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Category:

Breast Imaging

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Question:  #1621 11/11/2002		Q:	My mother is in her late 40's and has very sensitive breasts. She refuses to have a mammogram because she thinks it will be very painful. She has been reading alot of books and thinks that if she has any abnormal mass in her breast that a mammogram will spread it to other areas. Is there an alternative to the mammogram for her? I am very concerned for her health and I am looking for any suggestions to alternatives to mammograms.
		A:	You are being a good daughter... and she needs to get over her fears which are totally unfounded. Wherever she heard this, it is wrong... and the gold standard remains screening mammography for early detection. This is her time to set an example for you of demonstrating good breast health habits and getting her first annual mammogram. You can get her educational materials about mammography by calling your local American Cancer Society.
Question:  #1622 11/06/2002		Q:	Would you recommend digital mammography compared to regular mammograms? From what I am reading it is showing more tumors at an earlier stage. Also, when are we going to get rid of these barbaric machines and get something that does not cause compression and pain to the breasts?
		A:	mammography as we know it is here to stay for a long time-- yes, it is a strange comtraption but does find breast cancer when it is a speck before we feel a lump, in many cases. Digital mammography may or may not be better than film-- it isn't quite a clear as film yet actually, but let's us compare images more easily- so there are pros and cons with it. what IS helping many facilities that still have general radiologists reading mammograms (rather than radiologists who specialize in breast imaging) is CAD-- a device that allows a computer to help find things that might be missed with the naked eye.
Question:  #1623 11/06/2002		Q:	I get a burning in my left breast. I had an ultrasound but is their any thing else it could be.They said they could not see anything.I'm 42 and my mother was diagnosed at 50 and died at 55? Im afraid with my insurance the doctor is lax.
		A:	a mammogram should also be done as well as a clinical breast examination by a breast specialist. If your doctor doesn't follow up for you get a new doctor. burning is not a usual symptom of breast cancer but there is something abnormal going on and you deserve the right to know what it is and have it medically addressed
Question:  #1624 11/06/2002		Q:	My wife's doctor has prescribed "diagnostic mammography" as opposed to "ordinary mammography". My initial reaction is: Are they telling me they don't diagnose for the "ordinary"? What is the difference?
		A:	I think what is meant by "ordinary" would be a screening mammogram--- what a woman should be having annually-- 2 views of the breast-- top to bottom and side to side imaging. this is done when there are no known symptoms of a problem in the breast. a diagnostic mammogram is done when there IS a symptom of something going on-- lump, dimpling, nipple discharge-- it involves the same 2 views plus spot films of the abnormal area and an ultrasound.
Question:  #1625 11/01/2002		Q:	Just prior to my lumpectomy, I will be having a needle localization. What will that be like?
		A:	this will involve going to breast imaging and having a very thin wire (as thick as a strand of hair) inserted into the breast under local anesthetic, into the center of the breast tissue targeted for excision. the surgeon uses this wire as a guide. sometimes they also use blue dye to mark the area inside as well. you then will go to surgery for the actual operation.
Question:  #1626 11/01/2002		Q:	My mother died of breast cancer. I had a yearly mamogram and they saw a spot and did a spot compression mamo gram and the same spot showed appeared but when they did an ultra sound they didn't find anything. On my other breast I have had 2 cysts removed and these were just found by a mamo gram never had a ultra sound done. I'm not sure what to do I saw my mother die from breast cancer and don't want to take any chances, could I still have a cyst or something even though it doesn't show up on an ultra sound???
		A:	mammograms and ultrasounds are wonderful tools for breast imaging and early detection of breast cancer but they are not 100% accurate. there can be things going on in the breast, like cysts, benign tumors or even cancer that isn't seen on any breast image.when doing a mammogram they are looking for changes from last years to this years. your mammogram should be done around the same time you are getting a clinical breast exam by a doctor or nurse practitioner so the findings on mammo can be correlated with your breast exam. Consider being followed by a high risk breast program since you have family history and obviously are concerned about following your mother with this disease.
Question:  #1627 10/29/2002		Q:	I am a 46 year old woman who is about to have my eighth breast excision; two on the left; six on the right. Pathology results in the past noted mastitis and chronic inflammation. All results have been benign. Symptoms are generally yellow or bloody discharges. This is the first time I've had a ductogram followed up by several (about five) magnified mammograms. Why this time? Will my ducts continue to be trouble?
		A:	Your doctor must have decided it was time to get more definitive information as to the causes of your breast problems. he might look for the presence of a papilloma or other findings in the lining of the ducts. Your doctor needs to advise you if he/she anticipates your ducts since being trouble going forward
Question:  #1628 10/26/2002		Q:	Called back for a second mammogram. I am a 47 year old last mammogram was fine. Results were the presence of clustered microcalcification in the outer right breast. Some of these appear punctate, thought they are not clearly benign and do not definitively represent milk of calcium. As they are new, biopsy is advised and stereotactic biopsy is suggested. Is this the best way to go or should I ask just to have this surgically removed so as no have no furture worries? I have been informed that the chances of this being cancerous are very slim. Confused and worried as to which way to go.
