Ductal lavage is a procedure for collecting cells from the milk ducts of the breast for analysis. The procedure is used to identify precancerous cells, called atypical cells. Ductal lavage currently is performed only on women who have multiple breast cancer risk factors to try to detect breast cancer before it starts.
Ductal lavage works on the premise that most breast cancers (about 95%) develop in cells that line the milk ducts of the breast. Cancer usually begins in one duct and may be contained to that duct if caught early, making treatment more effective and increasing survival.
By the time cancer is detected, however, it often has progressed beyond a single duct. (Experts estimate that it takes 8 to 10 years for cancer to grow from 1 cell to a mass large enough to be detected on a mammogram -- about 1 billion cells.)
Doctors hope that performing ductal lavage as a screening tool in women at high risk for breast cancer may catch the disease early when it is most treatable.
How Does Ductal Lavage Work?
Ductal lavage is a minimally invasive procedure that may be performed in a doctor's office or outpatient center. It is performed in three steps:
An anesthetic cream is applied to numb the nipple area. Gentle suction is used to withdraw a small amount of fluid from the milk ducts. This is done to locate the opening of the ducts on the nipple's surface and to identify ducts to be tested. Ducts that do not produce fluid generally are not tested with the lavage procedure, since atypical cells are more commonly found in ducts that produce fluid. Not all women are able to produce fluid with this test. If fluid is not made, the test is not continued any further.
A hair-thin catheter (small tube) is inserted into the natural opening of the duct. Additional anesthetic is delivered into the duct. A saline (salt and water) solution is then infused through the catheter to rinse the duct, which loosens cells from the duct lining. The solution containing the loosened cells is withdrawn through the catheter. (The word "lavage" is French for "wash" or "rinse.")
The sample is sent to the laboratory for analysis to determine if the cells are normal or abnormal (atypical cells). Women with atypical cells have an increased risk of developing breast cancer.
Who Is a Candidate for Ductal Lavage?
Ductal lavage is recommended only for women who are at high risk for breast cancer. There are several factors that put a woman at high risk for developing breast cancer, including:
A personal history of breast cancer.
A family history of breast cancer, particularly in a mother, daughter or sister.
Evidence of a specific gene (BRCA1/BRCA2 mutation).
A Gail Index score of at least 1.7 percent (The Gail Index uses risk factors such as age, family history of breast cancer, age of first menstrual period and first pregnancy, and number of breast biopsies to calculate a woman's risk of developing breast cancer within the next five years.).
What Happens If Atypical Cells Are Found?
Not all abnormal cells are destined to become cancer. Atypical cells are those that have begun to change and are at risk of becoming cancerous. Knowing that you have atypical cells can help you and your doctor plan a strategy to reduce your risk of developing breast cancer. A strategy may include
Increased breast health monitoring, such as more frequent clinical breast exams.
Medication, such as tamoxifen that lowers breast cancer risk.
Surgery such as prophylactic mastectomy (surgery to remove a breast before cancer develops).
What Will I Feel During the Procedure?
Most women do not find the procedure to be painful, saying it is no more uncomfortable than a mammogram. You may feel temporary sensations such as fullness, pinching and tingling in the breast. However, numbing medications (anesthetics) are used to help reduce discomfort during the procedure.
Is Ductal Lavage Used Instead of a Mammogram to Screen for Breast Cancer?
No. Ductal lavage is used as an adjunct, or addition, to regular breast health practices -- such as breast self-exams, annual clinical exams and mammography -- not in place of these screening tools. In addition, ductal lavage is not recommended for women with a low risk for breast cancer.
What Risks Are Associated With This Procedure?
There are few risks associated with ductal lavage. Rarely, an infection may develop at the site of the catheter insertion. It is possible to perforate, or puncture, the milk duct, although perforation is rare and generally causes no permanent damage to the breast.
Thursday, November 8, 2007
Breast Cancer: Sentinel Node Biopsy
Sentinel node biopsy is a relatively new way of pinpointing the first few lymph nodes into which a tumor drains (called the "sentinel" node). This helps doctors remove only those nodes of the lymphatic system most likely to contain cancer cells. The sentinel nodes are the first place that cancer is likely to spread.
In breast cancer, the sentinel node is usually located in the axillary nodes, under the arm. In a small percentage of cases, the sentinel node is found somewhere else in the lymphatic system of the breast. If the sentinel node is positive there may be other positive lymph nodes upstream. If it is negative, it is highly likely that all of the upstream nodes are negative.
How is the Procedure Performed?
