Screening Mammography
The Basics
The purpose of screening mammography is to find breast cancer at a very early stage before it becomes noticeable any other way. A screening mammogram is recommended once a year for all women 40 years of age or older who are healthy, not pregnant, and who are not experiencing any breast related concerns. It is an x-ray examination consisting of 2 views of each breast taken by a certified technologist according to standard guidelines. Sometimes more than 2 views of each breast are required. At least 4 views of each breast are required to adequately evaluate breasts with implants. Screening mammography is a quick in-and-out appointment lasting between 15-30 minutes from check-in to check-out. You will receive results by mail within three weeks. Receiving results may take longer if your previous mammography was done at another facility. Your primary physician also receives a report of the results 1-2 days sooner by fax, or at the same time by mail.
Finding Breast Cancer and False Alarms
The majority, about 90%, of screening mammograms are normal with a recommendation to continue annual screening. About 5-10% of all mammograms will be recalled to return for supplemental diagnostic imaging. If your mammogram shows something that requires diagnostic mammogram views or breast ultrasound then our nurse will promptly call you to make an appointment to return. The radiologist directs, evaluates, and assesses this supplemental diagnostic imaging as it is done and gives the results to each patient in person at that time making sure all your questions are answered. Most patients who are recalled will receive normal results with the recommendation to continue routine yearly mammography or to have 6-month follow-up imaging. However, about 20% of the ones recalled may require a needle biopsy if there is any suspicion of breast cancer. Most of the findings that are biopsied will not be cancer, but up to 40% of the needle biopsies of suspicious findings detected by mammography will be early stage breast cancer. In these cases the radiologist and nursing staff at BCA working with your referring physician will facilitate prompt referral to a preferred surgeon. At BCA we will detect early stage breast cancer in 4-5 mammograms out of every 1000 mammograms that we do.
Digital Breast Tomosynthesis: State of the Art Technology
All screening mammography done at BCA utilizes the latest and best technology proven by research and recommended by experts in the field of breast imaging including the radiologists at BCA. Digital Breast Tomosynthesis (DBT) takes the same 2 views of each breast in essentially the same amount of time using the same positioning as conventional mammography. The experience of the patient taking the mammogram is no different than conventional mammography performed in the past. What is different is that numerous exposures are made rapidly at different angles as the X-ray tube moves in an arc over the breast as it takes each mammogram. Complex computer software then creates a 3-dimensional image that allows the radiologist to view very thin image slices of the breast tissue to allow smaller cancers to be visible. Also, the radiologist may more reliably distinguish normal tissue from a suspicious mass which prevents recall of some false alarms. Recent research has shown that using this technology improves the cancer detection rate of screening mammography while decreasing the recall rate. DBT uses slightly increased X-ray radiation dose compared to conventional mammography, but this dose is considered safe, well within accepted guidelines, and well worth the benefit it provides.
Screening Whole Breast Ultrasound
The purpose of screening breast ultrasound (SBU) is to help detect small early stage breast cancer in women whose breast tissue appears dense on their mammogram. SBU should always be done at the same time as the screening mammogram so that the radiologist can assess them together. The SBU does not replace the mammogram, but it improves to the ability to detect early breast cancer compared to the mammogram alone in women who have dense tissue on their mammogram. The radiologist describes the tissue density seen by mammography on the report in a standard way as one of four categories (A,B,C, or D). If the report states that the tissue is “heterogeneously dense (density category C)” or as ”extremely dense (density category D)” then the patient is offered SBU. The SBU is typically done during the same appointment as the screening mammogram and takes an extra 15-30 minutes. Both breasts are scanned entirely by a specialized certified technologist using a hand-held probe while observing the ultrasound image in real time. The technologist will also take numerous standard images of each breast, and may take some measurements of normal findings. The screening mammogram and SBU are typically evaluated and reported together by the radiologist. Like screening mammography alone, you will receive your results by mail within three weeks.
Screening Breast MRI
Breast MRI is recommended as a supplemental screening test for women who are at very high risk of developing breast cancer because of a genetic or hereditary risk of breast cancer. Annual screening breast MRI should always be done in combination with an annual screening mammogram. It does not replace the mammogram. These women at high risk typically have multiple close family members who have had breast cancer or ovarian cancer. Also, there is a blood test that can identify women and men who carry an abnormal gene, or hereditary trait, which makes them at very high risk of developing breast cancer. For these women, yearly screening with mammography and breast MRI may start at an earlier age, usually at 25 years of age. Also, annual screening breast MRI is recommended for women who were treated at an early age for Hodgkin’s lymphoma with radiation to the chest.
Bone Density
Bone density is a fast, simple screening procedure to determine the density of your bone tissue. The measurements from the procedure are compared to those of a reference population based on relevant information such as age, weight, sex and ethnic background. This information is used in making a diagnosis about your bone status and fracture risk. This information will be helpful to your physician in determining if a bone building therapy is needed.
