WHY WOULD I NEED DIAGNOSTIC BREAST IMAGING?

Diagnostic breast imaging is a type of medical imaging requested to investigate the cause for symptoms in breast tissue, such as lumps, pain, or redness. For both men and women, this often involves a breast ultrasound, a mammogram, or both.

When investigating breast concerns, your doctor would most likely order imaging as follows:

• Woman 35+: Diagnostic mammography, possibly combined with supplemental breast ultrasound imaging.
• Women under 35: Diagnostic breast ultrasound only.
• Men 18+: Diagnostic mammography combined with supplemental breast ultrasound imaging.
• Men under 18: Diagnostic breast ultrasound only.

Please note that for women with a family history of breast cancer who are within 10 years of the age a first-degree relative (parent, sibling, child) was diagnosed with breast cancer, you could potentially be sent for a diagnostic mammogram, even if you are not experiencing symptoms. For example, if you are 27 and your mother was diagnosed at age 34, a diagnostic mammogram possibly followed by additional ultrasound imaging might be requested. Usually, the earliest age this might happen is age 25.

WHEN WOULD I HAVE SCREENING MAMMOGRAPHY?

Screening mammograms occur when there is no obvious breast abnormality. These exams are the gold standard for detecting breast cancer early, before there are signs of breast cancer. Having regular screening mammograms makes it easier to compare images and see changes that are too small for you or your doctor to feel.

Screening mammography can be requested for women 40 and over when there are no symptoms, as part of a breast screening program. The Alberta Health Insurance Plan covers one screening mammogram per year for women, starting at age 40.

Breast cancer will affect one in eight women in Canada, but if you find it early, there is less chance of recurrence and an increased chance that it has not spread to the lymph nodes, so the odds are better you will survive it. Thanks to preventative screening more women are surviving a breast cancer diagnosis. In 2017, 89% of women diagnosed with breast cancer were still alive after five years.

During a screening mammogram, four images are taken. Occasionally you may be asked to return for additional breast imaging, such as a diagnostic mammogram and/or diagnostic breast ultrasound. This is done to get a more detailed look at any areas of concern and ensure you have received a complete breast exam.

WHAT’S THE DIFFERENCE BETWEEN THE TYPES OF BREAST IMAGING?

A breast ultrasound can help determine the composition of a lump, distinguishing between a cyst, fibroglandular tissue, and a solid mass. It uses high-frequency sound waves that travel into the breast until they hit a boundary between tissues, such as fluid and soft tissue, or soft tissue and bone. At these boundaries some of the sound waves are reflected back to the probe, while others travel farther until they reach another boundary and are reflected back. Since the pitch, direction, and distance sound waves travel differ depending on the boundary they run into, a computer can interpret this information as a two-dimensional image on a screen.

Mammography is a type of X-ray exam that takes an image of the inside of the breasts – called a mammogram. It’s the best way to detect breast cancer in its early, most treatable stage, because it provides a detailed look at the internal structure of breast tissue in both men and women and can reveal changes that are too small to feel.

When used together a mammogram and breast ultrasound can help provide a comprehensive look at breast tissue.

A biopsy can be performed in cases where ultrasound or mammography cannot differentiate benign from malignant lesions. This involves the insertion of a needle into the lesion to take a small tissue sample, which is then sent to a laboratory for analysis.

WHAT ARE THE RISK FACTORS FOR DEVELOPING BREAST CANCER?

Women with the following risk factors are considered high risk and may be encouraged to start screening earlier and more frequently.

• Personal history of breast or ovarian cancer.
• First-degree relative (parent, sibling, child) diagnosed with breast or ovarian cancer.
• BRCA1, BRCA2 positive.
• Three or more second-degree relatives with breast or ovarian cancer.
• Volpara D (extremely dense) breast density* score.
• Chest wall radiation at an age younger than 30.
• History of lobular carcinoma in situ or atypical hyperplasia on previous breast biopsy.

*Dense breast tissue refers to how it appears on the mammogram based on the mix of fatty and fibrous tissue. Women with very dense breasts may require a more personalized screening approach than what is recommended for the general population. This may include both mammography and ultrasound exams.

Please note that having a family history of breast cancer does not mean that you WILL develop breast cancer; it simply increases your risk. Many women who develop breast cancer do not have a family history of the disease, which is why screening is important for all women, regardless of family history.

Mayfair Diagnostics has 14 locations which offer mammography exams, and except for our Coventry Hills clinic, all of them 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 (2021) “Breast Screening.” www.screeningforlife.ca. Accessed September 18, 2022.

American Cancer Society (2018) “Can Breast Cancer in Men Be Found Early?” www.cancer.org. Accessed September 18, 2019.

American Cancer Society (2022) “Key Statistics for Breast Cancer.” www.cancer.org. Accessed September 23, 2019.

Canadian Cancer Society (2022) “Risks for breast cancer.” www.cancer.ca. Accessed September 18, 2022.

Canadian Cancer Society (2022) “Breast cancer statistics.” www.cancer.ca. Accessed September 18, 2022.

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 September 18, 2022.

Monticciolo, Dr. et al. (2018) “Current Issues in the Overdiagnosis and Overtreatment of Breast Cancer.” American Journal of Roentgenology. February 2018, 210 (2). Accessed September 18, 2022.

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 September 18, 2022.