Answer: Mammography is the best first-line screening tool for the general population for the detection of breast cancer.

Yearly screening mammography is recommended starting at age 40 for women of average risk. High risk women may start earlier than age 40 based on their personal history.

Screening mammography has been proven to decrease death rates from breast cancer as a result of early detection.

Additionally, the radiation exposure from modern mammography is extremely small and minuscule from the risk benefit perspective.

Ultrasound is an extremely good helper test, but it is not by itself a primary screening tool.

It is useful as a supplemental screening tool in women with dense breasts (in addition to mammography).

Thus, women of average risk with dense breast tissue should consider screening mammography plus screening ultrasound as their annual routine protocol.

Answer: Your concerns about your self breast examination (SBE) are just as valid as your doctor’s reliance on a clinical breast examination (CBE).

If you think you feel a lump that is concerning, address the issue with your doctor, who can then order a diagnostic (problem solving) breast evaluation.

Answer: Many referring providers describe the diffuse nodular feel of the breast tissue as “fibrocystic."

I have seen this term for a lumpy pattern used for patients with completely fatty breasts as well as for women with dense breasts and all patterns in between.

For fatty and average- density breast tissue, palpation of the breast lobules (which are segmented by ligaments) reveals a lumpy pattern.

In dense and very dense breasts, it is the firmness of the tissue, more than the lobulations, that typically accounts for this findings on the CBE.

However, most women do not have true fibrocystic changes which are demonstrated on imaging by, multiple cysts, clusters of cysts, and dilated ducts throughout the breast tissue and are evident on mammography, ultrasound, or magnetic resonance imaging (MRI).

Answer: No. If you have a new lump, you should address the issue with your doctor as a new finding.

Your doctor should refer you for a diagnostic evaluation and not wait for the routine screening examination.

Having had cysts in the past does not mean that a new lump will also be a cyst.

The new lump should be assessed based on its own merits.

Answer: No. Image- guided needle biopsy is a safe and effective method of diagnosing breast diseases, including breast cancer.

Biopsy using this method does not result in spread of the tumor to other parts of the body or change in the stage of the cancer.

Image-guided, percutaneous (through the skin) biopsy is an outpatient procedure that is performed in the breast center and can be performed using ultrasound, mammogram (stereotactic)), or MRI as the “picture” used for seeing the lesion.

Since most biopsies are benign, this is an excellent low risk and accurate method of biopsy and saves the patient from going to surgery.

Even if the result is cancer, the percutaneous needle biopsy is beneficial to the patient and her treatment team.

With a confirmed diagnosis she can participate in the planning for the best possible options based on her situation.

For example she may need additional imaging such as MRi to radiographically stage the tumor (is she a lumpectomy candidate or does she need mastectomy; is there another lesion seen that needs biopsy). Or she may need chemotherapy before surgery).

Thus, by the time she goes for her definitive surgery she has the best chance of a successful outcome.

Answer: No. Fibroadenomas, the most common benign tumors of the breast, do not turn into cancer.

They can be stable, increase or decrease in size, orrarely resolve completely.

After being confirmed as fibroadenomas, they do not require removal unless they are rapidly growing or are producing symptoms (e.g., palpable lesion, tenderness).

Answer: This is not correct. 75% of women who are diagnosed with breast cancer do not have an identifiable additional risk factor (other than being a woman).

Another way of saying it is that only 25% of women who are diagnosed have known additional risks such as family history, gene positivity, etc.

Thus, if only “high-risk” women were screened we would miss the screening detected cancers in the majority of women.

And like 50 years ago we would not diagnose them until they had symptoms and presented at a later stage in the disease process.

This is incorrect. It is important to know 75% of women who get a diagnosis of breast cancer have no known additional identifiable risks. It is recommended that the average risk woman who is asymptomatic should start yearly screening mammograms at age 40.