- Screening mammography, normal & high risk, including 3-D (tomography)
- Diagnostic mammography, including 3-D (tomography)
- Diagnostic ultrasound
- Screening MRI for high risk individuals
- Diagnostic MRI, for breast tissue evaluation or silicone implant evaluation
- Stereotactic biopsy
- Ultrasound guided core biopsy
- Ultrasound guided aspiration and/or drainage procedures
- MRI core biopsy
- Radioactive seed localization
Imaging of the breast is done primarily for detection of cancer. Screening mammography is used to detect cancer before it produces signs or symptoms. A screening mammogram includes images of each breast taken from two standard directions, with or without the 3-D images. The exams are performed at locations around the community to make it as close and convenient as possible for women to get screening exams. Women who have a higher risk of developing breast cancer because of family history, genetic mutation or chest wall radiation as a child also get basic screening mammograms but may start screening at a younger age than other women. In the Summa Health System women having a screening mammogram who have never had breast cancer will also have the opportunity for a cancer risk assessment by answering questions. A computer program takes the answers to the questions and compares to a large volume of collected information and gives each woman a percent risk of developing breast cancer in her lifetime or of having some forms of genetic mutation which carry higher than normal risk of breast cancer and other diseases. Women who have more than 20% risk of cancer in their lifetime are considered high risk and may have additional screening beyond mammography alone. Screening mammograms are read by a select group of radiologists who have specific qualifications to do so. Each woman who has a screening mammogram receives a letter through the mail about the results in plain language. Screening mammography detects about 80-90% of breast cancers. It is not perfect, but it is the best option we have currently to screen a community of women.
Diagnostic mammography is used to look into a problem, such as a lump, fluid coming from the nipple other than milk, new focal pain or something that looked different or not quite right on a screening mammogram. There are many different views which may be used in looking into a problem and 3-D is very helpful in many cases. These views are chosen and immediately looked at by a specialized radiologist. Women who have a diagnostic mammogram frequently will also have a diagnostic ultrasound, which looks at breast tissue in a completely different way than a mammogram. Between the mammogram and the ultrasound the radiologist can tell if there is something that will need a biopsy, something that is almost certainly not cancer but will get a double check exam in less than a year, or there is no additional testing required. Women leave a diagnostic exam knowing what the radiologist has recommended from the tests.
MRI is an additional way of looking at breast tissue which uses a different method compared to mammography or ultrasound. MRI is used to look for cancer in women who have something placing them at higher risk of developing breast cancer than most women. MRI is sometimes used as additional screening for women who have dense breast tissue, which makes cancers harder to find on a mammogram. In some women who have been diagnosed with breast cancer that could have components not well seen on mammogram or ultrasound, MRI is used by their surgeon to look at how much cancer is in the breast to help plan treatment.
When something is found which might be cancer, a needle biopsy is the next step to diagnosis. Special needles can be placed into the specific area that is worrisome after the tissue has been numbed. Needle biopsies can be done using mammography (stereotactic), ultrasound or MRI, with the method depending on how the worrisome area is best seen. Even though areas biopsied may look somehow worrisome, most biopsy results come back as not cancer and the worrisome changes being the result of other things that happen to breast tissue which can look similar to cancer on the mammogram, ultrasound or MRI.
For women who need surgery for the problem in the breast, cancer as well as some pre-cancerous abnormalities, the surgeon needs a guide to find things that cannot be felt by the surgeon’s fingers. Radioactive seed localization involves putting a tiny metal seed with a small amount of radioactive material into the area of worrisome breast tissue. This is done by numbing the breast tissue and putting the seed into the specific area through a needle using mammogram or ultrasound. The surgeon uses a special radiation detector in surgery to find the seed and removes the tissue and the seed. All radioactivity is in the seed so once it is removed there is no radioactivity left in the person.
While the majority of the time all these exams and procedures involve women, there are breast problems and cancers which occur in men. Because we have a specialized team working in dedicated breast centers, we have experience with male breast problems. We use the same tools to evaluate these unique problems in men.