Breast Cancer FAQs

There is no one known cause for breast cancer. Genetics, having a family history, and other lifestyle or environmental factors can play a part. Cancer begins when the cells of a breast undergo changes, leaving the cell damaged. The damaged cell then changes its growth pattern and mutation begins.

There are approximately 15 different types of breast cancer. Tumors can develop from different types of breast tissue, in different parts of the breast, and may have differing characteristics. Breast cancers are named according to the part of the breast in which they develop.

Typical treatments for breast cancer include surgery, radiation therapy, chemotherapy and biologic therapy. At BID Plymouth, we are pleased to have a multidisciplinary team available to meet with you, review your test results, confer and determine recommendations for your treatment options and plan.

A core biopsy is a minimally invasive procedure to determine the pathology (diagnosis) of an abnormality or finding (on mammogram, ultrasound, or MRI). A small tissue sample is obtained with a needle. The sample is then sent to the pathologist to be examined. Results of the biopsy will be given to you within 2-3 business days (48-72 hours).

A needle localization is a pre-surgical procedure in which a wire is inserted, via a hollow needle into the breast to direct the surgeon to the area of abnormality or calcifications which cannot be felt on physical examination or to localize a clip which has been placed during a previous core biopsy.

Mammography or ultrasound is used to guide the needle into the area of concern. A flexible wire is placed through the needle and locked in place in your breast. The wire is then covered with a dressing to hold it in place. The average time for this part of the procedure is 30-60 minutes and is done under local anesthesia.

Following this needle localization, you will then be taken to the operating room where the surgeon will remove the needle along with the targeted tissue. This is usually done under general anesthesia or local anesthesia with IV sedation.

Stereotactic breast biopsy is another way of performing a core biopsy using digital mammography and a computer program that finds the exact location of the abnormality in the breast. Multiple samples are extracted and sent to pathology for examination. This biopsy method is ideally suited for microcalcifications found on mammography. Microcalcifications are extremely small (about the size of a grain of sand) usually located within a dime-sized area designated as a cluster. Occasionally a larger area, designated as a geographic area, may require a core biopsy of two separate areas—one on each end of the abnormality.

We allow one hour for this appointment but the biopsy itself only takes 2-3 minutes. Only local anesthesia is used and most patients can return to their normal routine afterwards.

You may experience some bruising or discomfort following this biopsy.

A clip is a metallic marker that is placed through the biopsy device at the site of the biopsy targeted tissue. It is used to mark the site of biopsy in case additional surgery is required such as a needle localization. This clip is left inside the breast and is not harmful to the body. If the biopsy leads to more surgery, the clip will be removed at that time. The clips placed in the breast at BID Plymouth are MRI compatible.

Please notify your surgeon prior to scheduling a breast biopsy if you take Aspirin, Aggrenox, Coumadin, Fish Oil, NSAIDS (such as Advil, Indocin, Ibuprofen, Motrin or Naprosyn), Plavix or Vitamin E.

MRI uses a powerful but harmless magnetic field to create an image of the body. This involves no x-rays or radiation. This method of imaging is complimentary to mammography and ultrasound. An abnormality found on MRI may require a focused ultrasound based on the location of the abnormality on MRI. If it is seen on ultrasound, a biopsy may be done using ultrasound. If it is not seen by focused ultrasound, a MRI guided biopsy will be scheduled or an appropriate follow up given.

The MRI is painless. The average time for the breast MRI is 30-45 minutes. You will be asked to lie down on your stomach on a cushioned bed. Your breasts will be positioned within a padded cutout on the bed. The bed will be moved into the machine for the exam. The most important thing for you to do is to lie still. All breast exams require an injection of a contrast agent (Gadolinium). An IV will be placed in your arm before you lie on the bed so that the contrast can be administered.

Once you are settled in, the technologist will step out of the room and you will be able to speak with them through a microphone. Please let the technologist know if you get nervous or have any concerns.

You enter the MRI scanner feet first so your head is not in the scanner. If you get anxious in small or tight places, please let your doctor know prior to scheduling your MRI appointment. They may prescribe a sedative or give you other options to help deal.

You will need to lie still the entire time. You will not feel anything, but you will most likely hear tapping or thumping as the machine does its work. This is all normal. When the test is finished, the technologist will bring the table (and you) out of the machine. They will look at the images and let you know when it is okay to leave. The Radiologist will interpret the test and send the results to your physician.

Upon greeting by the technologist, you will be asked a series of questions. It is important to tell the technician if you have any metal or electronic devices implanted in your body as these may affect the image. If you have ever had metal in your eye, please tell the technologist. You should not have an MRI if you have a certain type of pacemaker, defibrillator or other implanted life-support device as the MRI may interfere with its functioning. Most VADS (ports) are MRI compatible but please discuss this with the technologist.

