Common Questions About Breast Cancer Detection

Screening mammograms are important for the early detection of breast cancer. They are used to identify breast changes that may represent cancer in women who have no breast complaints or symptoms. Finding breast cancer early greatly improves a woman’s chance for successful treatment. The Women’s Imaging Center at Newton-Wellesley Hospital offers sensitive, compassionate care of the highest quality provided by expert radiologists using the most advanced equipment available.

Alan Semine, MD, Chief of Breast Imaging and Medical Director at the Center addresses some common questions about mammography and breast cancer detection. He brings a wealth of experience in breast imaging, as well as extensive expertise in advanced interventional procedures in the evaluation of breast concerns. He helped pioneer the use of digital mammography and breast ultrasound as well as breast MRI in clinical practice.

I am 42 years old and I want to be screened for breast cancer. Do I need a mammogram every year or every other year?
I recommend that patients have a mammogram every year. Screening mammograms are performed to detect breast cancer when it is still small. If cancer develops and it gets an extra year to grow, we are giving up an important advantage. Also, when cancer develops in a younger or premenopausal woman, it may grow faster so it is even more important for younger women to have yearly mammograms.

I don’t have any risk factors that I know of for breast cancer. At what age should I begin having mammograms?
The American Cancer Society, American College of Radiology, American College of Obstetrics and Gynecology as well as other organizations recommend beginning regular mammograms at 40. The risk of developing breast cancer increases with age. While some believe that screening women in their 40s is not cost effective, decades of experience and data show that screening mammography significantly lowers the death rate from breast cancer in all women including those in their 40s.

In addition, because younger women have denser breast tissue, cancer can be more difficult to detect. Fortunately, digital mammography has significantly improved our ability to detect cancer in women with dense breasts. Breast cancer is unfortunately too common, even in women in their 40s without risk factors. I strongly believe that being able to detect and treat breast cancer effectively in a 40-year-old woman is worthwhile. I encourage women to discuss this decision with their physician. Once you have decided that you want to be screened, you should have a mammogram every year.

I have been getting regular mammograms. Do I still need to do breast self examination? 
Absolutely. A mammogram is the best single examination to detect breast cancer. It will detect 85 to 90 percent of cancers before they can be felt. However, that also means that 10 to 15 percent of cancers can be felt before they are seen on a mammogram. Cancers may be hidden on a mammogram by surrounding breast tissue, and in these situations self examination is crucial. It is a myth that by the time breast cancer can be felt, it’s too late. This is simply not true. If you feel a change in your breast, bring it to your physician’s attention.

When I check my breasts, they feel lumpy. How can self examination help if I don't know what a cancer lump feels like?
Many of my patients are frustrated by the fact that their breasts feel lumpy. I recommend that they approach self examination with a different perspective. Don’t examine yourself with the idea of finding a lump. All breasts feel lumpy to varying degrees. Instead, check your breasts regularly enough to know how they feel. Then, continue checking to make sure they feel the same as they always have. If you notice any changes, share them with your physician because there is a possibility that you have detected an early cancer.

If I have to have additional mammogram views, does that mean I have cancer?
The vast majority of women who have extra views do not have cancer. It is our responsibility to be exceedingly thorough and to evaluate any suggestion of changes on a mammogram. Taking additional views will often help determine if an area of concern is present. Common reasons for additional views include:

  • Overlapping tissue – A mammogram is a two-dimensional picture of a three-dimensional object. Breast tissue can overlap making it look like a mass is present. Taking another view will often help determine if that’s the case.
  • Calcifications – Calcium deposits in the breast are common and mostly due to benign conditions, but sometimes calcifications can be an indication of cancer. Magnified views can help the radiologists determine which type of calcification is present.
  • Masses – To determine if a mass seen on a mammogram is suspicious, the radiologist needs to see the borders of the mass. Extra views may be necessary to see all sides of the mass more clearly.
  • Motion – Even slight movement by the patient can cause an image to be blurred. This occurs on less than one percent of patient's films. The image must be repeated to make sure details can be seen.
  • Anatomical factors – Sometimes a patient's own physical build can make it difficult to obtain a clear picture of all the breast tissue. Additional views are obtained to see areas of the breast that cannot be seen well on standard views.

