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INFORMATION FROM BEVERLY TOWER WILSHIRE ADVANCED IMAGING CENTER |
| Information about PET,
CT, MRI, Ultrasound. Fluoroscopy (Read
More)
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| Frequently Asked
Questions About Breast Cancer
1. Who is at risk of
developing breast cancer?
2. Aren't there women
with special risk factors?
3. What can be done to
protect against breast cancer?
4. What are the
recommended guidelines for early detection of breast
cancer?
5. What are the signs
and symptoms of breast cancer?
6. What is a
mammogram?
7. What if breast
cancer is found?
8. What is LCIS?
9. How does LCIS
develop?
10. What is my risk
for developing invasive cancer?
11. What are my
choices if I have LCIS?
12. What is DCIS?
13. How is DCIS
diagnosed?
14. What are margins
(and what do they mean)?
15. What are my
choices if I have DCIS?
16.What do the numbers on a mammogram
reading refer to?
17.What are
calcifications, and what do they mean on a mammogram?
18.I feel a breast
lump, but my mammogram was negative. Do I still need to
see a specialist?
19.VIDEO : How
to prepare for a mammogram
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| 1.Who is at risk to
develop breast cancer? |
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| A .Every woman is at
risk for developing breast cancer. Breast cancer is the
most common cancer of women, and as a woman gets older,
her risk for breast cancer increases. Three-quarters of
all breast cancers occur in women over age 50. Though
rare, men can also develop breast cancer. |
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| 2.Aren't there women
with special risk factors? |
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| A. Risk is somewhat
higher in women whose close female relatives (i.e. mothers
or sisters) have the disease. It has been observed
generally that women who never have had children (or had
their first child after age 30) appear to be at somewhat
higher risk for breast cancer, although individual cases
may vary considerably. Other possible risk factors include
not having breast-fed, early menarche and late menopause,
exposure to environmental carcinogens and lifestyle
factors (i.e. radiation, pesticides, alcohol and tobacco
use, poor diet, stress, lack of adequate sleep), obesity,
exposure to hormones (i.e. hormone replacement therapy),
race/ethnicity (i.e. Caucasians may have a somewhat higher
risk than other races), and higher socioeconomic status. |
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| 3.What can be done
to protect against breast cancer? |
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| A. It is still not clear
what causes breast cancer, or how to prevent it. The best
protection against breast cancer is to detect it at its
earliest stage and to treat it promptly. Researchers are
investigating the possible roles of heredity, the
environment, lifestyle and diet. Also, there is currently
research underway to develop a breast cancer “vaccine”
that can be used to prevent the onset of breast cancer. |
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| 4.What are the
recommended guidelines for early detection of
breast cancer? |
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A. The recommendation of the
American Cancer Society and the nation's leading health
organizations is this three-step early detection program:
- Have regular
mammograms : Screening mammograms should
begin by age 40, and should continue every year up
until about age 75; after this time, it will be up to
the discretion of the patient and healthcare provider
to either continue annual mammograms, reduce
mammograms to once every three years, or to
discontinue mammograms altogether based on the
patient’s overall health status and co-morbidities
(other diseases that might make it difficult or even
impossible for the patient to receive mammograms).
- See your healthcare
provider for regular breast exams : This
should be done at least every three years between the
ages of 20 and 40, and every year starting at age 40
and beyond.
- Practice monthly
breast self-exam : Ask your healthcare
provider to teach you the proper method for breast
self-examination. These guidelines for early detection
of breast cancer are for women who have no symptoms.
They are designed to find breast cancer at the
earliest stages, when there is the best opportunity to
treat it successfully.
