Breast Cancer Diagnosis
Breast Cancer Diagnosis
Richard E. Gould (Hematologist/Oncologist, Cedars-Sinai Outpatient Cancer Center) gives expert video advice on: How often should I have a mammogram?; Is a mammogram painful?; Is the radiation exposure from getting a mammogram harmful? and more...
What is a "mammogram" and why is it important?
A mammogram is an imaging test that looks at the breast tissue under an X-ray to determine if there are any abnormalities concerning for cancer. What we're looking for on a mammogram is any mass, anything that has abnormal calcifications around it, anything that is distorting the normal appearing breast tissue. Women should have a mammogram yearly starting at the age of 50 according to some guidelines and 40 according to other guidelines. The studies have definitely shown an improvement in overall survival for women who develop breast cancer when they get mammograms starting yearly at the age of 50. The studies looking at women at the age of 40 have not definitively shown this, but there's enough circumstantial evidence that a large number of the consensus groups recommend starting mammograms yearly at the age of 40. In general, getting a mammogram is not painful but is not comfortable because the breast tissue needs to be compressed between the X-ray plates so that there is as much resolution of the breast tissue as possible.
How often should I have a mammogram?
With regards to breast cancer diagnosis, women should have a mammogram yearly, starting at the age of 50 (according to some guidelines) and 40 (according to other guidelines). The studies have definitively shown an improvement of overall survival for women who develop breast cancer when they get mammograms starting yearly at the age of 50. The studies looking at women at the age of 40 have not definitively shown this, but there's enough circumstantial evidence that a large number of the consensus groups recommend starting mammograms yearly at the age of 40.
Is a mammogram painful?
With regards to breast cancer diagnosis, a mammogram is not painful, but it's not comfortable because the breast tissue needs to be compressed between the x-ray plates. This is because there needs to be as much resolution of the breast tissue as possible.
Is the radiation exposure from getting a mammogram harmful?
With regards to breast cancer diagnosis, the risks of a mammogram are really minimal. The radiation exposure when a woman gets a mammogram is so small that there has been no documented increased risk of second malignancies with mammographic screening. Therefore the benefits of a mammogram far outweigh the risks.
What is an "ultrasound" or a "sonogram"?
An ultrasound is a non-invasive way of looking into the breast tissue. An ultrasound uses sound waves to bounce off of the breast tissue to look at different densities within the breast. Breast cancers are denser than the surrounding breast tissue, and so they will appear on an ultrasound as a solid area. An ultrasound can also pick up cysts, and ultrasounds are good for evaluating any abnormal lump or mass that a patient or a physician feels.
When is an ultrasound useful for diagnosing breast cancer?
With regards to breast cancer diagnosis, an ultrasound is a non-invasive way of looking at the breast tissue. It's usually ordered when a woman or her physician feels an abnormal lump in her breast. The ultrasound uses sound waves to help differentiate between normal breast tissue and any underlying masses. The ultrasound can tell whether these masses are solid or cystic, to which it can then be used to determine the next steps in the evaluation for that mass.
What is a "fine-needle aspiration"?
A fine needle aspiration, or FNA, is where a surgeon uses a small needle to go into the breast to get cells from a concerning area or a seen on a mammogram or ultrasound, or a palpable abnormality. It is a needle, so there is a small amount of pain. A topical anaesthetic is usually used to dull the pain. Once those cells are obtained by the fine-needle aspiration, they are stained and analyzed underneath the microscope to determine whether they are benign (not cancer), or whether they are malignant. If they are malignant, further evaluation is needed to determine exactly what the extent of the cancer is, and what the next treatment is.
What is a "stereotactic biopsy"?
A stereotactic biopsy is done when there is a concerning area on mammogram, but it's not palpable on exam. In a stereotactic biopsy a radiologist uses a wire to localize exactly where the abnormality is, so they are able to biopsy that specific area of concern to determine whether there is cancer there or not.
What is a "core needle biopsy"?
A core needle biopsy is a larger specimen of tissue than a fine needle aspiration, an FNA, and a surgeon uses this to go into an area of concern to get a piece of tissue to analyze under a microscope to determine whether it's benign, not cancer, or malignant, cancerous. A core needle biopsy gets enough tissue that you are able to determine whether it is a pre-invasive cancer or whether it's an invasive cancer because treatment options may be different depending on whether the core needle biopsy reveals an invasive cancer or pre-invasive cancer.