Breast MRI is sometimes done to image silicone breast implants. If you have breast implants, it is important that you tell the technologist when she calls prior to your exam. We will also need to know if your implants are filled with saline, silicone, oil or a combination. In addition we need to know if the implant has a polyvinyl chloride sponge covering. Please get this information from your plastic surgeon’s office before the test.

Breast MRI is an excellent method to evaluate implant rupture or breast tissue not visualized by routine mammography.

MRI is not appropriate if you have breast expanders in place following lumpectomy and prior to reconstruction. If you have breast expanders, an MRI must be delayed until the expanders have been removed and implants have been inserted as current expanders have metal components.

Clips placed in the breast at BID Plymouth during minimally invasive biopsy are not a contraindication to having an MRI.

There is nothing special to do. Before taking the test, you will be asked to remove all jewelry, hearing aids or dentures. You will need to wear clothing without any metal parts.

In some instances prior to MRI, a simple blood test may be required to assess kidney function.

An ultrasound uses high-frequency sound waves to create pictures of the body. Ultrasound can also be done of the axilla (arm pit) to assess lymph nodes. It sends out sound waves into your body and collects them after they bounce off tissues. A computer collects these sound waves and creates an image of the tissues. The change from known normal tissue characteristics to abnormal can be interpreted by the radiologist to further define the abnormality.

An ultrasound is a painless test. A sonographer spreads a layer of warm gel over the breast tissue. This gel helps to conduct the sound waves. The sonographer then moves the probe back and forth over the breast tissue. Images can be seen in black and white on the nearby screen. This test can take between 20-60 minutes depending on the number of areas evaluated and if both breasts are examined.

Your ultrasound will be performed by a board certified ultrasonographer and a radiologist. If the ultrasound shows a finding that requires biopsy, a biopsy may be done at that time or done at a follow up appointment. If a biopsy is suggested and you take Aspirin, Aggrenox, Coumadin, Fish Oil, NSAIDS (such as Advil, Indocin, Ibuprofen, Motrin or Naprosyn), Plavix or Vitamin E, the biopsy will likely need to be performed at a follow up appointment.

There is no preparation necessary.

A 3D exam includes both 2D images and tomosynthesis scans. During the tomosynthesis portion of the exam, an X-ray arm sweeps in a slight arc over the breast, taking multiple images. A computer then converts the images into a stack of thin layers, allowing the radiologist to review the breast tissue one layer at a time. A 3D exam requires no additional compression and takes just a few seconds longer than a conventional 2D breast cancer screening exam. 3D exams are recommended for women of all ages and breast densities. A 3D exam allows our radiologists to more effectively pinpoint the size, shape and location of abnormalities. This leads to better detection and greater peace of mind for our patients. All of our mammography units offer 3D mammography.

Large clinical studies in the U.S. and Europe have demonstrated the positive benefits of a 3D mammogram.

According to a 2014 study on breast cancer screening using the 3Dexam published in the Journal of the American Medical Association (JAMA), benefits include:

• A 41% increase in the detection of invasive breast cancers
• A 29% increase in the detection of all breast cancers
• A 15% decrease in women recalled for additional imaging

When you arrive for your appointment, you will be escorted to a private changing area. You will be provided with a gown and asked to remove your clothing from the waist up. You can expect that the appointment will take about 30 minutes. The technologist will ask you to stand in front of the mammogram unit and she will position your breast on the image receptor. A clear plastic paddle will compress your breast tightly to spread the breast tissue and prevent motion. This will provide us with quality images that are best for interpretation. The compression will be tight but should not hurt. The paddle will release automatically when the image has been taken. The technologist will assist in positioning you for the remaining views. We would encourage you to ask questions you may have about your exam. The technologist will be happy to answer them and will try to make you as comfortable as possible.

You will be asked to fill out a patient history and indicate any possible family history of breast cancer. If possible you should try to schedule your mammogram for the week after your menses (period). On the day of the test, do not wear perfume, powder, or deodorant. Perfume, powder, or deodorant can create an artifact that can appear like an abnormality. You will also be asked to remove any jewelry around your neck, so you may want to leave it at home.

No, it does not. Ten percent of all cancers are not found by mammography therefore self-breast exam and physician clinical exam are critical components to breast health for diagnosis and surveillance. However, every woman is different and not all cancers act the same way. The best way to detect breast cancer is by combining your self-breast exam, your doctor’s breast exam, and a mammogram.

Additional imaging, such as breast ultrasound, or breast biopsy may be indicated. This information will be discussed with you at the time of your visit. If a breast biopsy is recommended, we will assist you in scheduling the procedure before you leave the center.

Our goal is to contact you within two business days (48 hours) if additional mammographic views are needed. We will set you up with an appointment to come in for additional imaging. Many times the additional mammographic views indicate the area is not of true concern. At other times, they more clearly show an area of abnormality. The Radiologist may recommend another imaging study, and if needed, a biopsy. The results of your breast imaging will be discussed with you before you leave the center.