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| 5.What are the signs
and symptoms of breast cancer? |
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| A. The most common
symptom of breast cancer is an adherent (non-mobile),
either vague or discrete lump or thickening that does not
go away or change, or even increases gradually in size
over time. Most lumps in the breast are not cancerous;
four out of five are from other benign causes. All lumps
should be checked by a doctor. Other symptoms to be aware
of are swelling, puckering or dimpling, skin irritation or
skin changes, persistent focal pain of the breast/nipple,
or nipple discharge (clear or bloody). If any of these
symptoms occurs in a man, they should be checked
immediately. Signs of breast cancer, especially in an
asymptomatic woman who has none of the above symptoms in
her breasts, can be seen on a mammogram (i.e. suspicious
clusters of calcifications, changes in the density pattern
of breast tissue, or a new or growing tissue mass. |
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| 6.What is a
mammogram? |
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| A. mammogram is an x-ray
picture of the breast. Modern mammography equipment and
techniques expose women to only minimal amounts of
radiation (less than the cosmic radiation you might
receive while on a 3-hour airplane flight). A trained
radiolologic technologist positions your breast between
two plastic plates that compress it, spreading the tissue
out so that the x-ray can produce as precise a
two-dimensional image as possible. Two x-rays are taken of
each breast during mammography: One from above, and one
from side to side. A specially trained physician (a
radiologist / mammographer) reads the mammogram to see if
any suspicious areas exist in either breast. |
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| 7. What if breast
cancer is found? |
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| A. Not all breast
cancers or breast cancer patients are alike. Treatments
for early breast cancer can include: Lumpectomy (a limited
surgery which removes the cancer, but not the entire
breast), followed by radiation therapy; or mastectomy
(surgical removal of the breast). Additional treatment may
include chemotherapy or hormone therapy. A woman with
breast cancer should fully review her treatment options
with her doctor before decisions are made on a treatment
program. |
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| 8.What is lobular
carcinoma in-situ (LCIS)? |
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A. Despite its
frightening name, lobular carcinoma in-situ is not a
“true” cancer. It does not have the ability to invade
tissue or spread beyond the breast at this point in time.
Even when closely monitored for many years, cancer does
not develop in the majority of cases.
LCIS originates in the breast lobules, the part of the
breast which produces milk. LCIS does not show up on the
mammogram, and does not produce a lump; therefore, it is
usually only discovered incidentally when a biopsy has
been done for some other reason, such as to evaluate a
palpable lump or abnormal mammogram. Previous studies have
demonstrated that when LCIS is present in one part of the
breast, it frequently can be found in multiple spots in
the breast.
LCIS is sometimes confused with ductal carcinoma in-situ (DCIS),
which is another type of non-invasive breast cancer;
however, the two behave quite differently. When a patient
with LCIS develops invasive lobular cancer, it usually
does not develop at the site of the original LCIS biopsy.
It is just as likely to occur at any other place within
either breast.
However, when a patient with DCIS develops invasive ductal
cancer, it is almost always found at the site of the
original biopsy. Also, when a patient with LCIS develops
an invasive cancer, it is more likely to be of the ductal
type rather than the lobular variety. When a patient with
DCIS develops invasive cancer, it is virtually always of
the ductal variety. Thus, LCIS is considered a high-risk
tissue marker for the future development of invasive
breast cancer (either lobular or ductal), and DCIS is
considered to be an actual pre-cancerous condition. |
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| 9.How does LCIS
develop? |
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| A. woman's breast
contains numerous milk-producing lobules and milk-carrying
ducts, which connect the lobules to the nipple. LCIS
starts in the breast lobules. A normal lobule is lined
with small, rectangular cells with a small, discrete
central nucleus. An early step in the development of LCIS
is hyperplasia, in which these normal cells increase in
number and pile up upon themselves in the lobules. When
the lobules become filled with abnormal cells that have
changed in cellular structure (i.e. enlarged,
irregularly-shaped cells with large, diffuse nuclei), the
condition is labeled LCIS. In the final step, the abnormal
cells break through the lining of the lobules and invade
into the breast tissue. This process is called invasion,
and has the potential to spread beyond the breast. |
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| 10. Q. What
is my risk for developing invasive cancer from
LCIS? |
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| A:. The risk of a woman
with LCIS developing invasive cancer is in the range 1-2%
per year; thus, the maximum risk after 10 years of
follow-up would be as high as 20%. This risk is increased
in the presence of other risk factors, such as family
history of breast cancer or hormone replacement therapy
use. |
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| 11.What are your
choices if you have LCIS? |
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A: If LCIS is diagnosed, you do not
have a true cancer, but you are at increased risk for
developing future cancer. The Breast Care Center
recommends the following schedule for monitoring most
women diagnosed with LCIS:
Every month: Breast
self-examination.
Every 6 months: Physical
examination by a healthcare provider experienced in breast
health and breast diseases.
Every Year: High-resolution
digital diagnostic mammogram, and possibly a diagnostic
breast MRI every 1-2 years.
