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You notice changes in your breasts – a lump, redness, or possibly pain. Or perhaps you’ve had a screening mammogram and been called back in for further imaging. Now you’re a little concerned, is it breast cancer?
Changes in breast tissue that cause symptoms or show up on a mammogram are often benign, but they do need to be investigated. If you have symptoms, the first step is to see your doctor, who will likely perform a physical exam and order medical imaging as follows:
*PLEASE NOTE: For women under 35 with a family history of breast cancer, you may also be sent for a diagnostic mammogram, if you are within 10 years of when a first-degree relative (parent, sibling, child) was diagnosed with breast cancer. For example, if you’re 27 and your mother was diagnosed at 34, you might have both a mammogram and breast ultrasound. Usually, 25 is the earliest age this might happen.
If you catch breast cancer when it’s very small, its more easily treated and there are more options for treatment. Women 40+ are encouraged to get regular screening mammograms, which are the gold standard for detecting breast cancer early. These exams are often performed yearly, depending on your risk factors. Having regular screening mammograms makes it easier to compare images and see changes that are too small for you or your doctor to feel.
During a screening mammogram, four initial images are taken. The radiologist reviews the images and, if there are changes or new areas of concern, you might be called back for a diagnostic mammogram and/or diagnostic breast ultrasound.
Mammography is a type of X-ray exam that takes an image of the inside of the breasts – called a mammogram. During your exam, the machine will gently press down on the breasts to spread the breast tissue out and, using a very small dose of radiation, captures 3D images of the breast that can then be viewed in slices. The pressure lasts for a few seconds, while the machine quickly takes a number of pictures. Then the process is repeated for the other breast. It may be a bit uncomfortable, but it’s very quick, only 10 or 15 minutes in total.
A breast ultrasound uses high-frequency sound waves to help determine what an area of concern is made of, distinguishing between a cyst, fibroglandular tissue, and a solid mass. The sound waves travel into the breast until they hit a boundary between tissues, such as fluid and soft tissue, or soft tissue and bone. Since the pitch, direction, and distance sound waves travel differ depending on the boundary they run into, a computer can interpret this data as a two-dimensional image on a screen and provide information about what’s inside an area of concern.
Mammograms provide a very good picture of breast tissue, while breast ultrasound provides information about internal structure. By combining these two imaging types, radiologists can get a clearer picture of both the look and composition of the area of concern.
If a mammogram or breast ultrasound indicates that further investigation is needed, you might be sent for breast MRI or a breast biopsy – a procedure that removes small pieces of tissue from within the breast. A needle is guided into an area of concern to take a small tissue sample.
When reporting breast imaging results, radiologists use a standard system to describe medical imaging findings and results. Called BI-RADS® (Breast Imaging Reporting and Data System), this system sorts the results into categories based on the likelihood of cancer and where biopsy is appropriate.
Prior to booking your biopsy, we will ask you about any history of bleeding or allergic reactions to local freezing. We recommend you arrange for a driver to take you home after your appointment.
Please wear a two-piece outfit (e.g., shirt and pants), so you can change for the exam more comfortably. You will be asked to remove your clothing from the waist up and given a robe. Once you are changed, we will escort you to the exam room where the technologist will go over the consent form, explain the procedure, and answer any questions you may have.
We will then perform a pre-scan to document the area of interest. Your breast area will need to be visible to your technologist for the exam. The radiologist will administer local freezing and guide a thin needle into the correct location under image guidance. Band-Aids will be placed over treatment areas.
You will then be checked by the technologist and if there are no concerns, you are free to leave with your driver.
SPECIAL NOTE: The procedure may vary depending on the biopsy method:
After the biopsy is complete, your tissue will be sent to a laboratory for analysis. Your pathology report will be sent to your health care practitioner. It will indicate if cancer is present or not, and what type it is. If it’s positive, you will likely be referred to a breast cancer specialist, and you may need more imaging, lab tests, or surgery. You may also be referred to a cancer support program, such as Wellspring Alberta.
The survival rates for breast cancer have been increasing since the 1980s, thanks to earlier detection from regular mammogram screening and improvements in breast cancer treatments. According to the Canadian Cancer Society, breast cancer will affect one in eight women in Canada.
Mayfair Diagnostics recommends screening mammography every year from 40- 49, then every two years between 50- 75, if there are no risks factors that would necessitate a shorter interval. After age 75, screening frequency will depend on a number of factors, including your medical history.
Women with the following risk factors are considered high risk and may be encouraged to start screening earlier and more frequently.
*Dense breast tissue can only be determined by mammography and is not something that can be felt or seen. Dense breasts have less fat and more fibroglandular tissue, which can make it difficult to detect changes in the breast on a mammogram and small cancers may be hidden. For women with dense breast tissue in 75% or more of their breasts, their breast cancer risk is double relative to the general population. Using mammography and ultrasound together helps provide a more complete picture of dense breast tissue.
Mayfair Diagnostics has 13 mammography locations in Calgary, one in Cochrane, and one in Regina. Our Cochrane location and 12 of our Calgary locations use the Senographe Pristina mammography system – which helps provide a more comfortable mammogram. Visit our breast imaging page for more information.
REFERENCES
Alberta Health Services (2024) “Breast Screening.” screeningforlife.ca. Accessed July 9, 2024.
American Cancer Society (2022) “Understanding Your Mammogram Report.” cancer.org. Accessed July 9, 2024.
American College of Radiology (2013) “Breast Imaging Reporting & Data System (BI-RADS®).” acr.org. Accessed July 9, 2024.
Canadian Cancer Society (2024) “Breast cancer statistics.” cancer.ca. Accessed July 9, 2024.
Coldman, A., et al (2014) “Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer.” Journal of the National Cancer Institute. November 2014, 106 (11). Accessed July 9, 2024.
Mayo Clinic Staff (2021) “Breast biopsy.” mayoclinic.org. Accessed July 9, 2024.
National Breast Cancer Foundation (2024) “Breast Biopsy.” nationalbreastcancer.org. Accessed July 9, 2024.
Tabar, L., et al. (2019) “The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening.” Cancer. Accessed July 9, 2024.
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