Screening Guidelines:
Women without significant family history (breast cancer
in a first-degree relative, i.e. mother or sister) Baseline
Exam at age 35, then annual screening beginning at age 40.
Women with significant family history of breast cancerBaseline
exam at age 30, then annual after age 35.
When a radiologist interprets a mammogram, he or she will
look for several signs of cancer such as asymmetric areas,
certain kinds of calcifications, tissue distortion, a nodule,
a focal star-shaped pattern, or a change from a previous
mammogram. Normal or other noncancerous tissues can resemble
cancerous ones. That is what makes interpretation of mammograms
difficult and why it requires professional radiologists
with mammographic training.
If a questionable area is found on a screening mammogram,
it will need further assessment. This may involve additional
special mammographic views or breast ultrasound. A determination
is then made whether the area in question is benign, probably
benign, or suspicious for cancer. If benign, the patient
should resume routine annual screening mammograms. If
“probably benign” the area in question is
considered to have a very low likelihood of malignancy
and a short interval follow-up mammogram in 3-6 months
is indicated to confirm that the area in question is stable
and benign. If the finding has an appearance that is suspicious
for cancer, a biopsy is indicated.
Depending on the type of finding, there are different biopsy
options available including open biopsy, or imaging-guided
percutaneous needle core biopsy using stereotactic mammography
or ultrasound for guidance. The surgeon is typically the
physician that discusses with the patient which type of
biopsy is best for her specific situation. If a patient
does not have a surgeon, a primary care doctor can obtain
a referral.
Breast Imaging Glossary:
Screening Mammogram – A screening
mammogram is an x-ray of the breasts performed in women
without any symptoms or signs of breast cancer on exam.
The study includes two x-rays of each breast. The American
Cancer Society recommends a baseline study at age 35, then
annual exams from the age of forty onward. In patients with
a family history of breast cancer in a mother or sister,
baseline study and annual screening would be started earlier.
Diagnostic Mammogram – A diagnostic
mammogram is an x-ray of the breasts performed in women
with a new lump or other abnormality on physical exam. This
involves the routine two views of each breast, plus additional
special views to evaluate the area of abnormality.
Additional Mammographic Views –
If a questionable area is identified on a screening mammogram,
the patient is asked to return for further assessment
with targeted supplementary views to better evaluate the
area in question. Breast sonogram may also be performed
at the same return visit. The radiologist then decides
whether the area is benign, probably benign, or suspicious
for cancer. If benign, the recommendation is to return
at the time of the next routine screening exam. If probably
benign, a short follow-up period of 3-6 months may be
recommended to confirm the site in question is stable.
If a finding remains suspicious for possible cancer, biopsy
will be recommended.
Breast Sonogram – A breast sonogram
is a targeted ultrasound exam performed to assess a palpable
breast lump or a suspicious area found on a mammogram.
Breast Biopsy – When a suspicious
area is identified by mammography or ultrasound, biopsy
may be indicated to determine whether or not it represents
cancer. Approximately 80% of all biopsies
turn out to be benign. Depending on the type and location
of abnormality, this may be performed in one of several
ways including open surgical biopsy under general anesthesia
or percutaneous (through the skin) needle core biopsy
under local anesthesia using ultrasound or stereotactic
mammography to guide the biopsy.
Open Biopsy – This is the surgical
removal of the suspicious appearing area in the breast
by a surgeon through a skin incision under general anesthesia.
The suspicious area will typically be targeted by placement
of a thin guide wire by a radiologist under mammographic
guidance or ultrasound guidance techniques immediately
prior to the surgery. Wire localization is sometimes not
necessary if the breast abnormality can be palpated (felt)
by the surgeon.
Needle Core Biopsy – This technique
utilizes a needle like biopsy probe that is placed in
the breast through a small skin nick under local anesthesia
and obtains multiple small core like tissue samples from
the suspicious area. Imaging guidance is used by a radiologist
to accurately place the probe in the suspicious area.
Imaging guidance may be stereotactic X-ray or ultrasound,
depending on which imaging technique best demonstrates
the suspicious area. Advantages of needle core biopsy
are that it does not require general anesthesia or stitches.
The patient may return home or work immediately following
the procedure, which typically lasts about 1 hour.
Stereotactically Guided Breast Biopsy –
This is a technique used for accurate placement of a needle
core biopsy probe for biopsy of a suspicious area found
on a mammogram. The suspicious mammogram finding may be
a density, calcifications, or a nodule. The patient lies
comfortably on her stomach on a special table that allows
the breast to be suspended through a hole in the table where
it is held in place for the procedure by gentle compression.
Ultrasound Guided Breast Biopsy –
This technique is used for accurate targeting for biopsy
of a suspicious abnormality visible by ultrasound.
Fine Needle Aspiration (FNA) –
FNA is used for sampling of fluid from breast cysts that
appear suspicious (“complex” appearance on
ultrasound). Most breast cysts are benign (“simple”
appearance on ultrasound) and do not require aspiration.
Aspiration is performed using a small needle placed in
the breast by a radiologist under ultrasound guidance
and local anesthesia. Needle Core Biopsies and FNA are
performed by Summit Radiologists at Cartersville Medical
Center and Piedmont Mountainside Hospital.
Mammograms are available at:
Marietta Imaging Center 770-792-1234
Cartersville Medical Center 770-606-2210
Piedmont Mountainside Hospital 706-301-5401
Murray Medical Center 706-517-3717
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