Breast Imaging 1500 East Duarte Road Duarte, CA 91010-3000 800.826.HOPE www.cityofhope.org MED 8116 0607 25M
Breast Imaging Benefits of Early Detection One out of eight women in the U.S. will develop breast cancer in her lifetime. Fortunately, when detected early, the great majority of breast cancers are curable. In fact, 96 percent of women treated for early stage breast cancer are still free of disease five years after diagnosis. This makes routine breast imaging an important part of a woman s health care, so that problems can be detected when they are most treatable. Several different technologies are available for breast imaging today. This brochure outlines the choices available at City of Hope. It explains how they work, and when they may be most useful. Breast imaging services are provided at the Rita Cooper Finkel and J. William Finkel Women s Health Center at City of Hope. As an NCIdesignated Comprehensive Cancer Center, we take a multidisciplinary approach that ensures a woman receives the best possible care. In addition to breast imaging, we offer a full range of diagnostic procedures and treatments, as needed. Mammography A mammogram is a safe and reliable lowdose X-ray exam that provides a view inside breast tissue. It allows specially trained doctors (radiologists) to examine the internal structure of the breast, and to detect growths and other potential problems. In recent years, new technologies have reduced the amount of radiation needed to obtain mammogram images. Also, computer systems are now being used to examine mammograms, aiding in their interpretation.
Breast Cancer Screening City of Hope follows guidelines recommended by the National Comprehensive Cancer Network: For women age 20 to 39: A monthly breast self-exam A clinical breast exam by a trained health professional every one to three years For women age 40 and older: A monthly breast self-exam A yearly clinical breast exam by a trained health professional A yearly screening mammogram starting at age 40 Health Watch A mammogram can detect an abnormality long before it can be physically felt. These screening guidelines apply only to women with no unusual symptoms or breast problems. If you have an increased risk of breast cancer because of family history or other reasons, ask your doctor about beginning screening mammograms at an earlier age, or having more frequent exams. You may also want to discuss other options, such as breast MRI (described in this brochure). To learn how to perform a breast self-exam, please ask for a copy of the City of Hope brochure, Your Guide to Breast Self-exam. Preparing for Your Mammogram On the day of your mammogram, please avoid using powders or deodorants, because these can show up on the X-ray and interfere with the analysis by the radiologist. You may bring these products to use afterward. When you arrive at the mammography suite, a dressing area will be provided. You will be asked to undress down to your waist, and will be given an examination gown. Screening Mammogram A specially licensed radiologic technologist will take your mammogram. First, a compression paddle will be lowered slowly onto your breast. This prevents any movement and allows the maximum amount of tissue to be examined. You may experience some brief discomfort from the compression. Then, a series of images will be taken and checked for quality. If no additional images are needed, you should be finished with the exam. Results Your mammogram will be read by a qualified radiologist trained to detect any abnormal areas of breast tissue. The mammogram will also be scanned by a computer-aided detection (CAD) system programmed to detect very small abnormalities. This system works rapidly, so you can get your results as soon as possible. You will receive a letter with your results and information on any additional steps to take, if needed. Diagnostic Mammogram Similar to a screening mammogram, a diagnostic mammogram is performed when there is a known problem, such as a lump. It may also be used if you are experiencing other symptoms such as pain, or if you have had a previous breast cancer. In a diagnostic examination, the radiologist will review your results while you are at the Cooper Finkel Women s Health Center. That way, he or she can decide immediately if additional views are needed, or if another procedure is needed, such as a diagnostic ultrasound. Additional views allow the radiologist to see the
breast from different angles and magnifications. This helps to get a better look at areas of overlapping tissue, or microcalcifications (tiny specks of calcium that sometimes indicate a small cancer). The radiologist can then decide if a followup mammogram will be required, or if a biopsy is recommended to examine a tissue sample directly. Digital Mammography This state-of-the-art advance in mammography uses X-rays, but images are captured by electronic detectors instead of traditional film. Generally, digital mammography is comparable to film mammography for screening and diagnostic imaging. However, recent studies show it can detect breast cancer more effectively in certain groups of women, including: Younger women (such as women in their 40s) Women with dense breast tissue Digital mammography has other advantages. Procedures are faster, image contrast can be enhanced, digital files replace the need for film storage, and images can be transmitted electronically. A CAD system is also used with digital mammography