To locate the sentinel nodes, a labeling substance, either radioactive tracer, blue dye or both is injected into the area around the tumor before a mastectomy or lumpectomy is performed. The tracer travels the same path to the lymph nodes that the cancer cells would take, making it possible for the surgeon to determine the one or two nodes most likely to test positive for cancer by either visualizing the color or using a hand held Geiger counter.
This method varies in how it is performed among hospitals and is still being tested to determine the best way to identify the positive nodes.
What are the Advantages of This Method?
Research suggests that the sentinel node biopsy procedure can be useful in determining which lymph nodes to remove, without the risk of complications associated with surgically removing all potentially cancerous nodes.
When a lumpectomy or mastectomy is performed, only a few lymph nodes are removed for laboratory analysis using the sentinel node biopsy technique. In traditional lumpectomy or mastectomy procedures, a greater number of the axillary nodes are removed, which can lead to complications after surgery such lymphedema.
In breast cancer, the sentinel node is usually located in the axillary nodes, under the arm. In a small percentage of cases, the sentinel node is found somewhere else in the lymphatic system of the breast. If the sentinel node is positive there may be other positive lymph nodes upstream. If it is negative, it is highly likely that all of the upstream nodes are negative.
How is the Procedure Performed?
To locate the sentinel nodes, a labeling substance, either radioactive tracer, blue dye or both is injected into the area around the tumor before a mastectomy or lumpectomy is performed. The tracer travels the same path to the lymph nodes that the cancer cells would take, making it possible for the surgeon to determine the one or two nodes most likely to test positive for cancer by either visualizing the color or using a hand held Geiger counter.
This method varies in how it is performed among hospitals and is still being tested to determine the best way to identify the positive nodes.
What are the Advantages of This Method?
Research suggests that the sentinel node biopsy procedure can be useful in determining which lymph nodes to remove, without the risk of complications associated with surgically removing all potentially cancerous nodes.
When a lumpectomy or mastectomy is performed, only a few lymph nodes are removed for laboratory analysis using the sentinel node biopsy technique. In traditional lumpectomy or mastectomy procedures, a greater number of the axillary nodes are removed, which can lead to complications after surgery such lymphedema.
Breast Cancer: Minimally Invasive Breast Biopsy
When a breast biopsy is recommended for an abnormal mammogram finding, patients may be able to choose a minimally invasive alternative to surgery known as image-guided needle biopsy. This is a technique that does not require surgery. Most of the time, the radiologist performs this type of biopsy.
How Is This Type Of Biopsy Performed?
The needle biopsy can be performed using ultrasound or stereotactic guidance. Stereotactic refers to the use of stereo images -- pictures of the breast taken from different angles -- to determine the precise location of the abnormal tissue.
When stereotactic guidance is used, the patient lies on her abdomen on a specially designed exam table. An opening in the table allows access to the breast. The table is raised and the biopsy is done from below the table. This procedure may also be done with the patient sitting upright in a chair - particularly for those who are unable to lie on their abdomen for any reason. When ultrasound guidance is used, the patient lies on her back on the exam table.
The area that needs to be tested is centered in the window of a specially designed compression paddle. Mammogram films are taken so the radiologist can examine the breast tissue to be biopsied. These films are called SCOUT films.
After giving a local anesthetic, the radiologist makes a small opening in the skin. A sterile biopsy needle is placed into the abnormal breast tissue. Computerized pictures help confirm the exact needle placement using digital imaging.
Tissue samples are taken through the needle. It is common to take multiple tissue samples (about three to five). There are a number of biopsy instruments that can be utilized to obtain the tissue sample. They include core biopsy which uses a needle to obtain a piece of tissue about 1/16 inch across and ½ inch long, and a vacuum assisted needle biopsy device (VAD), which uses vacuum suction to obtain a tissue sample. This tissue is then examined under the microscope to look for cancer cells. This part of the biopsy takes approximately 15 minutes. Upon completion, sterile strips and a small adhesive bandage are applied to the skin. The entire procedure takes approximately 30 minutes to an hour. Results are usually available in three to five working days.
What Are The Benefits Of Minimally Invasive Biopsy?
Minimal scarring instead of a large incision.
Reduced post-procedural pain and risk of infection.
Potentially lower hospital costs.
Immediate return to work.
Shorter recovery time and immediate resumption of daily activities.
How Safe Is Minimally Invasive Biopsy?
This procedure is as safe as "open" surgery when performed by breast imaging specialists in this field.
How Is This Type Of Biopsy Performed?
The needle biopsy can be performed using ultrasound or stereotactic guidance. Stereotactic refers to the use of stereo images -- pictures of the breast taken from different angles -- to determine the precise location of the abnormal tissue.
