http://www.whcenter.org/body.cfm?

id=556757
Early Detection/Screening
The Center for Breast Health at Washington Hospital Center offers early-detection
programs that include:
mammography
breast physical examinations
instruction in breast self-examination upon re!uest"
High-Ris
#t the $reast %enter& women at an increased ris' of de(eloping breast cancer recei(e
regular examinations and counseling. )his helps our patients to better understand their
ris's and minimi*e their chances of de(eloping cancer.
!earn more a"out:
+ho ,hould $e ,creened?
,creening -rocess
.enetics
Who Should Be Screened#
/ur doctors recommend different breast cancer screening guidelines based on the
following three ris' categories:
0. +omen of a(erage ris'. #(erage ris' may include:
personal history of breast abnormalities
current age
breast cancer history of close relati(es
whether a woman has had a breast biopsy
obesity
physical inacti(ity
race
1. +omen with a family history of breast cancer& i.e. at least one first-degree relati(e
i.e. parent or sibling" who has had breast cancer.
2. +omen who ha(e recei(ed a diagnosis of benign breast disease or breast cancer
confined to the mil' duct or lobule.
$uidelines for Women of %&erage Ris
+omen should be aware of any changes in their breasts. 3onthly breast self-
examination beginning at 14 years old is optional& but highly recommended.
#nnual clinical breast examination beginning at age 15.
#nnual mammography beginning at age 54.
$uidelines for Women 'ith a (amily History of Breast Cancer -- i)e) *ne or +ore
(irst-Degree Relati&es ,-arent or Si"ling.
+omen should be aware of any changes in their breasts. 3onthly breast self-
examination beginning at 14 years old is optional& but highly recommended.
%linical breast examination e(ery six months starting ten years before the age at
which the youngest family member was diagnosed with breastcancer.
#nnual mammography starting ten years before the age of the youngest family
member with breast cancer but not earlier than age 15 and not later than age 54".
%onsider annual 367 consult with your physician".
$uidelines for Women 'ith a Diagnosis of Benign Breast Disease or Breast Cancer
confined to the mil duct
+omen should be aware of any changes in their breasts. 3onthly breast self-
examination beginning at 14 years old is optional& but highly recommended.
%linical breast examination e(ery six months beginning at time of diagnosis.
#nnual mammography beginning at the time of diagnosis.
%onsider annual 367 consult with your physician".
Screening -rocess
#t the %enter for $reast 8ealth& the screening process is (ery streamlined& ma'ing it easy
for you to schedule the necessary tests.
$ased on your ris' factors& your doctor will gi(e you a prescription for the appropriate
test.
0. 9our first step is a Routine %nnual Screening +ammogram. 9ou will recei(e a
letter se(en to 04 days after your mammogram& notifying you of your results. )he
results of your mammogram will determine your next steps.
1. 9ou may need follow-up testing. )his may include a repeat mammogram with
magnified (iews and/or an ultrasound. )he physician who ordered the initial
mammogram usually your ob/gyn& but may also be your primary care physician"
will recei(e these results. 7f necessary& you will be referred by your physician to a
surgical oncologist at the %ancer 7nstitute for an e(aluation.
2. #t this point& our surgical oncologist will meet with you to do a clinical breast
exam and e(aluate your films. 9our doctor may order a biopsy to gain more
specific information. $iopsies can be ultrasound guided& stereotactic or core.
5. 9ou will recei(e the results of your biopsy two to three days after the procedure is
performed. :sually ;4 percent of these biopsies are negati(e for disease.
5. 7f the biopsy comes bac' positi(e& your doctor will e(aluate which treatment
options will be most effecti(e for you.
6. #t this point& our breast care coordinator will schedule the 3/%, meeting for
you. 7n this critical meeting& you will meet your team of doctors& learn about your
treatment options and recei(e important information. -atients usually bring along
a family member or close friend to these meetings& to pro(ide additional support.
7. 9our breast care nurse coordinator is a critical member of your team. ,he is there
to answer all !uestions about your treatment as well as pro(ide guidance about
support programs a(ailable at the %ancer 7nstitute.
$enetics
+e understand that any diagnosis of cancer causes concern for related family members.
#t +ashington %ancer 7nstitute& we can offer you the support you need.
/ur new clinical cancer genetics ser(ice is a <oint initiati(e in(ol(ing +ashington
8ospital %enter=s +ashington %ancer 7nstitute& .eorgetown :ni(ersity 8ospital and
>ran'lin ,!uare 8ospital.
)iffani ?e3arco& 3,& is the genetic counselor and clinical coordinator of our program.
,he has nine years of experience in counseling indi(iduals who are at high ris' for
hereditary cancers.
