Mammograms are probably the most important tool doctors have not only to screen for breast cancer, but also to diagnose, evaluate, and follow people who’ve had breast cancer. Safe and reasonably accurate, a mammogram is an x-ray photograph of the breast. The technique has been in use for about 40 years.
Screening mammograms are typically done every year to check the breasts for any early signs of breast cancer. Diagnostic mammograms are different from screening mammograms in that they focus on getting more information about a specific area (or areas) of concern — usually due to a suspicious screening mammogram or a suspicious lump. Diagnostic mammograms take more pictures than screening mammograms do. A mammography technician and a radiologist would coordinate to get the images your doctor needs to address that concern. The technician may need to magnify a suspicious area to produce a more detailed picture that will help your doctor make the diagnosis.
There are two main types of mammography: film-screen mammography and digital mammography, also called full-field digital mammography or FFDM. The technique for performing them is the same. What differs is whether the images take the form of photographic films or of digital files recorded directly onto a computer. The Breast Center has digital mammography for both screening and diagnostic testing.
Mammography technique: When you have a mammogram, a skilled technologist positions and compresses your breast between two clear plates. The plates are attached to a highly specialized camera, which takes two pictures of the breast from two directions. Then the technologist repeats the technique on the opposite breast. For some women, more than two pictures may be needed to include as much tissue as possible.
Mammography can be painful for some women, but for most it is mildly uncomfortable, and the sensation lasts for just a few seconds. Compressing the breast is necessary to flatten and reduce the thickness of the breast. The x-ray beam should penetrate as few layers of overlapping tissues as possible. From start to finish, the entire procedure takes about 20 minutes. A diagnostic mammogram generally takes more time than a screening mammogram because it takes more pictures from more angles.
Mammography involves minimal radiation exposure. In fact, the amount of radiation exposure from modern-day mammography machines is much lower than it was in past decades. The American Cancer Society notes that the dose of radiation received during a screening mammogram is about the same amount of radiation a person gets from their natural surroundings (background radiation) in an average 3-month period.
If you’ve had breast surgery for another reason, such as a benign biopsy or surgery to reduce the size of your breasts, the radiologist will want to know where those scars are in case the scar tissue has to be distinguished from another kind of breast abnormality. If you've had breast cancer surgery, small metal balls will be taped on your skin to mark your scar. Your scar defines the site with the highest risk of recurrence.
At least one radiologist reads the mammogram. A radiologist is a doctor who specializes in analyzing imaging studies of the body to diagnose disease or other problems. Having two radiologists read your mammogram reduces the chance of missing a problem by about 10-15%. Some centers routinely have your mammogram read twice, but this is expensive, and most insurance companies won’t pay for it. You can also get a “second opinion” on your mammogram by having the images analyzed by a computer. This is called computer-aided detection (“CAD”). Special computer software reviews the images and marks any areas of suspicion. The radiologist then examines each area and decides if it needs further evaluation.
What is a Dexascan?
DEXA Scan stands for Dual Energy X-Ray Absorptiometry, and it is a method of Bone Mineral Density Assessment. Bone Mineral Density Assessment is used to:
- Detect the presence of osteoporosis in men and women with particular risk factors
- Screen for osteoporosis, particularly in women making decisions about hormone replacement therapy at menopause
- Predict future fracture risk
- Monitor bone density in those with low normal levels and in those with osteoporosisundergoing treatment.
- Common uses of this procedure
Dexascan is used to diagnose osteoporosis on men and women with the following particular risk factors.