When stereotactic guidance is used, the patient lies on her abdomen on a specially designed exam table. An opening in the table allows access to the breast. The table is raised and the biopsy is done from below the table. This procedure may also be done with the patient sitting upright in a chair - particularly for those who are unable to lie on their abdomen for any reason. When ultrasound guidance is used, the patient lies on her back on the exam table.
The area that needs to be tested is centered in the window of a specially designed compression paddle. Mammogram films are taken so the radiologist can examine the breast tissue to be biopsied. These films are called SCOUT films.
After giving a local anesthetic, the radiologist makes a small opening in the skin. A sterile biopsy needle is placed into the abnormal breast tissue. Computerized pictures help confirm the exact needle placement using digital imaging.
Tissue samples are taken through the needle. It is common to take multiple tissue samples (about three to five). There are a number of biopsy instruments that can be utilized to obtain the tissue sample. They include core biopsy which uses a needle to obtain a piece of tissue about 1/16 inch across and ½ inch long, and a vacuum assisted needle biopsy device (VAD), which uses vacuum suction to obtain a tissue sample. This tissue is then examined under the microscope to look for cancer cells. This part of the biopsy takes approximately 15 minutes. Upon completion, sterile strips and a small adhesive bandage are applied to the skin. The entire procedure takes approximately 30 minutes to an hour. Results are usually available in three to five working days.
What Are The Benefits Of Minimally Invasive Biopsy?
Minimal scarring instead of a large incision.
Reduced post-procedural pain and risk of infection.
Potentially lower hospital costs.
Immediate return to work.
Shorter recovery time and immediate resumption of daily activities.
How Safe Is Minimally Invasive Biopsy?
This procedure is as safe as "open" surgery when performed by breast imaging specialists in this field.
Breast Cancer: Breast Biopsy
A biopsy is the removal of cells or tissue from a suspicious mass. The tissue or cells are then examined under a microscope to check for cancer cells. A biopsy may be performed when an abnormal breast change is found during a mammogram, ultrasound or physical examination. A biopsy is the only way to determine if a potential trouble spot is cancerous or benign.
There are many types of biopsy procedures. The method recommended by your doctor will depend on how large the breast lump or abnormal area is; where in the breast it is located; how many lumps or abnormal areas -- such as suspicious calcifications -- are present; if you have any other medical problems; and what your personal preferences are.
There are many types of biopsy procedures. The method recommended by your doctor will depend on how large the breast lump or abnormal area is; where in the breast it is located; how many lumps or abnormal areas -- such as suspicious calcifications -- are present; if you have any other medical problems; and what your personal preferences are.
Breast Cancer: MRI
Breast MRI (magnetic resonance imaging) is a test that may be used to distinguish between benign (noncancerous) and malignant (cancerous) lesions. Performing this test may reduce the number of breast biopsies done to evaluate a suspicious breast mass. Although MRI can detect tumors in dense breast tissue, it cannot detect tiny specks of calcium (known as microcalcifications), which account for half of the cancers detected by mammography.
Is the Breast MRI Test Safe?
Yes. MRI examination poses no risk to the average patient if appropriate safety guidelines are followed.
People who have had heart surgery and people with the following medical devices can be safely examined with MRI:
Surgical clips or sutures.
Artificial joints.
Staples.
Most heart valve replacements.
Disconnected medication pumps.
Vena cava filters.
Brain shunt tubes for hydrocephalus.
Some conditions may make an MRI examination inadvisable. Tell your doctor if you have any of the following conditions:
Heart pacemaker
Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulators ("TENS") for back pain
Metal in the eye or eye socket
Cochlear (ear) implant for hearing impairment
Implanted spine stabilization rods
Severe lung disease
Uncontrolled gastroesophageal reflux (a condition causing severe heartburn)
In addition, tell your doctor if you:
Are pregnant.
Weigh more than 300 pounds.
Are not able to lie on your back for 30 to 60 minutes.
Have claustrophobia (fear of closed or narrow spaces).
How Long Is the Breast MRI Test?
Allow 1 1/2 hours for your MRI exam. In most cases, the procedure takes 45 to 60 minutes, during which time several dozen images may be obtained.
What Happens Before the Exam?
Personal items such as your watch, wallet -- including any credit cards with magnetic strips (they will be erased by the magnet) -- and jewelry should be left at home if possible, or removed prior to the MRI scan. Hearing aids should be removed before the test since they can be damaged by the magnetic field. Secured lockers are typically available to store personal possessions.
