Breast Cancer Awareness Month
Our services include:
- Advanced imaging screening studies
- Diagnostic mammography and ultrasound appointments
- Live screening mammography/ultrasound appointments where same-day results are given. We also offer standard appointments which involve not receiving results the day of the appointment.
- Diagnostic and screening breast MRI
- High-risk breast cancer surveillance
- Lay Patient Navigators to assist with answering questions and guiding patients through the breast care journey. A lay navigator is a non-clinical(lay person) who is trained to perform specific activities related to system navigation functions which helps patients eliminate barriers to care.
Mammography
A mammogram is an X-ray image of your breasts. It can be used for breast cancer screening and diagnostic purposes, to investigate symptoms, and to surveil findings on previous imaging or unusual findings on other imaging tests.
What are the different types of mammograms?
There are two types of mammograms:
Digital mammography in 2D.
A digital mammogram usually involves at least two pictures of each breast taken at different angles — typically from top to bottom and from side to side — and provides a two-dimensional (2D) view.
Digital mammography in 3D (digital breast tomosynthesis).
3D mammography, also known as digital breast tomosynthesis (DBT), is a type of mammogram in which each breast is compressed once and a machine takes several low-dose X-rays as it moves in an arc over your breast. A computer then puts the images together, which allows healthcare providers to see your breast tissues more clearly in three dimensions. Many studies have revealed that 3D mammography increases cancer detection, including lower-grade cancers, and decreases false-positive rates. Given these advantages, 3D mammography for both screening and diagnostic mammograms has become a great addition to breast health and imaging.
What’s the difference between a screening mammogram and a diagnostic mammogram?
A screening mammogram is used to detect breast changes that could be cancerous in people who have no signs or symptoms. The goal is to detect cancer when it’s small and treatment may be less invasive.
A diagnostic mammogram is used to investigate suspicious breast health changes, such as a new breast lump, breast pain, an unusual skin appearance, nipple thickening or nipple discharge. It’s also used to evaluate unexpected findings on a screening mammogram or other modalities of imaging including CT, MRI, or X-ray. A diagnostic mammogram includes additional mammographic imaging pictures that differ from the ones that may have been previously taken.
Breast Density
Breast density is the ratio between the amount of glandular tissue versus the amount of fatty tissue in the breasts. Your breasts are considered dense if you have a lot of fibrous or glandular tissue but not much fat. Breast cancer and glandular tissue have a similar presentation on mammograms which makes it hard to assess. Density may decrease with age, but there is little, if any, change in most women. Breast density can make it difficult to detect cancer during routine mammograms.
The radiologist who reads your mammogram will determine your breast density in one of the four categories:
- Predominately fatty (represented in the 1st picture)
- Scattered fibroglandular (represented in the 2nd picture)
- Heterogeneously dense (represented in the 3rd picture)
- Extremely dense (represented in the 4th picture)
These mammogram images show a range of breast density. Some breasts are mostly fat (fatty breast) and some breasts are mostly breast and connective tissue (dense breast).
Density is an independent risk factor for the development of breast cancer due. Depending on where you fall on the density scale, your physician will be able to tell you if you have dense breasts. If you have dense breasts, please talk to your doctor. Together, you can decide if you require additional breast screening exams.
In February 2014, New Jersey implemented the S-792 law requiring mammography providers to notify patients who were categorized as having dense breast tissue. The legislation also requires insurers to cover breast follow-up evaluations, such as ultrasounds and MRIs in women with dense breast tissue. The law was designed to improve early breast cancer detection as well as educate patients about dense breast tissue to make them aware of how having dense breast tissue might make it more difficult to detect abnormalities.
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 indicating you are high risk. Please talk to your doctor and discuss your history.
Even if you are at low risk, and have entirely fatty breasts, The Breast Center recommends an annual mammogram beginning at age 40. For more information, please contact us.
Results for breast imaging
The radiologist looks for evidence of cancer and other conditions that may require further testing, follow-up or treatment for your breast health. The results are compiled in a report and provided to your healthcare provider. A BI-RADS score is given on all breast imaging reports. A Breast Imaging Reporting and Data System (BI-RADS) score is a standardized system used by doctors to describe the results of breast health imaging tests, such as mammograms, ultrasounds, and MRIs. The score is a number between 0 and 6, with each category having a specific clinical meaning and suggested follow-up care.
| Category | Definition | What it means? |
|---|---|---|
| 0 | Incomplete - Additional imaging evaluation and/or comparison to prior mammograms (or other imaging tests) is needed. | This means the radiologist may have seen a possible abnormality, but it was not clear and you will need more tests, such as another mammogram with the use of spot compression (applying compression to a smaller area when doing the mammogram), magnified views, special mammogram views, and/or ultrasound. This may also suggest that the radiologist wants to compare your new mammogram with older ones to see if there have been changes in the area over time. |
| 1 | Negative | This is a normal test result. Your breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing new or abnormal was found. |
| 2 | Benign (non-cancerous) finding | This is also a negative test result (there’s no sign of cancer), but the radiologist chooses to describe a finding that is not cancer, such as benign calcifications, masses, or lymph nodes in the breast. This can also be used to describe changes from a prior procedure (such as a biopsy) in the breast. This ensures that others who look at the mammogram in the future will not misinterpret the benign finding as suspicious. |
| 3 | Probably benign finding – Follow-up in a short time frame is suggested | A finding in this category has a very low (no more than 2%) chance of being cancer. It is not expected to change over time. But since it’s not proven to be benign, it’s helpful to be extra safe and see if the area in question does change over time. You will likely need follow-up with repeat imaging in 6 to 12 months and regularly after that until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it still allows for early diagnosis. |
| 4 | Suspicious abnormality – Biopsy should be considered | These findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, this category is often divided further: 4A: Finding with a low likelihood of being cancer (more than 2% but no more than 10%) 4B: Finding with a moderate likelihood of being cancer (more than 10% but no more than 50%) 4C: Finding with a high likelihood of being cancer (more than 50% but less than 95%), but not as high as Category 5 |
| 5 | Highly suggestive of malignancy – Appropriate action should be taken | The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended. |
| 6 | Known biopsy-proven malignancy – Appropriate action should be taken | This category is only used for findings on a mammogram (or ultrasound or MRI) that have already been shown to be cancer by a previous biopsy. Imaging may be used in this way to see how well the cancer is responding to treatment. |
How you prepare for your breast health appointment
To prepare for your mammogram:
- Schedule the test for a time when your breasts are least likely to be tender. If you menstruate, that’s usually during the week after your menstrual period.