/ur cancer genetics ser(ice pro(ides comprehensi(e pre- and post-test genetic counseling
to patients and family members. 7f you are see'ing information and support concerning
your personal ris's and/or family history of any type of cancer& you can turn to our highly
trained staff for answers. 9ou will learn about the option of genetic testing for cancer ris'
along with information regarding cancer screening and pre(ention trials. 9ou will also
learn about how this information may impact your relati(es= ris's for de(eloping cancer.
)his is an interdisciplinary program that may in(ol(e referrals and consultations with
physicians from se(eral different medical specialties. -atients may also be e(aluated by a
geneticist and/or medical oncologist.
3s. ?e3arco is a(ailable to answer !uestions& identify resources and pro(ide guidance.
9ou may also call 141" 6;7-1722 for further information or to ma'e an appointment.
Diagnosis
?iagnosis in(ol(es e(aluating patient history& clinical exams& biopsy results and images.
3any different imaging and biopsy methods are a(ailable.
)he uni!ue interdisciplinary approach of )he %enter for $reast 8ealth means that:
9our diagnosis is made in consultation with other members of your medical team
)here is usually one doctor directing your treatment and e(aluating which
methods are appropriate for you& but se(eral other physicians are in(ol(ed.
/ur doctors will encourage you to use all the resources the %ancer 7nstitute
pro(ides& including the nurse care coordinator and other forms of support and
care.
#n important part of your diagnosis in(ol(es cancer staging. %ancer staging is a system
that describes how far the cancer has spread within your body. ,taging is (aluable&
because it attempts to put patients with similar prognosis and treatment in the same
group.
)reatment methods that ha(e been effecti(e for other patients within your staging group
may be appropriate for you& too.
)o learn more about staging& please see this fact sheet compiled by the @ational %ancer
7nstitute. You will be leaving Washington Cancer Institutes Website. "
!earn more a"out:
/maging
Biopsies
Comprehensi&e %pproach
Support -rograms
Treatment
/maging
)here are se(eral different 'inds of imaging techni!ues that doctors use at the $reast
%enter when they e(aluate patients for possible breast disease. )hese include:
3ammograms
:ltrasound
36 or 367
9our doctors will order the appropriate imaging studies& based on what they thin' is right
for you. 9our nurse coordinator and patient na(igator will assist you in scheduling your
appointments for these studies. )hey will also wal' you through the process if you need
further testing.
>eel free to as' any !uestions or (oice any concerns that you ha(e. )esting for breast
disease can be an intimidating process. )he more information that you ha(e before the
test& the more comfortable you will feel.
+ammograms
What is a mammogram?
# mammogram is a special 'ind of A-ray designed specifically for the breast.
3ammograms allow your doctor to ha(e a closer loo' at your breasts for breast lumps
and changes in breast tissue. )hese tests can show small lumps or growths that a doctor or
woman may not be able to feel when doing a clinical or self-breast exam.
3ammography is the best screening tool that doctors ha(e for finding breast cancer.
)here are three types of mammograms:
Screening mammograms are done for women who ha(e no symptoms of breast
cancer. )hese are typically done once a year. ,ee +ho ,hould $e ,creened? to
learn more about recommendations for scheduling your mammograms.
Diagnostic mammograms are done when a woman has symptoms of breast
cancer or a breast lump. )his mammogram ta'es longer than screening
mammograms because more pictures of the breast are ta'en.
Digital mammograms also use x-rays to produce detailed images of the breast.
8owe(er& digital mammography is e!uipped with a digital receptor and a
computer instead of a film cassette. ,e(eral studies ha(e demonstrated that digital
mammography is at least as accurate as standard mammography.
Screening Mammograms
What can I expect?
0. )he mammography technologist will gi(e you all the instructions for your
mammogram. )he total time needed to perform the mammogram is about 05
minutes.
1. 9ou will stand in front of a special x-ray machine. # radiologic mammography"
technologist will place each breast between two plastic plates. )he plates press
your breast to ma'e it flat.
2. 9ou will feel pressure on your breast for a few seconds. 7t may cause you some
discomfortB you might feel s!uee*ed or pinched. #lthough it may be
uncomfortable& it is important to flatten your breast as much as possible. )he
flatter your breast is& the better the picture will be. 3ost often& two pictures are
ta'en of each breast--one from the side and one from abo(e.
How should I prepare?
%hec' with your patient na(igator for any special instructions you may need to follow
before you go. 8ere are some general guidelines to follow:
3a'e your mammogram appointment for one wee' after your period& if possible.
9our breasts will hurt less during that time.