What Happens During the Exam?
You will be asked to wear a hospital gown during your breast MRI.
As the MRI scan begins, you will hear the equipment making a muffled thumping sound that will last for several minutes. Other than the sound, you should experience no unusual sensations during the scanning.
Certain MRI exams require that you receive an injection of a contrast material. This helps identify certain anatomic structures on the scan images.
Feel free to ask questions or tell the technologist or the physician if you have any concerns.
What Happens After the Exam?
Generally, you can resume your usual activities and normal diet immediately.
Is the Breast MRI Test Safe?
Yes. MRI examination poses no risk to the average patient if appropriate safety guidelines are followed.
People who have had heart surgery and people with the following medical devices can be safely examined with MRI:
Surgical clips or sutures.
Artificial joints.
Staples.
Most heart valve replacements.
Disconnected medication pumps.
Vena cava filters.
Brain shunt tubes for hydrocephalus.
Some conditions may make an MRI examination inadvisable. Tell your doctor if you have any of the following conditions:
Heart pacemaker
Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain medication), or implanted nerve stimulators ("TENS") for back pain
Metal in the eye or eye socket
Cochlear (ear) implant for hearing impairment
Implanted spine stabilization rods
Severe lung disease
Uncontrolled gastroesophageal reflux (a condition causing severe heartburn)
In addition, tell your doctor if you:
Are pregnant.
Weigh more than 300 pounds.
Are not able to lie on your back for 30 to 60 minutes.
Have claustrophobia (fear of closed or narrow spaces).
How Long Is the Breast MRI Test?
Allow 1 1/2 hours for your MRI exam. In most cases, the procedure takes 45 to 60 minutes, during which time several dozen images may be obtained.
What Happens Before the Exam?
Personal items such as your watch, wallet -- including any credit cards with magnetic strips (they will be erased by the magnet) -- and jewelry should be left at home if possible, or removed prior to the MRI scan. Hearing aids should be removed before the test since they can be damaged by the magnetic field. Secured lockers are typically available to store personal possessions.
What Happens During the Exam?
You will be asked to wear a hospital gown during your breast MRI.
As the MRI scan begins, you will hear the equipment making a muffled thumping sound that will last for several minutes. Other than the sound, you should experience no unusual sensations during the scanning.
Certain MRI exams require that you receive an injection of a contrast material. This helps identify certain anatomic structures on the scan images.
Feel free to ask questions or tell the technologist or the physician if you have any concerns.
What Happens After the Exam?
Generally, you can resume your usual activities and normal diet immediately.
Breast Cancer: Breast Ultrasound
Breast ultrasound is a procedure that may be used to determine whether a lump is a cyst (sac containing fluid) or a solid mass. If it is found to be a cyst, fluid is typically withdrawn from it using a needle and syringe (a process called aspiration). If clear fluid is removed and the mass completely disappears, no further treatment or evaluation is needed.
Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the physician during a biopsy or aspiration procedure. Ultrasound helps confirm correct needle placement.
Ultrasound testing works by transmits high-frequency sound waves, inaudible to the human ear, through the breast. The sound waves bounce off surfaces in the breast (tissue, air, fluid) and these "echoes" are recorded and transformed into video or photographic images
Are There Any Side Effects From the Breast Ultrasound Procedure?
Studies have shown that breast ultrasound is not hazardous. There are no harmful side effects. In addition, ultrasound does not use radiation, as X-ray tests do.
What Happens During the Breast Ultrasound Test?
There is no special preparation for the breast ultrasound test.
You will be asked to change into a hospital gown so you may consider wearing a two-piece outfit on the day of the test so that you only need to remove your top.
You will lie on a padded examining table during the test.
A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel does not harm your skin or stain your clothes.
A probe that looks like a little paddle is gently applied against the skin.
You may be asked to hold your breath briefly several times.
The ultrasound test takes about 10 minutes to complete.
After the test, the gel will be wiped off your skin. Your physician will discuss the test results with you.
Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the physician during a biopsy or aspiration procedure. Ultrasound helps confirm correct needle placement.
Ultrasound testing works by transmits high-frequency sound waves, inaudible to the human ear, through the breast. The sound waves bounce off surfaces in the breast (tissue, air, fluid) and these "echoes" are recorded and transformed into video or photographic images
Are There Any Side Effects From the Breast Ultrasound Procedure?
Studies have shown that breast ultrasound is not hazardous. There are no harmful side effects. In addition, ultrasound does not use radiation, as X-ray tests do.
What Happens During the Breast Ultrasound Test?