When appropriate: Risk-factor
analysis; genetic testing for BRCA 1 or BRCA 2 mutations;
biopsy of any suspicious lesions seen on imaging studies;
discontinuation of hormone replacement use.
Should you have other risk factors (such as a strong
family history, or if you have already had breast cancer
before), the our providers will help you evaluate your
personal risk. We will outline a personalized plan that
offers the best opportunity for early detection and cure.
And, we direct our efforts and expertise to provide you
with careful monitoring to detect any breast changes at
the earliest possible stage.
Women diagnosed with LCIS who are young, apprehensive, or
who have unusual risk factors (i.e. an extremely strong
first-degree family history of breast cancer; documented
BRCA 1 or BRCA 2 gene mutation) may consider a more
aggressive approach. In consultation with The Breast Care
and Imaging Center team, a woman may decide to have a
bilateral mastectomy with or without immediate breast
reconstruction. Women who choose this option are often
surprised at how natural their bust-line appears after
surgery. Aesthetics aside, a high-risk woman who chooses
surgery almost completely eliminates the threat of
developing breast cancer in the future.
Whatever your decision, The Breast Care and Imaging Center
of Orange County is committed to providing you ongoing,
personalized medical attention and emotional support.
Patient resources :
The Breast Care Center encourages patients and their
families to become better informed about breast health,
disease and treatment. You may find out more by reading
about our Patient Support and Wellness Program
Services. .
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| 12.What is ductal
carcinoma in-situ (DCIS)? |
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A: DCIS is a form of
breast cancer that is now diagnosed more frequently as a
result of the widespread use of screening mammography.
Most women with this condition have no symptoms, but are
diagnosed via mammographic findings. In our experience,
approximately 1 out of 5 women who require a biopsy due to
suspicious mammographic findings have a positive diagnosis
of DCIS.
DCIS originates near the origin of the ductal system,
adjacent to the lobules. Lobules make milk, which flows
along the duct to exit the nipple. Normal ducts are
composed of small, even rectangular cells, with small,
central round nuclei. It is thought that an early stage in
the development of breast cancer is hyperplasia, in which
the cells become irregular and pile up upon themselves
within the duct. In DCIS, the ducts are lined by cells
that are irregular in shape and tend to be larger than
normal in size, and the nuclei of these cells also become
enlarged and more distorted. In both hyperplasia and DCIS,
the cells are confined to the ducts. In invasive ductal
cancer, the cells break out of the duct and invade into
the surrounding breast tissue. These invasive cells have
the potential to spread to other parts of the body
(metastasize). |
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| 13. How is DCIS
Diagnosed? |
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A: In the past, most
cases of DCIS were associated with an actual breast lump,
and many of these lumps also contained invasive ductal
cancer. Currently, most women diagnosed with DCIS have no
symptoms, and are diagnosed because a screening mammogram
showed a distinct cluster of suspicious calcifications.
Calcium is a normal component of bone, and often deposits
in normal tissue; it has nothing to do with one’s
dietary intake of calcium. Most normal mammograms have
some areas of random, benign calcifications; it is only
when these calcifications show certain characteristics
(such as clustering, or irregularities in size or shape)
that they becomes of concern.
In cases where the calcification pattern is considered
suspicious, a biopsy is recommended. This is most often
done as a core needle biopsy, in which the breast is
anesthetized with local anesthetic, and then a thin
cannulated needle attached to a vacuum source is inserted
into the suspicious area of calcifications under x-ray
guidance. Small cylindrical “cores” of tissue
containing the calcifications are suctioned out and sent
for pathologic analysis.
Occasionally, an open surgical biopsy is done to remove a
larger area of calcifications in the breast, or an area of
calcifications that yielded a “benign” result on a
core needle biopsy, but still appear suspicious. A
"needle localization" is preformed prior to this
type of biopsy. This technique is used to mark the area of
calcifications that appears on the mammogram, but cannot
be palpated in the breast. Using x-ray guidance, a
radiologist places a wire needle(s) at or around the
spot(s) in question. Another mammogram confirms that the
needle(s) is in position. Then the patient is brought into
the operating room, where under light general anesthesia
the area localized by the wire needles is removed from the
breast and sent to the mammography suite, where it is
x-rayed to insure that the calcifications are present in
the specimen. It is then sent off for pathologic analysis. |
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| 14.What are margins?
