SCREENING

The best defense against breast cancer is a good offense. Physicians and individuals recognize that the most ideal “treatment” of cancer is to prevent its occurrence in the first place or, to detect it early when it may be most treatable.There are no perfect solutions, but screening can help with early detection and is one of the ways you can help to reduce your risk.

Regular screening tests for breast cancer, such as an annual mammogram and a breast exam during your annual checkup, allow you and your doctor to ensure that your breasts are as healthy as they can be. Screening can also increase the likelihood that your doctor will find breast cancer early, which is when it’s most treatable.

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WHAT IS A MAMMOGRAM?

A mammogram is an x-ray examination of the breasts, used to detect and diagnose breast diseases. Screening mammography is used as a preventive measure for women who have no symptoms of breast disease.

The Breast Center of Irvine is a “softer mammogram provider”. Our facility provides every woman with the Mammopad TM breast cushion, a soft, foam pad that creates a cushion between you and the mammography machine. This pad works to increase comfort during the mammography procedure. In addition, the fast paddle on our machines distributes pressure evenly which helps to reduce discomfort as well.

 

HOW WILL I GET MY RESULTS?

A radiologist who is a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician. You will receive a result letter 5-7 business days.

BREAST ULTRASOUND

Breast ultrasound is an imaging tool which produces high-frequency sound waves that pass through the breast tissue. A small hand-held unit called a transducer scans over the breast during the exam. A computer then converts the sound waves into images. The images are captured in real-time and can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram. Breast ultrasound does not use s-rays or other potentially harmful types of radiation.

 

WHO IS ELIGIBLE FOR SCREENING BREAST ULTRASOUND?

Screening breast ultrasound exams are primarily performed on women who fall into the high risk category:
 

• Asymptomatic women without implants that have a risk of developing breast cancer which is higher than 25%

• Women with breast that have at least 25% dense breast tissue

• Women who have more than one year following the diagnoses of breast cancer without known metastasis.

 

BENEFITS OF SCREENING BREAST ULTRASOUND EXAMS.

The greatest weakness of mammography is the difficulty in finding cancer in women with dense breast tissue. Ultrasound is apparently not hindered by dense tissue. Combining breast ultrasound with mammography significantly improves the ability to find more cancers in high risk women with dense tissue than the use of mammography alone. Finally, the cancers detected by ultrasound are predominantly small and invasive.

Ultrasound my be offered as a screening tool for women who:
 

• Are at high risk for breast cancer and unable to tolerate an MRI examination

• Are at intermediate risk for breast cancer based on family history, personal history of breast cancer, or a prior biopsy showing an abnormal result

• Have dense breast

• Have silicone breast implants and very little tissue can be included on the mammogram

• Are pregnant or should not to be exposed to x-rays (which are necessary for a mammogram)

GENETIC TESTING

Genetic predisposition is the most significant risk factor for the development of breast cancer. Having a family history on either your maternal or paternal side may put you at a higher risk for developing the disease.

 

One of the most common gene mutations associated with breast cancer is the Hereditary Breast and Ovarian Cancer (HBOC) Syndrome. This includes the BRCA1 and BRCA2 mutations. With this syndrome, there is a 0.1% risk of developing breast cancer in the average population, but a 203% of risk in those of Ashkenazi Jewish decent.

 

However, we now know of many other genes that can increase the risk of breast cancer including ATM, CDH1, CHEK2, PALB2, PTEN, STK11, TP53. BRCA1 has the greatest association with breast and ovarian cancer and usually occurs with younger age onset. BRCA2 carriers are typically at a later age onset and most common with postmenopausal women. BRCA2 also has a strong association with male breast cancer. In addition, both men and women with BRCA1 and BRCA2 have a higher risk for pancreatic cancer. Consider testing if you have personal or family history of the following:
 

• Diagnosed with breast cancer before age 50

• Ovarian cancer at any age

• Breast cancer with both breasts or ipsilateral (same side recurrence)

• Both breast and ovarian cancer

• Male breast cancer at any age

• Women of Ashkenazi Jewish decent with breast or ovarian cancer at any age

• A previously identified BRCA1 or BRCA2 mutation in the family

 

HOW THE TEST IS DONE AT OUR CENTER

At the Breast Center of Irvine, we use a very simple saliva collection method. It is imperative not to eat, drink, smoke or chew gum for 30 minutes prior to giving your sample. The collected cells sample is then sent to a laboratory to obtain DNA for testing. Your results are usually received within 2 weeks and will be sent to you and your primary healthcare physician. If preferable, a blood sample may be taken.

BONE DENSITY

Bone density scanning, also called dual-energy x-ray absorptiometry (DXA) or bone densitometry, is an enhanced form of x-ray technology that is used to measure bone loss. DXA is today’s established standard for measuring bone mineral density (BMD).

DXA is most often performed on the lower spine and hips. In children and some adults, the whole body is sometimes scanned. Peripheral devices that use x-ray or ultrasound are sometimes used to screen for low bone mass. In some communities, a CT scan with special software can also be used to diagnose or monitor low bone mass (QCT). This provides an accurate reading but is less commonly used than DXA scanning.