to perform a second reading that can detect very small abnormalities in breast tissue. Going Digital Digital mammograms appear to be better at detecting breast tumors in certain women. Diagnostic Ultrasound Ultrasound uses high-frequency sound waves to produce an image on a viewing screen. For women with a breast lump, it can help to tell the difference between a fluid-filled cyst and a solid mass. This procedure takes between 15 and 45 minutes. First, a warmed gel is placed on the breast to help transmit sound waves. Then, the technologist uses a hand-held device to obtain an ultrasound image, placing it on the breast and moving it back and forth to create an image on the viewing screen. Breast MRI MRI (magnetic resonance imaging) technology combines magnetic fields, radio waves and a computer system to obtain cross-sectional threedimensional images. Breast MRI is especially useful for women with breast implants, as well as women with dense breast tissue that can be difficult to image with regular mammography. It can also detect small lesions that may not be visualized with mammography. Breast MRI does not replace mammography. It is used as an additional way to detect, evaluate and stage breast cancer. Staging helps doctors determine how advanced a cancer has become, and how it should be treated. Breast MRI can also help doctors evaluate breast tissue density and check for leaking or ruptured breast implants, cysts, enlarged ducts and hematomas (pooled blood). It can locate multiple tumors, and can sometimes distinguish between scar tissue and tumors that have returned. A special contrast material is used with MRI to give doctors an enhanced image. This can help them determine whether an abnormality is benign (noncancerous) or malignant (cancerous), assess the location and size of any suspicious growths, and check for enlarged lymph nodes. Important Information Before Undergoing MRI You may be asked to provide a urine sample before your exam. This is needed for a pregnancy test. Normally, pregnant women do not receive MRI because potential risks to the fetus are not yet known. You may continue to take your usual medications before your exam, unless told not to.
If you have fears of being in an enclosed space (claustrophobia), you can ask your doctor to prescribe a mild sedative. Before you receive contrast material, you may be asked if you have any allergies. Having a serious health problem such as kidney disease or sickle cell anemia may prevent you from receiving contrast material. This exam will take about 1½ hours total. You may be permitted to wear your own loose-fitting clothing if it has no metal fasteners, or else you may need to change into a hospital gown. Leave jewelry and accessories at home if possible. Metal and electronic objects can interfere with the magnetic field or be damaged by it, and are not permitted. These include: Jewelry, watches, credit cards, hearing aids Pins, hairpins, zippers, removable dental work Pens, eyeglasses, pocket knives Tell the radiologist if you have: Artificial heart valves, artificial limbs or joint prostheses Implanted drug infusion lines or ports, nerve stimulators or other electronic devices Metal pins, screws, plates or surgical staples Magnet Power Combined with mammography, MRI helps assess many problems affecting the breast. MRI is usually safe for patients with metal implants, but recent implants may require another imaging procedure. Having metal objects in the body such as shrapnel may require a preliminary X-ray. Tattoo dyes containing iron may heat up during an MRI, but are rarely a problem. MRI Procedure If you are going to receive contrast material, a nurse will give you an intravenous (IV) line. You will lie face down on a moveable bed with your breasts hanging down in cushioned openings. Earphones and music will be provided to relax you. The bed will be moved into the MRI unit s magnetic field. Then, the radiologist and technologist will go into an adjacent room. You will need to lie still while the machine creates the images. When images are being recorded, you will hear loud tapping or thumping sounds from the equipment. Each imaging sequence takes from one to 15 minutes. You can relax between sequences. After the initial series, the contrast material will be injected, and an additional series of images obtained. After the exam is finished, you will wait on the table briefly while the images are evaluated to ensure no more need to be taken. Then the IV line will be removed. There is usually no recovery time needed, and you can resume normal activities. Breast MRI Results A radiologist experienced in MRI will analyze the results. You will most likely receive these results from your primary care physician or your referring physician. Following Breast MRI Sometimes, even breast MRI cannot always tell the difference between benign and malignant disease. The results may indicate that cancer is present, or it may be something else such as a fibroadenoma (a benign breast lump). Only a biopsy can determine this. If additional care is needed, City of Hope provides women with a full range of biopsy procedures, as well as standard and advanced cancer treatment options.
Breast Biopsy For more details about biopsies, please ask for a copy of our brochure, City of Hope Breast Biopsy. For Appointments and Information For more information, or to become a patient at City of Hope, please call 800-826-HOPE or visit us at www.cityofhope.org.