(and what do they mean?) |
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A: The margin refers to
the distance between the tumor and the edge of the
lumpectomy or mastectomy specimen. To save the breast and
avoid mastectomy, the margins must be cleared. This is not
as easy as it sounds. Breast cancers often have
microscopic extensions beyond the obvious tumor that are
not visible to the mammographer pre-operatively or to the
surgeon at the time of the surgery. Immediately after the
surgeon removes the tumor tissue from the breast, the
pathologist color codes the surfaces of the specimen with
ink, then preserves it in a solution. A few days later,
the specimen is examined under the microscope. If there is
wide enough area of normal tissue between the tumor and
the color coded edges, the margins are considered clear.
If the tumor is very near or at the edge, the margin is
considered positive. If the margins are positive and the
woman still desires to save as much of her normal breast
tissue as possible, another re-excision surgery is
required. Since the margins were color coded, the surgeon
will know exactly which area is in need of further
removal.
The reason that the margin issue is so important is that
breast cancer recurrence rates are much higher if the
margins are not adequately cleared. How much clearance is
necessary is controversial. In our practice, we prefer
ideally 5 mm of margin clearance for both invasive cancers
and for DCIS. If a woman is not planning on doing
radiation after surgery, we prefer 10 mm of clearance for
DCIS; radiation is always required after a diagnosis of
invasive cancer (no matter how generous the margin
clearance), unless a mastectomy was performed. With this
aggressive approach, we have a 10-year local DCIS
recurrence rate of less than 2%, which is very low as
compared to national standards.
A common problem facing a woman who has recently been
diagnosed with DCIS is that her margins are positive after
the area of calcifications has been completely removed.
The most common reason why this occurs is because much of
the DCIS in the affected area of breast does not actually
contain calcifications. For this reason, it cannot be seen
on the mammogram and cannot be felt by the surgeon.
Residual DCIS at or close to the margins is usually not
found until 4-5 days after the surgery, when the
pathologist examines the slides under the microscope. |
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| 15 .What are my
choices if I have DCIS? |
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A: If all the margins
are clear, a mastectomy can usually be avoided. Small,
non-aggressive forms of DCIS may be safely treated with
lumpectomy and subsequent careful observation and
follow-up. However, in extensive or more aggressive forms
of DCIS, radiation therapy is always required to lower the
rate of future local recurrence. Even cases with involved
margins can often be treated with breast conservation
surgery (lumpectomy), as long as the margins can be
cleared with a subsequent re-excision surgery.
In cases where the DCIS is found to be more extensive, or
when re-excision margins are again involved, mastectomy
with or without reconstruction is usually the treatment of
choice.
Conclusion:
The most important point to remember is that DCIS is 100%
curable! If diagnosed early, the breast can be preserved
with a good cosmetic result, and most (if not all) women
can continue to live happy and productive lives.
Patient resources:
Our Breast Care Center encourages patients and their
families to become better informed about breast health,
disease and treatment. |
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| 16. What do the
numbers on a mammogram reading refer to? |
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A: The numbers are a standardized
classification of mammogram results which tells the
physician what to do with the results. This classification
is called BIRADS. The following is a generalized
description of what is meant by each number:
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I. Normal mammogram, no
significant findings.
II. Benign finding(s) within the breast, nothing
to worry about.
III. Probably benign finding within the breast,
with a less than 2% chance that this is a cancer;
however, it is advised that a mammogram should be
repeated on the specified breast in 6 months.
IV. Worrisome, indeterminate, or suspicious
finding indicative of a possible cancer; consult a
surgeon for biopsy.
V. Highly suspicious finding indicative of cancer;
consult a surgeon for immediate biopsy.
VI. Assumed breast cancer until proven otherwise.
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| 17. What are
calcifications, and what do they mean on a
mammogram? |
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| A. Calcifications are
visible as discrete, white spots seen on the mammogram;
these represent calcium deposits / calcium salts, and may
appear as randomly scattered grains of coarse-ground salt,
clustered together as fine grains of salt of various
shapes and sizes, as larger grains of gravel, or even as
round, distinct white densities over the mammogram film.