There is no special preparation for the breast ultrasound test.
You will be asked to change into a hospital gown so you may consider wearing a two-piece outfit on the day of the test so that you only need to remove your top.
You will lie on a padded examining table during the test.
A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel does not harm your skin or stain your clothes.
A probe that looks like a little paddle is gently applied against the skin.
You may be asked to hold your breath briefly several times.
The ultrasound test takes about 10 minutes to complete.
After the test, the gel will be wiped off your skin. Your physician will discuss the test results with you.
Breast Cancer: Understanding Mammogram Results
What if the radiologist sees something suspicious or abnormal on your mammogram? The fear of abnormal mammogram results is real, but facts may help calm it. Most abnormalities found in mammogram results are not breast cancer.
The American Cancer Society recommends having a baseline mammogram between ages 35 and 40, and then a screening mammogram every year after age 40. Questionable mammogram results sometimes require additional evaluation. With further examination (imaging studies and/or biopsy), most of these abnormalities are found to be normal breast tissue or benign (non-cancerous) tissue.
What Is a Screening Mammogram?
Screening mammograms are recommended annually for all women starting at age 40, even if they are asymptomatic, meaning that they have no signs or symptoms of breast disease.
In a screening mammogram, each breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram image is viewed, breast tissue appears white and opaque and fatty tissue appears darker and translucent.
What If Something Looks Abnormal?
Potential abnormalities are found in 6% to 8% percent of women who have screening mammograms. This small group of women needs further evaluation that may include diagnostic mammography, breast ultrasound, or needle biopsy.
After the additional evaluation is complete, most of these women will be found to have nothing wrong.
What Is a Diagnostic Mammogram?
Diagnostic mammograms differ from screening mammograms in that the examination focuses specifically on an area of tissue that appeared abnormal in a screening mammogram. Diagnostic mammograms are also done for women who haven't had a screening mammogram but may be showing signs or symptoms of something abnormal in the breasts.
Depending on the potential abnormality, different studies may be done. In some women, only additional mammographic images are needed. In other women, additional mammographic images and an ultrasound are done.
How Does an Abnormality Appear on a Mammogram?
A potential abnormality on a mammogram may be called a nodule, mass, lump, density or distortion.
A mass (lump) with a smooth, well-defined border is often benign. Ultrasound is needed to characterize the inside of a mass -- if the mass contains fluid, it is called a cyst.
A mass (lump) that has an irregular border or a star-burst appearance (spiculated) may be cancerous and a biopsy is usually recommended.
Microcalcifications (small deposits of calcium) are another type of abnormality. They can be classified as benign, suspicious or indeterminate. Depending on the appearance of the microcalcifications on the additional studies (magnification views), a biopsy may be recommended.
How Accurate Is Mammography?
Mammography is 85% to 90% accurate. Mammograms have improved the ability to detect breast abnormalities before they are large enough to be felt during a breast examination.
However, it is possible for a mass to be felt but not appear on a mammogram. Because of this, your healthcare provider should evaluate any abnormality that you feel when examining your breasts. A diagnostic mammogram or additional studies may be recommended.
The American Cancer Society recommends having a baseline mammogram between ages 35 and 40, and then a screening mammogram every year after age 40. Questionable mammogram results sometimes require additional evaluation. With further examination (imaging studies and/or biopsy), most of these abnormalities are found to be normal breast tissue or benign (non-cancerous) tissue.
What Is a Screening Mammogram?
Screening mammograms are recommended annually for all women starting at age 40, even if they are asymptomatic, meaning that they have no signs or symptoms of breast disease.
In a screening mammogram, each breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram image is viewed, breast tissue appears white and opaque and fatty tissue appears darker and translucent.
What If Something Looks Abnormal?
Potential abnormalities are found in 6% to 8% percent of women who have screening mammograms. This small group of women needs further evaluation that may include diagnostic mammography, breast ultrasound, or needle biopsy.
After the additional evaluation is complete, most of these women will be found to have nothing wrong.
What Is a Diagnostic Mammogram?
Diagnostic mammograms differ from screening mammograms in that the examination focuses specifically on an area of tissue that appeared abnormal in a screening mammogram. Diagnostic mammograms are also done for women who haven't had a screening mammogram but may be showing signs or symptoms of something abnormal in the breasts.
Depending on the potential abnormality, different studies may be done. In some women, only additional mammographic images are needed. In other women, additional mammographic images and an ultrasound are done.
How Does an Abnormality Appear on a Mammogram?
A potential abnormality on a mammogram may be called a nodule, mass, lump, density or distortion.