7f you ha(e breast implants& be sure to tell your mammography facility that you
ha(e them when you ma'e your appointment.
+ear a shirt with shorts& pants& or a s'irt. )his way& you can <ust undress from the
waist up when you get your mammogram.
?onCt wear any deodorant& perfume& lotion& or powder under your arms or on your
breasts on the day of your mammogram appointment. )hey can cause shadows on
your mammogram film.
Will it hurt?
3ost women report feeling minor discomfort or pressure when their breast is placed
between the two plates. )hese feelings should !uic'ly subside once the mammogram is
completed.
How do I get the results?
9ou will recei(e a written report within 7 to 04 business days of the examination& and the
referring physician will be sent the report (ia fax or mail.
0ltrasound
What is ultrasound?
:ltrasound is a (aluable& widely a(ailable imaging method that uses sonar sound wa(es"
to e(aluate (arious areas of the body. )his test does not use radiation& and is also useful in
helping guide fine-needle aspirations.
What can I expect?
0. )he ultrasound technologists will gi(e you all the instructions for your ultrasound
scan. )he total time to perform the ultrasound scan is usually less than 24
minutes.
1. 9ou will lie on a table with your breast exposed. )he technologist will apply a
warm gel onto the s'in of the area to be scanned.
2. )he technologist will then pass a wand along the s'in surface to obtain the
images. )here is no pain and no in<ection.
5. /nce your images are completed& a radiologist will re(iew them in order to
determine if any repeat or extra images are needed. ?o not be concerned if repeat
or extra images are needed. 6epeat or extra (iews are fre!uently necessary& and
they do not necessarily mean that the radiologist has found something of concern.
5. #fter completion of the images& you will be able to lea(e. 7n most cases the
radiologist will re(iew the results with you& and will send a report to your
physician.
How does ultrasound work?
,ound wa(es abo(e our hearing fre!uency are DbeamedD into the patient& and these sound
wa(es hit an ob<ect deep within and bounce bac' to us. )he same process happens when
you call out in a canyon. 9our (oice hits the opposite wall of the canyon and returns to
you as an echo.
$ased on the time it too' from sending the sound wa(e until its return& the computer
calculates how deep the tissue structure must be. @ot all sound wa(es are reflected at
once& since they penetrate each layer of tissue with echoes returning from each layer in
turn. )his staggered pattern of echoes ultimately produces a two-dimensional& flat image.
Will it hurt?
@ot at all. :ltrasound is a (ery safe& painless way for doctors to see the inside of your
body without using any in(asi(e methods. 9ou will ha(e to clean the gel from your s'in.
How do I get the results?
9ou will recei(e a written report within 7 to 04 business days of the examination& and the
referring physician will be sent the report (ia fax or mail.
+R ,+agnetic Resonance /maging.
What is an +R#
36 is a relati(ely new imaging techni!ue that is widely a(ailable in hospitals and
outpatient radiology facilities. #n 36 scanner is (ery similar in appearance to a %) or
-E) scanner& although there are some differences. 36 does not use radiation& and it
pro(ides excellent images of soft tissue structures& such as breast tissue.
What can / e1pect#
0. )he 36 technologists will gi(e you all the instructions for your 36 scan. )he
total time needed to perform the 36 scan is approximately 24 minutes.
1. 9ou will lie on a table within the 36 scanner=s opening. )he machine will
automatically mo(e as it obtains images of the entire area of interest. 7t is
important to stay as still as possible& so that the pictures will be of the best !uality.
?uring the procedure& you will hear a 'noc'ing sound& which is normal. )here is
no pain.
2. /nce your images are done& a radiologist will re(iew them in order to determine if
any repeat or extra images are needed. ?o not be concerned if repeat or extra
images are needed. 6epeat or extra (iews are fre!uently necessary& and they do
not necessarily mean that the radiologist has found something of concern.
5. #fter completion of the images& you will be able to lea(e. #s a rule& the
radiologist does not re(iew the results with you& but will send a report to your
physician.
Ho' should / prepare#
0. $efore the procedure& it is &ery important that you inform the technologist of any
metallic implants in your body. ?ue to the powerful magnetic fields created by the
36& only certain 'inds of metal can be allowed in the machine. *nly the +R/
technologist can decide a"out the safety of any metallic implants)
1. 9ou will be as'ed to change into a dressing gown and to remo(e all of your
<ewelry.
Will it hurt#
)he 36 test does not hurt at all& but the machine ma'es a loud FclangingG noise while
ta'ing the pictures. )his can be bothersome to some people.