		A:	Stereotactic biopsy is a smart choice for evaluating microcalcifications in the breast that are clustered today. Clustering does increase the risk of them being an early stage breast cancer. That is why mammography is so valuable-- seeing things early before they can be even felt as a lump.
Question:  #1629 10/26/2002		Q:	On a routine doctor exam, my doctor felt a thickening in my breast, so I had a diagnostic mammogram and and ultrasound, The radiologist said my mammogram was same as year before and the ultrasound showed nothing. When this happen should it be taken one step farther?
		A:	it is not uncommon for a the doctor to recommend a six month follow up when the mammogram and ultrasound are normal ad look the same as last years. if you had a family history of breast cancer that was significant then they might get an MRI but otherwise this isn't uncommon. If the doctor felt an actual mass though, more breast imaging may be advised
Question:  #1630 10/22/2002		Q:	I have been diagnosed with a 5 by 10 millimeter "probable" fribroadenoma. It is not palpable. The surgeon feels he may "miss" it--even with radiologist-placed needle guided excision. Would an MRI give me more information? Also what would be the differences and benefits of US guided core biopsy vs. US guided sterotactic biopsy. New Approaches with MRI
		A:	The key is being able to either see it on mammography or on ultrasound. Whichever visualizes it best is usually the method then used to biopsy it. MR may not give more information in this case. Consider taking your mammograms and ultrasound films to another mammographer (radiologist at another facility who specializes in breast imaging) and get a second opinion regarding method of biopsy and perhaps have it done elsewhere if your current facility feels they can't biopsy it adequately.
Question:  #1631 10/22/2002		Q:	I recently had my annual mammogram and now being called back for something called coning and an ultrasound. I don't understand what coning is and is it a painful test? I am 53.
		A:	20% of women need to return for additional films after a screening mammogram. an ultrasound doesn't hurt. The breast isn't compressed for this image. it is the same device used to examine a fetus in utero for someone expecting a baby. it will tell them if what they see is a solid mass or liquid and if liquid then it probably is a cyst being seen. don't worry. it's good you are getting routine mammograms done. good for you
Question:  #1632 10/20/2002		Q:	A BB was placed on the 2 cm palpable lump. My mammogram showed a highly suspicious mass with calcifications in the centre and no other atypical areas or suspicous calcifications. The surgeon was told a 1.8 cm spiculated mass was "just deep of the BB". When excised, the lump was rounded rubbery fragment of pink tissue. Under the microscope there were foci of fybrocystic changes and tiny foci of calcification in benign ducts. Question: Can such a lump be invisible on a mammogram? And, how can the radiologist make a correlation between her interpretation of the pre-operative mammograms and the histologic findings? Is there any way of proving that what the surgeon took out was the image she saw on the mammogram?
		A:	Usually when there is a discrepancy between the anticipated findings by radiology and what was found by pathology the doctors in the breast center meet to review the case and determine why. ask if such a case conference was held to review your case. you may want a second opinion reading on both your mammograms and pathology findings too. a future mammogram ad ultrasound would help compare the findings as well to ensure that what was intended to be removed was in fast what was removed.
Question:  #1633 10/06/2002		Q:	I recently had a mammogram, then ultrasound in one breast because of a change in some tissue in that breast. The radiologists ultimately decided that it was "overlapping breast tissue" and that I should return for a routine exam in a year. What is "overlapping breast tissue" and does it have anything to do with the development of cancer (or can it "hide" cancer tissue)? Thank you.
		A:	overlapping breast tissue is literally what it sounds like--remember when the mammogram paddles squish your breast some of the tissue can get "pinched" in such a way that it causes literally tissue to overlap onto itself. Doing spot films and ultrasound apparently ruled out other findings. He'll have you return probably in 6 months for another evaluation. Overlapping tissue is a common problem when having mammograms done.
Question:  #1634 10/04/2002		Q:	I have a clear, orange colored discharge from my right breast that does not occur spontaneously, only when I squeeze the nipple. I was referred to have a ductogram which did show a small filling defect. I was then referred to a surgeon, and he said something I felt was odd. He said that if I had come to him with the complaint of a discharge like mine, without having had the ductogram, he would have told me to ignore it - mostly because it does not occur spontaneously. But since I had a positive finding on the ductogram, he felt "obligated" to remove the duct. I'm confused. I thought women were supposed to go to their doctor if they could express a discharge, and I also thought that the serous, watery and orange or red tinged ones were even more worrisome. So which is it? Do we ignore discharges which can only be expressed and do not leak out on their own onto our bras or pajamas, or do we have all discharges checked out?
		A:	nipple discharge, whether spontaneously occuring or only occuring when the nipple is squeezed should never be ignored. You did the right thing in pursuing it.
Question:  #1635 10/04/2002		Q:	I understand you should not have a mammogram when you are breastfeeding. How long do you have to wait after stopping before having one performed? What is the reason for this?
