Early Detection

Strategies for Early Detection

We know that the earlier a breast cancer is diagnosed, the more options a woman has for treatment and the better her outcome in general will be. A good breast cancer surveillance program for most woman involves three simple steps:

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1) Monthly Self Breast Exam 

Women who examine their breasts regularly find cancers at a smaller size than women who don’t – and when it comes to breast cancer, size matters. All women should begin monthly self breast exam in their early twenties when their risk of breast cancer is extremely low. In this way, they become "experts" at their own breasts and are comfortable with what is normal for them. Once normal is familiar, abnormal will be more obvious, allowing earlier evaluation of a potential problem. Breasts should be examined the week following the end of the menstrual period as they are least stimulated by hormones at that time. Lumps that change in size with the menstrual cycle are likely benign, those that persist through cycles should be evaluated.

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2) Annual Mammogram 

Every woman should have a screening mammogram annually beginning at age 40. It is helpful to have a baseline mammogram performed sometime in the late 30s in order to have a comparison for the first screen. A mammogram can detect a cancer long before it can be felt and these are the cancers that are most curable. Tomosynthesis, also known as 3-D mammography has been shown to be more effective than standard mammography. Learn More »

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3) Annual Clinical Breast Exam 

A breast exam performed by a woman’s primary physician should accompany her annual mammogram. At that time, the physician will also discuss her particular risk factors for developing breast cancer and evaluate any concerns about the monthly self breast exam or mammogram. A woman’s primary physician is her partner in maintaining good breast health!

For women who are at higher risk, such as those with a strong family history of breast or ovarian cancer, or a previous biopsy finding a high risk lesion, a more aggressive surveillance program may be warranted. This may involve the use of more sensitive imaging studies such as breast MRI, or a shorter screening interval starting at an earlier age. A breast cancer specialist can help determine the right strategy for early diagnosis in high risk women.

The Breast Biopsy

grange ultraOnce an suspicious abnormality has been found in your breast, a biopsy to sample some of the tissue from the area is recommended. There are a number of ways to sample breast tissue, and your doctor will recommend the method that is most appropriate to your situation.

Why Perform an Image-Guided Needle Biopsy

When a suspicious abnormality is detected on a screening mammogram, or a woman finds a lump in her breast that is associated with a suspicious finding on breast imaging, a biopsy to rule out cancer is recommended. Surgically removing those abnormalities was at one time the only option available, but that approach resulted in many unnecessary trips to the operating room, and often limited subsequent surgical options if a cancer was diagnosed. As such, we now recommend that an image guided needle biopsy be performed instead.

Sometimes the abnormality is classic for a cancer and the radiologist can perform the recommended biopsy in a timely fashion. Other times, the nature of the abnormality is much less clear, and a conversation about options for management of the finding before automatic needle biopsy is helpful. Focused ultrasound of the lump or the part of the breast that is mammographically abnormal often shows us an abnormality that can then be biopsied under ultrasound guidance in an office setting rather than stereotactically in the radiology suite. As ultrasound guided biopsies tend to be more comfortable for the patient, we are motivated to use that modality if possible. When I see a patient in my office, I perform breast ultrasound as part of my exam. If an abnormality is found, I am able to perform the needle biopsy at that visit to expedite the evaluation, and I contact the patient with those results along with my personal recommendations.