- Bring your prior mammogram images. If you’re going to a new facility for your mammogram, request to have any prior mammograms placed on a CD. Bring the CD with you to your appointment so that the radiologist can compare past mammograms with your new images.
- Don’t use deodorant before your mammogram. Avoid using deodorants, antiperspirants, powders, lotions, creams or perfumes under your arms or on your breasts. Metallic particles in powders and deodorants could be visible on your mammogram and cause confusion.
Breast Ultrasound
A breast ultrasound uses high-frequency sound waves to generate images of breast tissues. The sound waves pass through the breast and bounce back, or echo, to form a picture of the internal structures. It is non-invasive and involves no radiation or X-rays. Breast ultrasound is also used to study areas of the breast that can be hard to see with a mammogram, such as the area closest to the chest wall.
When a breast ultrasound is needed:
- To check a lump felt by a doctor during a clinical exam or by a patient on a self-exam after a mammogram.
- To further evaluate abnormalities seen on a screening or diagnostic mammogram.
- To determine whether a breast mass is solid or a fluid-filled cyst. Solid masses may require follow-up imaging or biopsy.
- To determine the cause of spontaneous nipple discharge.
- To evaluate the breast tissue in symptomatic women under age 30.
- As a supplement to screening mammography in select patients with dense breast tissue. • For women who are pregnant and should not be exposed to X-rays.
In most cases, no fasting or special preparation is required before a breast ultrasound. Please dress in clothes that permit access to the area to be tested or that can easily be removed.
Your Breast MRI
Breast MRI is a non-invasive diagnostic procedure that uses a powerful magnet and radio waves (instead of `) to produce detailed images of the breast. MRI may detect problems within the breast that cannot be seen with a mammogram or ultrasound. Breast MRI may be performed with or without and IV injection of contrast (dye) depending upon the indication for the test. MRI does not replace mammography but may be used if your doctor considers additional information necessary.
When a breast MRI is needed:
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 women at high risk, which means a 20 percent or greater lifetime risk of developing breast cancer
- Determining the extent of breast cancer and to screen the opposite breast after a new diagnosis so the best treatment can be determined
- Evaluating breast tissue changes during and after treatment for breast cancer
- Evaluating lumpectomy sites in the years following breast cancer treatment
- Evaluating breast implants to determine whether silicone implants have ruptured
Before Your Breast MRI
- Guidelines about eating and drinking before an MRI exam vary with the specific exam. For some types of exams, you will be asked to fast for 8-12 hours. Unless you are told otherwise, you may follow your regular daily routine and take medications as usual.
- Please inform us if you have any serious health problems or if you have recently had surgery. Some conditions, such as severe kidney disease may prevent you from being given contrast material for an MRI. If there is a history of kidney disease, it may be necessary to perform a blood test to determine whether your kidneys are functioning adequately.
- You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners. Jewelry and other accessories should be left at home if possible or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic objects are not allowed in the exam room.
- If your prior mammograms were not performed at Radiology Associates of Ridgewood, please make them available to us at the time of your exam, if possible.
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Information regarding prevention awareness
- Breast self-exam (BSE) is an option for women starting in their 20’s. Breast cancer risk assessments should be performed by the age of 25.
- Women should know how their breasts normally feel and promptly report any changes to their healthcare provider.
- Mammography screening has been proven effective in reducing breast cancer death in women 40 years and over. The American College of Radiology (ACR) recommends annual mammography screening at 40 or sooner if you are high-risk.
- Did you know that nearly half of women age 40 and older have dense breasts which makes mammograms harder to read and increases the risk of breast cancer?
- Supplemental screening breast ultrasounds are the preferred method for supplemental screening although the most recent research shows supplemental screening breast MRI following negative mammography in women with dense breasts have breast cancer detection rates of 16.6 per 1,000 women screened versus 2 to 3 per 1,000 supplemental screening breast ultrasounds performed.
When should I call my provider?
Call your healthcare provider if you:
- Feel a new or changing lump, dimpling, or other changes in your breast or armpit.
- Experience unusual pain or discomfort
- Have any nipple discharge, new inversion (a nipple that’s pointing in when it used to point out or vice versa) or skin changes on your nipples.
- Think a breast implant has ruptured.
Dr. Scott DeGregorio and the Importance of Mammograms for your breast health
You can learn more about the importance of breast cancer screening through an interview with our very own Dr. Scott DeGregorio and CBS News anchor Cindy Hsu.