		A:	Usually 6 months after you stop is enough time to get your lactation in control and your hormone levels back to nearly normal. This enables the radiologist to visualize the tissue more easily than is possible with a lactating breast. Ducts filled with milk show up as solid white on a mammogram, and tumors/abnormalities also appear white so it can be like looking for a polar bear in the snow storm. congrats on having a baby too!
Question:  #1636 09/17/2002		Q:	If you have a calcium deposit for 4 years and a history of breast Ca. in family,and age 59, what would be your next step.? I have yearly mammograms. Thank you
		A:	It is not uncommon to have calcium deposits in the breast tissue seen on mammography. What the radiologist looks for is a change in their shape and whether there is an increase in the number, thus forming a cluster of calcifications over time. If and when such a change occurs then biopsy is usually performed, otherwise annual mammography continues as the routine screening process
Question:  #1637 09/17/2002		Q:	At what age should I get a mammogram if I'm having a Breast reduction? Does a breast reduction require a mammogram? Is a mammogram required after a reduction and at what age?
		A:	Breast reduction doesn't require any special guidelines for mammograms. All women should get a baseline mammogram between the agesof 35 and 40 and begin annually mammography at age 40. A mammogram would have been performed prior to the breast reduction to help ensure that there were no evidence of suspicious findings that may effect the surgery. (i.e., there have been cases in which a mammogram has shown cancer that neither the patient or doctor were aware of prior to getting ready for surgery.) Post operatively, the guidelines follow the standard of practice as stated above assuming there were no abnormalities found.
Question:  #1638 09/13/2002		Q:	I have a Grade 1 1.1 cm tumor. I will have lumpectomy and radiation, and doctor will also remove sentinel node. Is it necessary to have a full body CAT scan and a bone scan prior to surgery? I would think these tests would only be necessary if surgery shows cancer spread to nodes.
		A:	The standard of care today is to not do these tests prior to surgery unless the tumor is known to be large or it is already known to be lymphatic involvement. Years ago these tests were routinely done-- not today. they usually show "something" which can merely be artifact and scare the patient to death when it fact it is nothing at all. If the lymph nodes have cancer, then scan; if the tumor shows angiolymphatic invasion then scan; otherwise, rely on a patient to report aches and pains that are new and aren't going away as a means of possibly there being a problem elsewhere.
Question:  #1639 09/03/2002		Q:	Has it been proven that there is any correlation at all between mammography and cause and effect in breast cancer? Also, can a core biopsy cause an already present malignancy to spread, especially something that is confined inside a membrane such as the in situ cancers? Can the biopsy itself release cancer cells to spread?
		A:	There is no correlation between mammography (radiation from this type of xray) and getting breast cancer. It is used as an excuse by some women wanting to avoid getting one though.Regarding your second question, Core biopsy does not spread the mailgnancy in the breast.
Question:  #1640 08/28/2002		Q:	I was told to get a stereotactic biopsy after a mammogram that showed some beast microcalifications. Is there any other option available ie., an ultrasound, etc. to see if these are anything serious?
		A:	See previous Q & A related to micocalcifications and what they are. Microcalcifications can only be visualized on mammogram as they are too tiny to see with ultrasound. An ultrasound might be done to determine if an actual mass correlates with the calcs, but a definitive diagnosis of the microcalcifications can only be achieved with a biopsy. Stereotactic biopsy enables the calcifications to be removed without leaving a scar or even an incision in the breast. A tiny metal clip will be placed where the calcs are removed so that the area in question can be visualized with ease and accuracy on future mammograms. Clustered micorcalcifications are more worrisome than diffusely scattered ones. It's smart to get an answer as to what they are rather than ignore them.
Question:  #1641 08/27/2002		Q:	my doctor has ordered a "Galacto-Gram". what is it and why would a mamo-gram not see the lump (cyst)i can feel?I also have a dark (blue/black)dis-charge from the nipple.
		A:	A galactogram is a ductogram. This is a special type of contrast enhanced mammography used for imaging breast ducts. Ductograms aid in diagnosing the cuase of abnormal nipple discharge and is valuable in diagnosing intraductal pappilloma and other breast conditions. Papillomas are wart structures in the ducts of the breast that oftentimes cause bloody discharge from the nipple.
Question:  #1642 08/16/2002		Q:	The compression of my breast for a mammogram really hurts. What can I do to prevent this?
		A:	Have your annual mammogram done when your breasts are their least tender which usually is 4-7 days are the start of your menstrual period. You may also want to take an over the counter pain reliever one hour before the mammogram is done, such as acetametaphen. Avoid the use of aspirin or ibuprofen agents however since they can cause bleeding in the event an invasive procedure needs to be done.
Question:  #1643 08/16/2002		Q:	Why do they tell women to not use deodorant before getting a mammogram?
		A:	Deodorant can appear as tiny white specs on the x-ray, which may resemble microcalifications in the breast. Not using deodorant helps to eliminate the chance of a false positive finding.
Question:  #1644 08/16/2002		Q:	When should I begin to get mammograms?
		A:	Women should begin getting annual mammograms at age 40. A baseline mammogram can be obtained between the age of 35 and 40. For women who have a family history of breast cancer, a doctor may recommend some form of annual breast imaging under the age of 40.