Calcium is a by-product of breast tissue metabolism and
cell turnover due to reproductive and hormonal changes
throughout a woman’s life. A vast majority of these
changes are not cancer. The radiologist can describe which
ones are not worrisome (benign) and which ones need to be
biopsied to see if they are associated with a cancer. |
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| 18. I feel a breast
lump, but my mammogram was negative. Do I need to
see a specialist? |
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| A. Mammograms are
falsely negative (meaning, they give a result that is
normal or benign, even if a cancer is actually present)
10-15% of the time in post-menopausal women, and 25% of
the time in pre-menopausal women. If a woman still has a
lump or breast mass that still persists, even after having
a normal mammogram, she should still have additional
workup to have her lump evaluated. |
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| FEATURED
LOCATIONS |
Temecula
Advanced Imaging Center (Hancock)
25395 Hancock Ave., Suite 110
Murrieta, CA 92562
Phone: 951-696-4230
Fax: 951-696-4240
Modalities: MRI, CT, Nuclear Medicine,
PET/CT, MR Arthrograms, Fluoroscopy, Nuclear Cardiology
Temecula Advanced Imaging Center
(Jefferson)
27699 Jefferson Ave., Suite 110
Temecula, CA 92590
Phone: 951-699-7161
Fax: 951-676-7287
Modalities: X-Ray, Digital Mammography (ACR Accredited),
Ultrasound
The Breast Care Center of Temecula
Valley
25395 Hancock Ave., Suite 200
Murrieta, CA 92562
Phone: 951-600-2839
Fax: 951-698-2354
Modalities: Digital Mammography (ACR Accredited),
Ultrasound Guided Biopsy, Ultrasound, Stereotactic Breast Biopsy,
DEXA
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We Proudly Support
the Fight Against
Breast Cancer
| Here is a partial list
of some of the services we offer: |
MRI, MRA, CT, Ultrasound,
Vascular Ultrasound, PET/CT, Nuclear Med, Nuclear Cardio,
X-Ray, Open MRI, Fluoro, Arthrograms, Mammography, Breast
Ultrasound, DEXA, Stereotactic Breast Biopsy, Breast Cancer
Reconstructive Surgery, Helical CT, MR Angiography, High Field
MRI, Orange County, Mission Viejo, Los Angeles, Anaheim, Santa
Ana, Irvine, community, Southern California, California,
orthopedic, sports medicine, bone fracture, Bone Density, Bone
Densitometer, Osteoporosis, GE Lunar, broken bones, hip, knee,
carpel tunnel, spine, back, Radiology, Diagnostics Imaging,
Digital Breast MRI, Breast Biopsy, iCAD, DynaCAD, MRI CAD,
Mammo CAD, Women's, Women's Imaging, Breast Cancer Screening
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| Here is partial list
of some of the areas we service: |
Los Angeles County:
Agoura Hills, Alhambra, Arcadia, Artesia, Azusa, Baldwin Park,
Bellflower, Beverly Hills, Big Pines, Burbank, Carson, Century
City, Cerritos, Chatsworth, China Town, City of Industry,
Claremont, Commerce, Compton, Covina, Culver City, Downtown
LA, Downey, Eagle Rock, El Monte, El Segundo, Encino, Gardena,
Glendale, Glendora, Granada Hills, Hawaiian Gardens,
Hawthorne, Hermosa Beach, Hidden Hills, Highland Park,
Hollywood, Inglewood, Irwindale, Japan Town, Korea Town, La
Canada/Flintridge, La Crescenta, La Habra, La Mirada, La
Puente, La Verne, Lakewood, Lancaster, Lenox, Lomita, Long
Beach, Los Angeles, Los Nietos, Lynwood, Manhattan Beach,
Marina Del Rey, Monterey Park, Montrose, Northridge, Norwalk,
Palmdale, Palos Verdes Estates, Paramount, Pasadena, Pico
Rivera, Pomona, Rancho Palos Verdes, Redondo Beach, Reseda,
Rolling Hills Estates, San Fernando Valley, San Gabriel, San
Marino, Santa Clarita, Santa Fe Springs, Santa Monica, Signal
Hill, South Pasadena, Temple City, Torrance, Valinda, Van
Nuys, Ventura County, Verdugo City, Walnut, West Covina, West
Hollywood, Westlake Village, Westwood, Whittier and all other
cities and communities of Los Angeles County.
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