Breast Cancer Screening, Detection and Diagnosis at Scripps
Early detection of breast cancer (before symptoms present themselves) is estimated to save thousands of lives yearly. An annual digital mammogram is recommended for women starting at age 40, according to the American Cancer Society.
Scripps Health offers a host of screening services and diagnostic procedures throughout San Diego to detect and diagnose breast cancer, including three dedicated breast care centers.
Available services include:
Clinical breast exams
Women in their 20s and 30s are recommended to have a clinical breast exam every 3 years, according to the American Cancer Society. The physical exam is performed by a physician, nurse, nurse practitioner or physician assistant. The health professional examines the breasts for abnormalities in size or shape, as well as changes in the skin of the breasts or nipples. The exam includes a palpation of the breasts using the pads of the fingers. Areas under the arms are also examined.
Screening mammograms are performed when breast cancer symptoms are not present, and can identify abnormalities well before they are felt by hand. Yearly screening mammograms are recommended for women at average risk of breast cancer starting at age 40 and continuing as long as they are in good health. The Scripps Health breast screening standard is digital mammography that uses low-dose X-rays to create high-contrast, high-resolution images for early detection of breast problems.
If a lump or other abnormality is found, Scripps provides comprehensive diagnostic mammograms. Using x-rays, views of the breast are taken from several angles. The suspicious area is magnified for accurate diagnosis. A diagnostic mammogram can find that an area that looked abnormal on a screening mammogram is actually normal, or it could result in a recommendation for further checks, including possibly a biopsy to be certain of the diagnosis.
Tomosynthesis (3-D mammograms)
Used with digital mammography equipment, tomosynthesis software converts images into a stack of very thin layers, creating a 3-D reconstruction of the breast. This advanced approach allows physicians to examine breast tissue in 1-millimeter sections at a time. Adding the test to digital mammograms can increase the detection rate for breast cancer and decrease false alarms, in which suspicious findings lead women to get extra scans that turn out normal.
Tomosynthesis is ideal for women with dense breast tissue and those with an increased breast cancer risk. Scripps Health became the first San Diego area provider to offer tomosynthesis in 2012 through Scripps Memorial Hospital Encinitas and the Polster Breast Care Center at Scripps Memorial Hospital La Jolla.
Ultrasound outlines a part of the body through the use of sound waves. A transducer (small, microphone-sized instrument) is placed on the skin, which is often first lubricated with a special ultrasound gel. The transducer emits sound waves and picks up echoes that bounce off body tissues. The series of echoes are digitally converted into a monochrome image displayed on a screen.
Breast ultrasound helps physicians distinguish between cysts (fluid-filled sacs) and solid masses and can help determine the difference between benign and cancerous tumors. Ultrasound is not recommended as a substitute for annual screening mammograms. A breast ultrasound is typically performed to target an area found during a mammogram that has caused concern.
Breast-specific gamma imaging (BSGI)
Breast-specific gamma imaging (BSGI) helps physicians determine if a breast abnormality requires a biopsy. A BSGI is not a primary screening tool or a replacement for a screening mammography. Some physicians use BSGI for women at higher risk of breast cancer but who are not candidates for a breast MRI. BSGI is also known as scintimammography, molecular breast imaging (MBI) and nuclear breast imaging.
MRI has multiple uses in breast health. An MRI can be used in conjunction with mammograms for screening women who have a high risk of developing breast cancer. MRI can also be used to help physicians better examine suspicious areas found during a screening mammogram. An MRI can give physicians a view to better determine the actual size of a cancer tumor after a positive diagnosis, as well as provide guidance during a breast biopsy.
Breast PET/CT scan
A breast positron emission tomography (PET) scan scan uses a glucose that contains a radioactive substance (called a “tracer”) to look for breast cancer. Cancer cells absorb large amounts of radioactive sugar, so if cancer is present in other areas of the body, it can appear as areas of radioactivity that are captured with a special camera. A PET Scan can help physicians identify cancer that has spread from the breast in areas of the body that an MRI or a CT scan may miss. A PET scan is combined with a CT scan, which can assist with early diagnosis, disease staging and localization, surgery and treatment planning . Scripps offers breast PET/CT scans at Scripps Clinic Integrated Medicine and Scripps Memorial Hospital La Jolla – Pavilion.
A breast biopsy is the sampling of suspect breast tissue to examine for signs of cancer or other abnormalities. A physician performs a biopsy after results of a diagnostic mammography, additional imaging procedures or office exam indicates a mass or potential abnormality in the breast tissue. The removed tissue is analyzed under a microscope to determine if cancerous cells are present (malignancy) or the suspicious finding is non-cancerous (benign). Breast biopsies are usually performed surgically or through image (mammography, MRI, ultrasound) guidance.
- Ultrasound-guided breast biopsy
An ultrasound-guided breast biopsy uses ultrasound images to help the radiologist accurately position a needle in the breast to remove a small tissue sample to be analyzed.
- Stereotactic breast biopsy
A stereotactic breast biopsy uses mammography images to help the radiologist accurately position a needle in the breast to remove a small tissue sample. This procedure is usually used when a small growth or calcifications are visible on a mammogram, but they are not seen during a breast ultrasound.