A mass (lump) with a smooth, well-defined border is often benign. Ultrasound is needed to characterize the inside of a mass -- if the mass contains fluid, it is called a cyst.
A mass (lump) that has an irregular border or a star-burst appearance (spiculated) may be cancerous and a biopsy is usually recommended.
Microcalcifications (small deposits of calcium) are another type of abnormality. They can be classified as benign, suspicious or indeterminate. Depending on the appearance of the microcalcifications on the additional studies (magnification views), a biopsy may be recommended.
How Accurate Is Mammography?
Mammography is 85% to 90% accurate. Mammograms have improved the ability to detect breast abnormalities before they are large enough to be felt during a breast examination.
However, it is possible for a mass to be felt but not appear on a mammogram. Because of this, your healthcare provider should evaluate any abnormality that you feel when examining your breasts. A diagnostic mammogram or additional studies may be recommended.
Breast Cancer: Mammograms
Mammography uses special X-ray images to detect abnormal growths or changes in the breast tissue. Mammograms performed on healthy, normal breasts provide a baseline reference for later comparison.
Using a machine and X-ray film made especially for breast tissue, a technician compresses the breast and takes pictures from at least two different angles, creating a set of images for each of your breasts. This set of images is called a mammogram. Breast tissue appears white and opaque and fatty tissue appears darker and translucent.
In a screening mammogram, the breast is X-rayed from top to bottom and from side to side. A diagnostic mammogram focuses in on a particular lump or area of abnormal tissue.
Why Do I Need a Mammogram?
Mammograms are performed as part of a regular physical exam or to evaluate any unusual changes in the breast.
A mammogram can help your healthcare provider decide if a lump, growth or change in your breast needs further testing. The mammogram is also used to look for lumps that are too small to be felt during a physical exam.
Why Should I Get a Mammogram?
Mammography is your best defense against breast cancer because it can detect the disease in its early stages, before it can be felt during a breast examination. Research has clearly shown that mammography can increase breast cancer survival.
How Should I Prepare For a Mammogram?
Inform your doctor or the technician performing the test if you are pregnant or think that you may be.
No dietary changes are necessary. Take your medicines as usual.
Do not wear body powder, cream, deodorant or lotion on your chest the day of the test. These substances may interfere with the X-rays.
You will be asked to remove all clothing above the waist and you will be given a hospital gown to wear. You may want to wear a two-piece outfit the day of the test.
You will be asked to remove all jewelry.
Using a machine and X-ray film made especially for breast tissue, a technician compresses the breast and takes pictures from at least two different angles, creating a set of images for each of your breasts. This set of images is called a mammogram. Breast tissue appears white and opaque and fatty tissue appears darker and translucent.
In a screening mammogram, the breast is X-rayed from top to bottom and from side to side. A diagnostic mammogram focuses in on a particular lump or area of abnormal tissue.
Why Do I Need a Mammogram?
Mammograms are performed as part of a regular physical exam or to evaluate any unusual changes in the breast.
A mammogram can help your healthcare provider decide if a lump, growth or change in your breast needs further testing. The mammogram is also used to look for lumps that are too small to be felt during a physical exam.
Why Should I Get a Mammogram?
Mammography is your best defense against breast cancer because it can detect the disease in its early stages, before it can be felt during a breast examination. Research has clearly shown that mammography can increase breast cancer survival.
How Should I Prepare For a Mammogram?
Inform your doctor or the technician performing the test if you are pregnant or think that you may be.
No dietary changes are necessary. Take your medicines as usual.
Do not wear body powder, cream, deodorant or lotion on your chest the day of the test. These substances may interfere with the X-rays.
You will be asked to remove all clothing above the waist and you will be given a hospital gown to wear. You may want to wear a two-piece outfit the day of the test.
You will be asked to remove all jewelry.
Breast Cancer: Doctor's Breast Exam
A breast examination by a health professional (such as your doctor, nurse, nurse practitioner or physician assistant) is an important part of routine physical checkups.
How Often Should I Have a Clinical Breast Exam?
You should have a clinical exam at least every three years starting at age 20 and every year starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family history of breast cancer.
When Should I Schedule a Clinical Breast Exam?
Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. If you have stopped menstruating, schedule the yearly exam on a day that's easy for you to remember, such as your birth date.
What Happens During a Breast Physical Exam?
Your healthcare provider will ask you detailed questions about your health history, including your menstrual and pregnancy history. Questions might include what age you started menstruating, if you have children and how old you were when your first child was born.
