Breast Health Care

Women have mixed feelings about breast health care. They know vital screening and diagnostic services are essential. But regular mammograms and related tests can also provoke fear and anxiety.

This information is designed to help you better understand the whole scope of breast care you might encounter. All of these services are provided at several sites throughout the Southcoast system. (See card on Southcoast breast health services.)

Anatomy of the Breast

The breast is made of two different structures - lobes and ducts. Each breast has 15 to 20 different lobes, which have even smaller sections called lobules. These end in tiny bulbs that can produce milk. All are connected by thin tubes called ducts.

Each breast also has blood and lymph vessels. The lymph vessels carry an almost colorless fluid, lymph, that helps the body fight disease. Lymph nodes near the breast are usually located under the arm pit, above the collarbone and in the chest.

Mammography: The Best Defense

A mammogram uses special x-ray images to detect any abnormal growths, or changes in breast tissue. The breast is x-rayed from two different angles, creating a set of images. There are two kinds of mammograms - a screening mammogram, which is a routine study done on a regular basis - and a diagnostic mammogram, which is a more involved x-ray study done when the screening mammogram suggests something abnormal, or when your doctor feels a lump or change in the breast.

Recommendations are that you have a baseline mammogram between the ages of 30 & 40, and a screening mammogram every year after the age of 40. - Recommended by the American Cancer Society

Additional Testing

Approximately 10 percent of women require additional testing after a screening mammogram. This might include a diagnostic mammogram, breast ultrasound or a biopsy.

Don't be alarmed if this happens. Only one or two mammograms out of every 1,000 lead to a diagnosis of breast cancer.

Additional testing may include:

• Diagnostic mammograms, which differ from a screening mammogram in that the exam focuses on a specific area of breast tissue that may appear abnormal or has changed from a previous mammogram.

• Breast ultrasound, often combined with mammography to further examine an area of concern in the breast. Ultrasound is very effective in determining whether a suspicious mass is a fluid-filled cyst or a solid tumor. Ultrasound uses sound waves to create an image and is painless.

• Ductogram: This test involves injecting contrast dye into the breast duct to determine if there is a mass inside of the duct.

• Computer-Aided Detection & Diagnosis (CAD): This is a computer technique that helps the radiologist better diagnose suspicious abnormalities on mammograms. Research suggests the CAD system can help radiologists detect more early stage cancers than mammography alone. (See related card on CAD).

• Breast Biopsy: If your physician still has concerns after complete radiologic testing, he or she may recommend a biopsy. There are several types of breast biopsy available, most performed in an outpatient setting with local anesthesia.

• Fine Needle Aspiration Biopsy (FNAB): This uses an extremely thin needle - thinner than that used for blood tests - to withdraw some cells from a suspicious lump or mass. The doctor will sometimes use ultrasound or other radiologic tests to guide the needle to the mass. If the mass is actually a cyst, then withdrawing the fluid will shrink it or even make it disappear. Cells from the biopsy are sent for further testing to determine if they are benign or cancerous.

• Stereotactic Breast Biopsy: This involves locating the exact spot to be tested using special radiologic equipment. Using a local anesthetic, a radiologist makes a small opening in the skin and inserts a sterile biopsy needle in the suspicious area. Computerized pictures help pinpoint the exact needle placement. Several tissue samples are then removed through the needle and sent for further testing.

• Surgical Biopsy: This involves the removal of an entire lump, and usually a rim of tissue around the lump, through surgery. The tissue is then tested further.