DXA scans are used to diagnose osteoporosis before fractures occur, predict the chances of future bone fractures, determine the rate of bone loss and monitor the effects of bone replacement therapy.

 

WHY IS IT IMPORTANT TO HAVE A BONE MINERAL DENSITY TEST?

A bone mineral density (BMD) test or DXA scan (dual-energy x-ray absorptiometry) is considered the most accurate test for bone density. While standard x-rays show changes in bone density after about 40% of bone loss, a DXA scan can detect changes after about a 1% variation in bone mass. This scan lasts about 10 minutes and exposes the patient to less radiation than a standard chest x-ray. A bone mineral density test can tell if you are at risk for osteoporosis, a disease in which the bones become a weak and are more likely to break. Osteoporosis can be prevented and treated if diagnosed early.

 

 WHO SHOULD BE TESTED?

• All postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis in addition to being postmenopausal and female)

• All women age 65 and older regardless of additional risk factors

• Postmenopausal women who have a past history of a fracture

• Women who are considering therapy for osteoporosis

• Women who have been on hormone replacement therapy (HTR/ERT) for prolonged period

 

WHAT ARE THE RISK FACTORS?

Some common risk factors include being female, advanced aging, being Caucasian or Asian, low bone mass, small body frame, family history of osteoporosis, estrogen deficiency due to menopause, anorexia nervosa, use of certain drugs, smoking, and excessive alcohol intake.

 

WHAT ARE THE RISK FACTORS?

Some common risk factors include being female, advanced aging, being Caucasian or Asian, low bone mass, small body frame, family history of osteoporosis, estrogen deficiency due to menopause, anorexia nervosa, use of certain drugs, smoking, and excessive alcohol intake.

 

WHAT TO EXPECT DURING THE EXAM?

During the exam, you will be instructed to lie on your back while your hip ad spine are scanned by the DXA machine to determine your BMD scores and risk of fractures. With most types of machines, you will be fully dressed and the test usually takes 10 minutes. You should refrain from taking calcium supplements for 24 hours prior to the test as the tablet could interfere with test results.

 

HOW OFTEN TO REPEAT A BMD TEST?

Patients taking an osteoporosis medication should repeat their BMD test every one – two years, according to the National Osteoporosis Foundation (NOF). Some healthcare providers may have certain patients repeat their BMD test after one year.

BIOPSY

A biopsy is a simple procedure that involves sampling tissue from an area of concern within the breast. As an alternative to an open surgical biopsy, the Breast Center of Irvine offers minimally invasive biopsy procedures performed with the guidance of ultrasound or mammography. If a lesion is discovered, a biopsy is performed to determine whether cancer is present or not.

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ULTRASOUND-GUIDED BIOPSY

An ultrasound-guided needle biopsy is a medical test used to learn more about a suspicious lesion or mass. The biopsy is done by using ultrasound to find the lesion or mass. Image-guided biopsy combines the use of ultrasound with either a Fine Needle Aspiration or Core Needle Biopsy. This test is most often used for lymph node, breast, thyroid and liver biopsies.

 

FINE NEEDLE ASPIRATION / ULTRASOUND

Fine needle aspiration (FNA) is the least invasive method of biopsy and it usually leaves no scar. You will be lying down for this procedure. An injection of local anesthesia is given to numb the area of interest. The radiologist uses a thin needle with a hollow center to remove a sample of cells from the suspicious area. Ultrasound guidance is used for FNAs, however in the most cases, he or she can feel the lump and guide the needle to the right place.

 

CORE NEEDLE BIOPSY / ULTRASOUND

Core needle biopsy uses a larger hollow needle than what is used for fine needle aspiration. This type of biopsy is done while you are lying down. After numbing the breast with local anesthesia, the radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area. In most cases, the needle is inserted about 3 to 6 times so that the doctor can get enough samples. Usually core needle biopsy does not leave a scar.

The radiologist will use an image-guided technique such as ultrasound or mammography. A small metal clip will be inserted into the area to mark the site of biopsy in case the tissue proves to be cancerous and additional surgery is required. This clip is left inside and is not harmful to the body. If the biopsy leads to more surgery, the clip will be removed at that time.

 

STEREOTACTIC BIOPSY

Stereotactic biopsy use 3D tomosynthesis mammographic images to accurately locate breast abnormalities. This techniques is most frequently used for biopsy of calcifications or lesions that are apparent on the mammogram, but not on the ultrasound. The procedure requires local anesthesia and only low-dose radiation.

 

VACUUM-ASSISTED BIOPSY or VAB

Vacuum-assisted breast biopsy, also known as mammotome biopsy, minimally invasive breast biopsy (MIBB) and vacuum core biopsy.

A vacuum-assisted biopsy is a way of removing an area of abnormal cells from the breast tissue. The radiologist uses a special needle attached to a vacuum device to remove the cells with either ultrasound or mammography guidance to take samples of breast tissue. The samples can then be examined under a microscope. This can show whether there is a cancer or another type of breast condition.

This test may be performed if your doctor has seen an abnormal area in your breast during your mammogram or ultrasound exam.