- Advanced age
- History of bone fracture
- A small thin frame
- A family history of osteoporosis
- Removal of the ovaries
- Early menopause
- A low calcium dietLack of exercise
- Eating disordersCertain medicines (such as steroids or anticonvulsants)
- Alcohol and tobacco
How does it work? Certified medical personnel will conduct the exam. You will be asked to lie without moving on the scan table but you will be able to breathe normally throughout the procedure. A scanner will pass over one area of your skeleton: your lower spine, wrist or hip. A dual energy beam of very low dose x-rays passes through that area of your body and is measured by a detector. You will not feel anything during the exam. The scan is repeated for a second skeletal area. Dual-energy Xray Absorptiometry (DEXA) technology works by measuring the amount of x-rays that are absorbed by the bones in your body. The two x-ray energies allow the machine to differentiate between bone and soft tissue, giving a very accurate estimation of bone density. The radiologist will produce a report for your physician based on the bone density measurements and your medical history.
Patient Comfort. You will not feel any discomfort during the procedure
Even though x-rays are used, the amount absorbed by the patient is only about 1/10th of that received from a chest x-ray. Other x-ray procedures have even higher x-ray doses. The x-ray dose from the bone densitometry test is comparable to the naturally occurring radiation you are
exposed to in one week.
Caution: Even though the x-ray dose from the bone densitometry test is very low, please inform the operator if you are pregnant or might be pregnant before your test.
Preparation required. Eat normally on the day of the exam, but avoid calcium supplements the day of your appointment.
If possible, wear a two piece outfit so you will not need to disrobe entirely and avoid wearing clothing with metal (buttons, zippers, etc.).
After the test: The patient can resume normal activities.
Who should have a DEXA scan? A DEXA scan may be advised if you are at increased risk of osteoporosis. Osteoporosis usually causes no symptoms at first. However, if you have osteoporosis, you have an increased risk of breaking a bone. If a DEXA scan shows that you have osteoporosis, then you may be given advice and treatment to help strengthen your bones. Therefore, a DEXA scan may be advised if you have:
- A fracture following a minor fall or injury.
- Loss of height due to fracture of a vertebra (back bone). Taken steroid tablets for three months or more.
- An early menopause (aged less than 45). A history of periods stopping (amenorrhoea) for more than one year before the menopause.
- Other disorders associated with osteoporosis such as rheumatoid arthritis or Celiac disease.
- A family history of hip fracture on your mother's side.
- A body mass index of less than 19. (That is, if you are very underweight.)
What are the Biopsy Procedures?
Breast Core Biopsy: This is a minimally invasive procedure which will be performed by your physician. During the procedure ultrasound images may be used to guide your physician to the nodule in your breast so tissue samples may be obtained. Through a tiny incision in the skin, your physician will use a biopsy device to obtain tissue samples which will be sent to the hospital pathologist to review. After the biopsy is completed, a tiny clip may be placed at the site to mark the area for future reference. The clip is smaller than a piece of rice and is not harmful or cause discomfort.
Stereotactic Core Biopsy: A stereotactic core biopsy is a minimally invasive procedure which will be performed by your physician. This type of biopsy uses a special mammography system and computer to complete your biopsy. You will be positioned on a special table in a way best to identify the area to be biopsied. The computer along with your physician can pinpoint the exact area in the breast to be biopsied. This is usually completed when you can not feel the area in your breast. Through a tiny incision in the skin, your physician will use a vacuum biopsy device to obtain tissue samples which will be sent to the hospital pathologist to examine under the microscope. After the biopsy is used, a tiny clip may be placed at the site to mark the area for future reference. The clip is smaller than a piece of rice and will not be harmful or cause discomfort.
Ultrasound-guided cyst aspiration: An ultrasound guided cyst aspiration is a minimally invasive procedure which will be performed by your physician. During the procedure ultrasound images may be used to guide your physician to the cyst (cysts) in your breast so the fluid contents may be withdrawn. If after the aspiration, a nodule persists; your surgeon may proceed with a core needle biopsy of that nodule. A larger needle would be introduced through a tiny incision in the skin and small tissue samples would be removed and sent for examination under a microscope. If this method of biopsy is used, a tiny clip may be placed at the site to mark the area for future reference. The clip is smaller than a piece of rice and will not be harmful or cause discomfort.