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FAQ: Understanding Breast MRI
FAQ: Understanding Digital Mammography

Early Breast Cancer Detection
What is a mammogram?
Who should have mammograms?
How is mammography performed?
What is "Second Look" detection?
What is digital mammography?
Why did I need a breast ultrasound?
Should I have a breast MRI?
What are minimally invasive breast biopsies?
Key Statistics
Helpful Links

Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer. Numerous studies have shown that early detection of breast cancer greatly improves the chances for successful treatment.

Methods for early detection of breast cancer include breast self-examinations, clinical exams by a healthcare professional, and mammography. In most cases, mammography can identify an abnormal breast mass as much as two years before it can be detected by touch. "Second Look" detection, breast ultrasound, MRI, and minimally invasive biopsies are additional screening and diagnostic methods that aid in early detection.

The American Cancer Society* recommends the following screening guidelines:

• Yearly mammograms starting at age 40. The age at which screening should be stopped should be individualized by considering the potential risks and benefits of screening in the context of overall health status and longevity.
• Clinical breast exam should be part of a periodic health exam, about every 3 years for women in their 20s and 30s, and every year for women 40 and older.
• Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
• Women at risk (e.g. family history of breast cancer) should talk with their doctors about when to start mammography screening (presumably sooner than age 40), having additional tests (breast ultrasound and MRI), or having more frequent exams.

  * American Cancer Society's "Cancer Prevention & Early Detection Facts & Figures 2004."

What is a mammogram?

A mammogram is an X-ray examination of the breasts used to detect abnormalities.

Screening mammography is used to image the breast and aid in the early detection of breast cancer. A screening mammogram usually involves two views of each breast.

Diagnostic mammography involves additional views of the breast, and is used when an abnormality is found during screening, or in women who have breast complaints such as a breast mass, nipple discharge, breast pain, or skin irritation.

Today's mammograms use very low doses of radiation to produce high-quality X-ray images, making this a very safe procedure.

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Who should have mammograms?

In addition to annual screening mammograms for women aged 40 and older, women with certain risk factors should discuss an appropriate screening program with their physician. Some of the risk factors for breast cancer are:

• Family or personal history of breast cancer
• Early menstrual onset or late onset of menopause
• Use of oral contraceptives
• Use of hormone replacement therapy
• Alcohol use (2 or more drinks per day)

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How is mammography performed?

You will need to undress above the waist for your mammogram. You will be given a wrap to wear during the examination. The entire procedure will take about 20 minutes. Your X-rays will be developed before you leave, to make sure each film shows the right view and exposure.

The technologist will position each breast, one at a time, on a film cassette on the mammography equipment. The breast will then be compressed with a paddle and the X-ray image will be taken. Breast compression spreads the tissue apart so that the maximum amount of breast tissue can be imaged using a low dose of radiation. The compression will last for only a few seconds. It may be uncomfortable, but should not be painful.

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What is "Second Look" detection?

"Second Look" is a breakthrough technology that provides an extra level of protection and radiological assistance in breast cancer detection. As part of the mammography reading process, Second Look uses sophisticated computer technology to give you the benefits of a second opinion without any additional procedures or doctor's appointments.

Second Look uses a computer to analyze mammograms. It can alert the physician to take a closer look at subtle warning signs that might easily be missed. Your mammogram is scanned into the Second Look system and is analyzed using sophisticated software. A report, called a Mammograph, is printed out which helps to identify potentially cancerous lesions.

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What is digital mammography?

Digital (computerized) mammography is similar to standard mammography in that x-rays are used to produce detailed images of the breast. Digital mammography uses essentially the same mammography system as conventional mammography, but the system is equipped with a digital receptor and a computer instead of a film cassette. Conventional film mammography requires several minutes to develop the film while digital mammography provides the image on the computer monitor in less than a minute after the exposure/data acquisition. Thus, digital mammography provides a shorter exam for the woman and can allow the images to be manipulated to correct for under or over exposure after the exam is completed, eliminating the need for some women to undergo repeat mammograms before leaving the facility.

Click here for our FAQ on Understanding Digital Mammography

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Why did I need a breast ultrasound?

A breast ultrasound may be used to supplement your mammogram or as an independent examination in order to most effectively detect and classify breast lesions. Whether or not you will need a breast ultrasound depends on your specific case. Ultrasound is completely painless and uses no radiation.

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Should I have a breast MRI?

Breast MRI is not appropriate for everyone, so risks and benefits must be assessed individually. The best candidates for Breast MRI are women who:

• have had a suspicious lump or mammogram
• already have had a diagnosis of cancer and will have surgery or chemotherapy followed by surgery
• have dense breasts, implants, or scar tissue from previous breast surgery
• women who are at high risk for breast cancer due to a previous cancer diagnosis, strong family history for breast cancer, or a positive test result for one of the breast cancer genes

Click here for our FAQ on Understanding Breast MRI

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What are minimally invasive breast biopsies?

A biopsy is performed if an abnormality is found on your mammogram and in your ultrasound. Advances in technology have made it easier and safer to detect breast cancers at an early stage. Minimally invasive breast biopsy and the equipment used have been designed to make the procedure as comfortable as possible for the patient, while producing superior clinical results.

There are three main types of biopsy procedures: stereotactic, ultrasound-guided, and MR-guided biopsy. All are called "less" or "minimally" invasive because they do not require hospital visits, surgery or stitches. The method chosen for your biopsy depends on your specific case.

Stereotactic breast biopsy is a safe and simple procedure that is performed in the office by our team of breast imaging professionals. Advanced computer imaging technology is used to map the precise location of abnormal appearing areas in the breast that can be seen on a mammogram, but cannot be located by touch. The technology used aids the physician in removing a small section of the suspicious tissue with pinpoint accuracy. The sample can then be sent to an outside laboratory for examination under a microscope.

Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically, and also eliminates the radiation exposure that comes from using x-rays to locate a mass. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy device directly into the mass. Tissue specimens are then taken and sent to an outside laboratory for further analysis.

MR-guided biopsy uses MRI rather than ultrasound or mammogram to locate and analyze suspicious areas for biopsy. Doctors predict that MRI-Guided Breast Biopsy procedure will lead to better treatment, fewer unnecessary mastectomies, and a better early detection method for women who are at high risk. MR-guided breast biopsy is usually a preferred alternative to surgical biopsy. It is used when ultrasound or mammogram (stereotactic) guided biopsy is not appropriate because the area of concern is not seen, or not well seen, by mammogram or ultrasound. Sometimes, MR-guided biopsy is called for when an abnormality is seen only on a breast MRI and cannot be visualized by ultrasound or mammogram.

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Key Statistics

Here are some key statistics about mammography and breast biopsy results:

• Only 1 or 2 mammograms out of every 1,000 lead to a diagnosis of breast cancer.
• Approximately 10% of women will require additional mammography.
• Only 8% to 10% of those women will need to have a breast biopsy performed.
• 70% to 80% of all breast biopsies show no signs of cancer.

  Source: Lorad, the leading manufacturer of sophisticated medical imaging systems for early detection of breast cancer.

Helpful Links

American Cancer Society	www.cancer.org
Breast Cancer Answers	www.canceranswers.org
Connecticut Breast Cancer Coalition Foundation	www.cbccf.org
Y-ME Breast Cancer Support Site	www.y-me.org

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