A thorough breast exam will be performed. For the exam, you undress from the waist up. Your healthcare provider will look at your breasts for changes in size or shape. Your provider may ask you to lift your arms over your head, put your hands on your hips or lean forward. He or she will examine your breasts for any skin changes including rashes, dimpling or redness. This is a good time to learn how to do a breast self-exam if you don't already know how.
As you lay on your back with your arms behind your head, your healthcare provider will examine your breasts with the pads of the fingers to detect lumps or other changes. The area under both arms will also be examined.
Your healthcare provider will gently press around your nipple to check for any discharge. If there is discharge, a sample may be collected for examination under a microscope.
Complete Breast Cancer Screening
Clinical and breast self-examination are important methods of early breast cancer detection and should be performed along with mammography. All three of these methods provide complete breast cancer screening.
How Often Should I Have a Clinical Breast Exam?
You should have a clinical exam at least every three years starting at age 20 and every year starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family history of breast cancer.
When Should I Schedule a Clinical Breast Exam?
Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. If you have stopped menstruating, schedule the yearly exam on a day that's easy for you to remember, such as your birth date.
What Happens During a Breast Physical Exam?
Your healthcare provider will ask you detailed questions about your health history, including your menstrual and pregnancy history. Questions might include what age you started menstruating, if you have children and how old you were when your first child was born.
A thorough breast exam will be performed. For the exam, you undress from the waist up. Your healthcare provider will look at your breasts for changes in size or shape. Your provider may ask you to lift your arms over your head, put your hands on your hips or lean forward. He or she will examine your breasts for any skin changes including rashes, dimpling or redness. This is a good time to learn how to do a breast self-exam if you don't already know how.
As you lay on your back with your arms behind your head, your healthcare provider will examine your breasts with the pads of the fingers to detect lumps or other changes. The area under both arms will also be examined.
Your healthcare provider will gently press around your nipple to check for any discharge. If there is discharge, a sample may be collected for examination under a microscope.
Complete Breast Cancer Screening
Clinical and breast self-examination are important methods of early breast cancer detection and should be performed along with mammography. All three of these methods provide complete breast cancer screening.
Breast Cancer: Breast Self-Exam
The most effective way to fight breast cancer is to detect it early. A breast self-exam may help, although the most effective tools to detect breast cancer are mammography and clinical breast exam by your health professional. In fact, women who perform regular breast self-exams find 90% of all breast masses.
What Is a Breast Self-Exam and Why Should I Do It?
The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings) that may signal breast cancer. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. While 80% of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by regularly performing a self-exam.
When Should I Perform a Breast Self-Exam?
It is good to start performing breast self exams in your 20's. You should examine your breasts once a month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.
What Is a Breast Self-Exam and Why Should I Do It?
The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings) that may signal breast cancer. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. While 80% of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by regularly performing a self-exam.
When Should I Perform a Breast Self-Exam?
It is good to start performing breast self exams in your 20's. You should examine your breasts once a month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.
Breast Cancer: Screening and Detection Overview
When it comes to breast cancer detection, not all medical institutions and advocacy groups agree on when women should start getting regular breast cancer screening mammograms.
The lifetime risk (to age 85) of a woman developing breast cancer in 1940 was 5% or one in 20; the risk is now 13.4% or almost one in 8. In women 40 to 49 years of age, there is a one in 68 risk of developing breast cancer, compared with a one in 37 risk among women in the 50 to 59 year age group.
Women who undergo breast cancer screening mammograms have demonstrated significantly reduced deaths from the disease.
Women between the ages of 40 to 49 live longer if they undergo breast cancer screening, even though the reductions in deaths from breast cancer mortality are delayed for 10 to 15 years after diagnosis.
The benefit of mammography is related to early detection. Regardless of how advanced the cancer is when it is detected, more than 90% of women live longer than 10 years after the diagnosis (in women 40 to 74 years old diagnosed with tumors that are 10 millimeters or smaller in size).
The effectiveness of any breast cancer screening program will depend on how often women are screened, compliance with screening recommendations and the quality of the screening test.
Recommendations for Breast Cancer Screening by The Cleveland Clinic Experts
The following are the recommendations for breast cancer screening:
Monthly breast breast self-examination starting at age 20.
Breast examination by a health-care provider every three years starting at age 20; annual clinical breast exam starting at age 40.
Annual screening mammography starting at age 40.
Women in high-risk categories may want to consider starting screening at age 30.
The lifetime risk (to age 85) of a woman developing breast cancer in 1940 was 5% or one in 20; the risk is now 13.4% or almost one in 8. In women 40 to 49 years of age, there is a one in 68 risk of developing breast cancer, compared with a one in 37 risk among women in the 50 to 59 year age group.