,ome patients& especially those who are claustrophobic& may be disturbed while lying still
for so long in an enclosed space. >or these patients& ta'ing relaxation medication or using
an open 36 may impro(e the experience. 9ou should discuss these options with your
doctor if he or she orders an 36 for you.
Ho' do / get the results#
9our results will be sent to the referring physician within fi(e wor'ing days& and you will
be notified shortly thereafter.
Biopsies
7f images ta'en of your breast show suspicious or !uestionable areas& a breast biopsy may
be necessary in order to gain more specific information. # breast biopsy is a procedure
that obtains a sample of suspicious breast tissue and analy*es it in a laboratory for signs
of breast cancer. )here are se(eral different ways for your doctors to perform your biopsy.
They include:
,tereotactic biopsy
:ltrasound guided biopsy
%ore biopsies on palpable masses
9our doctors will order the biopsy that is most appropriate for you. 9our nurse
coordinator and patient na(igator will assist you in scheduling your appointments for
these biopsies& and will also wal' you through the process if you need further testing.
>eel free to as' any !uestions or (oice any concerns that you ha(e. 8a(ing a biopsy
performed can be an intimidating experience. )he more information that you ha(e before
the biopsy& the more comfortable you will feel.
Treatment
,uccessful treatment of breast cancer& and the li'elihood of long-term sur(i(al for women
with breast cancer often depends on the stage of the disease when diagnosed.
7f breast cancer is detected in its earliest stages& appropriate treatment results in a 04-year
sur(i(al rate for more than H4 percent of patients. Iife expectancy rates for breast cancer
sur(i(ors ha(e been impro(ing steadily during the past decade. )his impro(ement is due
to early detection and newer treatments& such as hormonal therapy and better
chemotherapy.
)reatment options for breast cancer will often include chemotherapy& hormonally based
treatments& radiation therapy and surgery. )ogether with your doctors and team& you will
ma'e informed decisions about the best possible care for you.
!earn more a"out:
%hemotherapy
6adiation
,urgery
Chemotherapy
Chemotherapy is the use of drugs to:
'ill cancer cells
slow the growth of cancer cells
)he treatment can be gi(en directly into the (ein or by mouth.
How does it work?
%hemotherapy enters the bloodstream and tra(els to all parts of the body to reach cancer
cells that may ha(e spread beyond the breast. # combination of drugs is used to increase
the effecti(eness of the treatment.
When is chemotherapy indicated?
%hemotherapy may be gi(en after a lumpectomy or mastectomy to help reduce the
chance of breast cancer recurrence. 9our doctor may also recommend a course of
chemotherapy before surgery to shrin' the tumor.
Surgery
>or many women& the idea of breast surgery is upsetting. 8owe(er& a decision to undergo
breast surgery does not necessarily mean that a woman will lose her breast. 3a<or
progress has been made in reconstructi(e surgeries& so that ;5 percent of patients can
preser(e their breasts. +omen with in(asi(e breast cancers ha(e also had pro(en success
in breast preser(ation.
The surgeries most often performed 'hen there is a diagnosis of "reast cancer are:
-artial mastectomy
3astectomy
6econstruction
)ogether with your medical team& you will decide what 'ind of surgery to undergo.
7mportant factors to ta'e into account include your indi(idual diagnosis and prognosis& as
well as your personal preferences and concerns. #s always& at the $reast %enter you will
ha(e the guidance and expert ad(ice of your physician& our nurse care coordinator and
other members of your medical team.
!earn more a"out:
/ur )eam of Experts
/ur ,taff
3/%,
)reatment
-artial mastectomy
-artial mastectomy is the most common form of breast cancer surgery. 9our surgeon will
remo(e only the part of your breast containing the tumor and some of the normal tissue
that surrounds it.
#ll of the remo(ed tissue will be carefully examined by our pathologists to (erify that the
margins the normal tissue surrounding the tumor" are cancer-free. #lthough you will
ha(e already discussed your treatment plan with your doctor& the course of treatment may
change depending on the results of your surgery.
#ny form of surgery that remo(es only part of the breast is considered Dbreast-
conser(ingD or Dbreast preser(ationD surgery. 9ou may hear your surgeon use any one of
se(eral names to describe your procedure: biopsy& lumpectomy or partial mastectomy.
)echnically& a lumpectomy is a partial mastectomy& because part of the breast is remo(ed.
8owe(er& the amount of tissue remo(ed can (ary greatly. ?iscuss with your surgeon the
plans for your surgery and reconstruction& so that you ha(e a clear understanding of all
your options.
What can / e1pect#
0. #fter the anesthesia ta'es effect and you are fully unconscious& an incision is
made into the breast. -art of the breast tissue that surrounded the tumor is
remo(ed from the o(erlying s'in and the underlying muscle.
