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Screening Mammography is the only scientifically proven method for screening for breast cancer. In women with an average risk for breast cancer, annual screening is recommended starting at age 40 years. In those with a higher risk, screening at an earlier age supplemented with breast ultrasound and or MRI has been shown to be beneficial.
False positives are defined as those cases that are recalled for additional testing following a screening mammogram and those that have a benign diagnosis following a recommendation for a biopsy after a diagnostic work up. Maintaining a low and acceptable false positive is critical benchmark of a quality screening program.
On an average about one in 10 women may be recalled following a screening mammogram to undergo additional testing. Among these women about 1 out of 5 may be recommended to undergo a biopsy. The positive rate of cancer among women undergoing a biopsy varies from 20-30%. For most abnormalities minimally invasive percutaneous biopsy is performed as an outpatient procedure with minimal to no complications.
The American College of Radiology and the Society of Breast Imaging. Recommendation for Breast cancer screening with imaging
|Population to be screened||Age to commence screening|
Women at average risk
|Women at an elevated risk
a. Women with certain BRCA 1 or BRCA mutations or those who have not been tested but have first degree relatives[Mother, sisters, daughters] with such proven mutations.
|Yearly starting by 30 years of age but not before 25|
|b. Women >or= 20% lifetime risk of breast cancer based on maternal or paternal family history.|
|c. Women with mothers or sisters with premenopausal cancer.||Yearly starting by 30 years of age but not before age 25 or 10 years before diagnosis of youngest affected relative whichever occurs later.|
|d. Women with history of mantle radiation usually for Hodgkin’s lymphoma received between 10 and 30 years||Yearly starting by 30 years of age but not before 25 or 10 years before diagnosis of youngest affected relative whichever occurs later|
|e. Women with biopsy proven lobular carcinoma in situ, atypical lobular hyperplasia, atypical ductal hyperplasia, ductal carcinoma in situ, invasive carcinoma, ovarian carcinoma||Yearly starting 8 years after therapy but not before age 25. Yearly from the time of diagnosis regardless of age|
Lee CH, Dershaw DD, Kopans D, Evans P, Monsees B, Monticello et al (2010) Breast cancer screening with imaging: recommendations from the society of breast imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 7:18–27
All possible abnormalities of the breast need to be evaluated with a diagnostic mammogram and ultrasound. In those patients under the age of 30 years and in those who are pregnant and or lactating, ultrasound is the initial and often the only modality utilized.
Breast ultrasound has been shown to be very accurate in assessing breast lumps and has been shown to identify all or most palpable cancers even those that are missed on mammograms. Dense breast tissue is the most common cause of a missed cancer on a mammogram. In women with a dense breast and a palpable lump ultrasound has to be performed in all cases.
Nipple discharge should prompt a medical consultation particularly when spontaneous in non pregnant and non lactating women. A unilateral spontaneous bloody nipple discharge is very concerning and needs immediate attention. Common tools used when patients have these symptoms are a mammography and ultrasound. In those patients with no abnormality identified, further investigation is needed by ductoscopy or ductography.
When the pain is bilateral and or cyclical no imaging is needed. Focal breast pain particularly when associated with a breast lump needs to be evaluated by ultrasound and mammography depending on the age of the patient.
Ultrasound is the first and often the only modality used to diagnose most of the common gynecological conditions such as pelvic pain, abnormal uterine bleeding or pelvic discomfort or mass. In women at high risk for endometrial or ovarian cancer, an ultrasound is useful to assess abnormalities. It is critical to have your Gynecological ultrasound supervised and interpreted by Radiology Physicians who possess experience and expertise in Women’s imaging.
Please call the clinic to reach our physicians to discuss questions or concerns regarding breast and or gynecological imaging prior to or following your visit.
We accept all major insurances and Medicare.