Women who undergo breast cancer screening mammograms have demonstrated significantly reduced deaths from the disease.
Women between the ages of 40 to 49 live longer if they undergo breast cancer screening, even though the reductions in deaths from breast cancer mortality are delayed for 10 to 15 years after diagnosis.
The benefit of mammography is related to early detection. Regardless of how advanced the cancer is when it is detected, more than 90% of women live longer than 10 years after the diagnosis (in women 40 to 74 years old diagnosed with tumors that are 10 millimeters or smaller in size).
The effectiveness of any breast cancer screening program will depend on how often women are screened, compliance with screening recommendations and the quality of the screening test.
Recommendations for Breast Cancer Screening by The Cleveland Clinic Experts
The following are the recommendations for breast cancer screening:
Monthly breast breast self-examination starting at age 20.
Breast examination by a health-care provider every three years starting at age 20; annual clinical breast exam starting at age 40.
Annual screening mammography starting at age 40.
Women in high-risk categories may want to consider starting screening at age 30.
How Do I Know If I Have Breast Cancer?
Breast cancer responds to treatment best when it is detected early. For this reason, you should be sure to have an annual medical checkup, perform monthly breast self-examinations, and get mammograms as recommended by your doctor.
Breast Self-Exam
Starting around age 20, examine your breasts every month so that you are familiar with their structure and can detect any new masses or lumps. Premenstrual changes can cause temporary thickening that disappears after the period, so it is best to check your breasts three to five days after your period ends. If you are no longer menstruating, examine your breasts on the same day of each month. Pick a date that's easy to remember. If a breast self-exam makes you anxious or you have questions about how to perform it, consult your health care provider.
Look for dimpling or changes in shape or symmetry. This may be best done by looking in a mirror. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. Using light pressure, you should check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge -- especially if it is bloody -- see your doctor.
Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done. Have your breasts examined by a healthcare provider once every three years starting at age 20, and every year after age 40.
A baseline mammogram -- an X-ray of the breast -- is recommended for women at age 35 by the American Cancer Society. Most women should also get a mammogram every year beginning at age 40. You should consult your doctor for the best schedule. Breast lumps can be identified on a mammogram up to two years before they can be felt.
Several tests that can help distinguish a benign lump from a malignant tumor. Because malignant and benign lumps tend to have different physical features, imaging tests such as mammography and ultrasonography can often rule out cancer. The only way to confirm cancer is to perform a needle aspiration or a biopsy and to test the tissue sample for cancer cells.
In the event of malignancy, you and your doctor need to know how advanced the cancer is. Various tests are used to check for the presence and likely sites of spread, or metastasis. Cancer cells can be analyzed for the presence or absence of hormone receptors, to find out if the cancer is likely to respond well to hormone therapy, such as tamoxifen. Other tests can help predict the likelihood of metastasis and the potential for recurrence after treatment.
Breast Self-Exam
Starting around age 20, examine your breasts every month so that you are familiar with their structure and can detect any new masses or lumps. Premenstrual changes can cause temporary thickening that disappears after the period, so it is best to check your breasts three to five days after your period ends. If you are no longer menstruating, examine your breasts on the same day of each month. Pick a date that's easy to remember. If a breast self-exam makes you anxious or you have questions about how to perform it, consult your health care provider.
Look for dimpling or changes in shape or symmetry. This may be best done by looking in a mirror. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. Using light pressure, you should check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge -- especially if it is bloody -- see your doctor.
Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done. Have your breasts examined by a healthcare provider once every three years starting at age 20, and every year after age 40.
A baseline mammogram -- an X-ray of the breast -- is recommended for women at age 35 by the American Cancer Society. Most women should also get a mammogram every year beginning at age 40. You should consult your doctor for the best schedule. Breast lumps can be identified on a mammogram up to two years before they can be felt.
Several tests that can help distinguish a benign lump from a malignant tumor. Because malignant and benign lumps tend to have different physical features, imaging tests such as mammography and ultrasonography can often rule out cancer. The only way to confirm cancer is to perform a needle aspiration or a biopsy and to test the tissue sample for cancer cells.
In the event of malignancy, you and your doctor need to know how advanced the cancer is. Various tests are used to check for the presence and likely sites of spread, or metastasis. Cancer cells can be analyzed for the presence or absence of hormone receptors, to find out if the cancer is likely to respond well to hormone therapy, such as tamoxifen. Other tests can help predict the likelihood of metastasis and the potential for recurrence after treatment.
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