What can I expect when I have my mammogram at Newton-Wellesley Hospital?
The Women’s Imaging Center is committed to providing the most advanced medical services in an atmosphere focused on sensitivity and consideration for the patient’s experience. The Center has been consistently recognized as a Breast Imaging Center of Excellence by the American College of Radiology.

This designation is awarded to centers that have demonstrated excellence in breast imaging by achieving accreditation in mammography, breast ultrasound, ultrasound-guided biopsy and stereotactic breast biopsy. Our Center is staffed by a team of board certified radiologists who have advanced post-graduate training in breast imaging. They have extensive experience evaluating breast concerns and performing the full spectrum of interventional breast procedures. We use the most advanced mammography, ultrasound and MRI equipment available. Our technologists are all certified in radiology and mammography.

Results
We are dedicated to providing access to breast imaging services in a timely and efficient manner. Our intent is to make it easier and more convenient for women to have their annual mammogram and to reduce the anxiety associated with breast cancer detection. We believe it is important to answer questions and provide understandable information about our findings and your options.

We understand that undergoing mammography can be an anxious experience. We also know that medical appointments can be difficult to accommodate in a busy schedule. Being mindful of these two realities, the Women’s Imaging Center offers two screening mammogram options:

For women who prefer to find out the results of their mammogram as soon as possible and prefer to complete their evaluation on the same day, we offer the option of same-day results. If there is a finding that requires further evaluation, then the necessary additional mammography or ultrasound testing would be performed during the same appointment. In fact, even when a needle biopsy is required, it is often performed the same day. Same-day results are available during specified hours and should be requested when you schedule your appointment. This visit may require extended time at the Center, especially if additional testing is required.

If you choose not to wait for same-day results, you will be notified of your mammogram results by telephone within five business days. This appointment does not require any additional waiting time once the mammogram is complete. If additional testing is needed, you will be contacted and scheduled for an appointment as soon as it’s convenient for you. Screening mammograms are offered at Newton-Wellesley Hospital and at our two off-site Ambulatory Care Centers in Natick and Walpole. To schedule an appointment at any of these locations, call 617-243-5345. For more information about Women’s Imaging at Newton-Wellesley Hospital, visit our website at www.nwh.org/breastimaging.

Technology at the Women's Imaging Center

100% Digital Mammography
The Women’s Imaging Center uses digital mammography with computer-aided detection and advanced image enhancement – a cutting-edge technology that uses sophisticated computer algorithms to aid the radiologist in analyzing findings on the mammogram. With digital mammography, the breast image is captured using a specialized electronic X-ray detector, which converts the image into a digital picture for review on a computer monitor. The magnification, orientation, brightness and contrast of the image may be adjusted after the exam is completed to help the radiologist more clearly see certain areas.

Breast Ultrasound
If an area of concern is seen on a mammogram or if a lump is felt on physical examination, then further study is needed. Breast ultrasound can be helpful in characterizing lumps that are felt as well as determining if a mass seen on a mammogram is solid or cystic (fluid-filled). This information is important and helps determine if a biopsy is necessary.

Breast MRI
Breast MRI may be used in addition to mammography and ultrasound in select cases. MRI is not an alternative to mammography. Radiologists at the Center determine when additional testing is necessary and will recommend breast MRI when appropriate. An MRI can be very helpful in evaluating patients newly diagnosed with breast cancer to assess the extent of the disease
and plan the most appropriate treatment plan. Breast MRI is also important as a screening examination for women with very high risk of developing breast cancer because of hereditary or other factors.

Breast Biopsy
The breast imaging specialists at the Women’s Imaging Center are experts at performing breast biopsies using mammography, ultrasound or MRI to guide them. These biopsies are performed using only local anesthesia, and patients can drive themselves to and from the Hospital. The use of image-guided biopsy allows precise targeting and sampling of abnormal tissue to achieve a definitive diagnosis. Pathology results are usually available 24 to 48 hours after the procedure. Thanks to image-guided biopsies, many women can avoid surgery.

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