Diagnosing

There are many reasons to come to the Margie Petersen Breast Center at Providence Saint John’s Health Center, but one of the best is that we have the ability to conduct screenings and then diagnose any potential breast cancers in one day. We have radiologists on staff during clinic hours to view mammograms and films. Our surgeons can then perform an appropriate biopsy, assess the cells in the lab for cancer, and then speak with you regarding the way forward.

Most breast-cancer-related tests fall into one or more of the following categories:

  • Screening tests - such as yearly mammograms, are given routinely to people who appear to be healthy and are not suspected of having breast cancer. Their purpose is to find breast cancer early, before any symptoms can develop and the cancer may be easier to treat.
  • Diagnostic tests - performed if you have a breast abnormality or an abnormal screening test result. These tests are used to determine whether or not breast cancer is present and, if so, whether or not it has traveled outside the breast. Diagnostic tests also are used to gather more information about the cancer to guide decisions about treatment.

Common tests used to evaluate breast abnormalities include clinical breast exams, mammograms, MRI, and ultrasound.

  • Breast exam. We will check both of your breasts and lymph nodes, feeling for any lumps or other abnormalities. This will likely be done in varying positions, such as with your arms above your head and at your side.
  • Mammogram. A mammogram is an X-ray of the breast and is commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, we may recommend a diagnostic mammogram to further evaluate that abnormality.
  • Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. We may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst or a solid mass, which may be either benign or cancerous. Breast ultrasound is helpful to guide radiologic biopsy to get a sample of breast tissue if a solid mass is found.
  • Biopsy. A biopsy to remove a sample of the suspicious breast cells helps determine whether cells are cancerous. The sample is sent to pathology for testing.
  • Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. This test may be ordered after a breast biopsy confirms cancer, but before surgery to give your doctor an idea of the extent of the cancer and to see if there's any evidence of cancer in the other breast. MRI is also used to screen high risk women for breast cancer.
  • Other tests and procedures may be used depending on your situation.

Monitoring tests

Once breast cancer is diagnosed, many tests are used during and after treatment to monitor how well therapies are working. Monitoring tests also may be used to check for any signs of recurrence.

Tests are individualized. You and your doctor should talk about your options, as well as the risks and benefits of each.

About breast density

On April 1, 2013, the state of California became the fifth state to enact a dense breast notification law (Senate Bill 1538). This law requires physicians to inform patients if their breasts appear dense on mammography. It was enacted to raise awareness about dense breasts, but also raises questions about the relevance of breast density and what recommendations we should make to patients.

Breast density is typically determined visually by the radiologist and is subjective.   It is a measure used to describe the proportion of the different tissues that make up a woman’s breasts. It compares the area of breast and connective tissue seen on a mammogram to the area of fat. Breast and connective tissue are denser than fat and this difference shows up on a mammogram.

  • High breast density means there is a greater amount of breast and connective tissue compared to fat.
  • Low breast density means there is a greater amount of fat compared to breast and connective tissue.

Breast density is classified using a scoring method developed by the American College of Radiology:

  • Level 1 = Entirely fatty tissue; less than 25 percent density
  • Level 2 = Scattered fibrograndular densities; less than 25-50 percent density
  • Level 3 = Heterogeneously dense; 50-75 percent density
  • Level 4 = Extremely dense; greater than 75 percent density

Having dense breasts has been associated with an increased risk of breast cancer, but it does not appear to worsen survival from cancer. In fact, when tumors are detected later in women with dense breasts, these tumors are typically no more aggressive or more difficult to treat, and survival is the same.

Breast density appears to decrease with age but can also be increased with the use of post-menopausal hormone replacement therapy.  Since the density of breast tissue has been shown to increase risk for breast cancer, consideration of additional imaging like screening ultrasound or MRI may be helpful for women with dense breasts.