A screening mammogram is performed at regular intervals for women at an average risk for breast cancer and who do not have any breast symptoms or complaints. There are recommendations for women to begin screening mammogram starting at 40 or 50 years old. Sometimes mammograms are started earlier if a person is considered high risk for the future development of breast cancer. A screening mammogram should be repeated every 1-2 years for as long as a woman is in good health. Women should discuss their risk for breast cancer with their doctor who will determine the best screening regimen. If you have had a screening mammogram, you should get a letter in the mail with the results. Do not assume your results are normal. If you do not receive this, you should contact your doctor that ordered the test for the results.
If you or your doctor has noticed a change in your breasts then diagnostic imaging may be ordered, which may include a mammogram and/or ultrasound. Check with your doctor regarding the results.
There are several different types of breast biopsies. The goal of each is to obtain a small piece of breast tissue so that it can be studied under a microscope for a diagnosis.
- Needle biopsy in clinic – If you have a mass that is easy to feel then the clinician may perform a biopsy in clinic. This is done by numbing the skin and inserting a needle into the breast so that a piece of tissue can be removed. It takes about 1-2 weeks to get the result from the pathologist.
- Ultrasound guided biopsy – If there is a mass that not easily felt but can be seen by the radiologist using an ultrasound then a biopsy will be performed this way. The patient lays on his or her back and a needle is inserted into the breast to obtain a piece of tissue.
- Stereotactic biopsy – If a patient has an abnormal mammogram but the area cannot be felt then a biopsy can be performed using the mammogram machine. During this procedure, the patient lies on her stomach and her breast goes through an opening in the table and into a mammogram machine. The radiologist uses the mammogram to guide the needle and obtain tissue from the breast.
- Excisional biopsy – Occasionally there will be a mass or finding on mammogram that cannot be diagnosed with a needle biopsy. This may require taking out the abnormal finding in the operating room through a small skin incision. This is an outpatient surgical procedure and does not typically require either general anesthesia or an overnight stay.
Benign Breast Tumors
A tumor is a group of cells that have formed a mass. Benign means that the mass is not cancer. Benign breast tumors are fairly common especially in young women.
Some examples of benign breast tumors:
- Intraductal papillomas
- Granular cell tumors
- Phyllodes (sometimes these tumors can be considered not benign and may need other treatment)
Sometimes benign tumors are removed with surgery because they are big or are getting bigger.
Most nipple discharge is not related to cancer, however, a small percentage can be. A clinician will evaluate the discharge and determine if further testing is recommended.
High Risk Lesions
There are several types of breast lesions that may be found on a breast biopsy and are considered “high risk lesions”. This means that a patient who has had an abnormal biopsy may be at a higher risk for developing breast cancer in the future. Patients are referred to a breast surgeon who will discuss these results and recommend a treatment. Treatments can include a surgical excision (additional biopsy), medication, or close follow up with imaging.
Some examples of high risk lesions:
- Atypical ductal hyperplasia
- Flat epithelial atypia
- Lobular intraepithelial neoplasia/lobular carcinoma in situ
- Papillary lesions (can include papillomas)
Noninvasive Breast Cancer
Ductal Carcinoma in Situ (DCIS) is a noninvasive form of breast cancer. You should be evaluated by a breast surgeon if you have had a biopsy with DCIS. Treatment may include surgery, radiation and endocrine therapy. Endocrine therapy is a pill that blocks hormones and is used to decrease the risk of the DCIS coming back in the breast and also may decrease the risk of a new breast cancer.
There are several different types of breast cancer including:
- Invasive ductal carcinoma
- Invasive lobular carcinoma
- Invasive mammary carcinoma
- Inflammatory breast cancer
- Papillary carcinoma
- Tubular carcinoma
- Metaplastic carcinoma
The workup for a newly diagnosed breast cancer usually includes additional breast imaging (mammograms, ultrasounds and maybe an MRI), tissue biopsies and possibly other imaging of the body including CT scans and bone scans. Once the necessary information has been obtained then a breast surgeon will work with the patient to make a treatment plan. Treatment for breast cancer may include: surgery, chemotherapy, radiation and endocrine therapy (pills that block hormones).
We work as a team of experts to come up with a treatment plan for each patient. This team may include a surgeon, a medical oncologist and a radiation oncologist.