1. /ne or two small plastic drains are usually left in place to pre(ent fluid from
collecting in the space where the breast tissue used to be.
2. 9our surgeon will usually decide to remo(e these drains when the amount of fluid
drainage decreases to an acceptable (olume. )his may ta'e from a few days to
more than a wee' . 3any women go home with their drains and ha(e them
remo(ed during a subse!uent office (isit.
Ho' should / prepare#
9our breast surgeon and nurse care coordinator will gi(e you specific instructions about
preparing for surgery. )hese will li'ely include
guidelines on eating and drin'ing
tips to !uit smo'ing
instructions to ta'e or a(oid certain (itamins and medications for a period of time
before your surgery
9ou should arrange for someone to dri(e you home after your surgery and to help you for
a few days.
+astectomy
3astectomy is the surgical remo(al of the entire breast& usually to treat serious breast
disease.
)he most common reason for performing a mastectomy is breast cancer. 3astectomy is
an alternati(e to breast conser(ation surgery.
?eciding which type of surgery is best for you is complex and in(ol(es many factors..
+hen you are diagnosed& you and your medical team will discuss your medical
circumstances& personal needs and preferences. 7mportant issues you and your team will
consider include: the si*e of the tumor in relation to the si*e of your breast& whether there
is more than one tumor in your breast and the side effects of radiation therapy.
)here are four general types of mastectomy:
Su"cutaneous mastectomy -- the entire breast is remo(ed but the nipple and
areola the pigmented circle around the nipple" remain in place
Total ,or simple. mastectomy -- remo(al of the whole breast& but not the lymph
nodes under the arm axillary nodes".
+odified radical mastectomy -- remo(al of the whole breast and most of the
lymph nodes under the arm axillary dissection"
Radical mastectomy -- remo(al of the chest wall muscles pectorals" in addition
to the breast and axillary lymph nodes. >or many years& this operation was
considered the standard for women with breast cancer& but it is rarely used today.
What can / e1pect#
0. #fter the anesthesia ta'es effect and you are fully unconscious& an incision is
made into the breast. )he breast tissue is remo(ed from the o(erlying s'in and the
underlying muscle.
1. /ne or two small plastic drains are usually left in place to pre(ent fluid from
collecting in the space where the breast tissue used to be.
2. 9our surgeon will usually decide to remo(e these drains when the amount of fluid
drainage decreases to an acceptable (olume. )his may ta'e from a few days to
more than a wee' . 3any women go home with their drains and ha(e them
remo(ed during a subse!uent office (isit.
Ho' should / prepare#
9our breast surgeon and nurse care coordinator will gi(e you specific instructions about
preparing for surgery. )hese will li'ely include
guidelines on eating and drin'ing
tips to !uit smo'ing
instructions to ta'e or a(oid certain (itamins and medications for a period of time
before your surgery
9ou should arrange for someone to dri(e you home after your surgery and to help you out
for a few days.
What can / e1pect after'ards#
3astectomy is (ery safe surgery& and most patients reco(er well with no complications.
#s with any surgery& howe(er& there are ris's. %omplications are possible& but please
'eep in mind that they are (ery unli'ely. 9ou should discuss e(ery aspect of the surgery
and its aftermath with your doctors and nurse care coordinator. )he more information that
you ha(e before the surgery& the more comfortable you will feel.
Iearn more about:
$reast 6econstruction
Breast Reconstruction
$reast reconstruction is a surgical procedure that restores the appearance of a breast for
women who ha(e had their breast remo(ed due to tumors and/or cancer. )he surgery
rebuilds the si*e and shape of the breast& and& if you desire& the nipple and areola the
dar'er area surrounding the nipple".
9ou may want to 'now the following about breast reconstruction:
$reast reconstruction is performed by a plastic surgeon
$reast reconstruction can help restore your appearance. )he techni!ues for
achie(ing excellent post-surgery appearance ha(e greatly impro(ed o(er the last
few years.
)he goal of reconstruction is to restore symmetry of the breasts when a woman is
dressed. )he difference between the reconstructed breast and the unaffected breast
will still be seen when the woman is nude
6econstruction will not restore normal sensation
?eciding whether to ha(e breast reconstruction is a matter of personal choice. 7f you
decide to ha(e breast reconstruction& you and your doctors will e(aluate the best timing to
do so. $reast reconstruction can ta'e place during the mastectomy operation immediate
reconstruction&" or at a later date& after other necessary treatments are gi(en delayed
reconstruction."
Each case is different& and you should discuss all of your options carefully with your
doctor& the nurse care coordinator and other trusted ad(isors on your medical team. /nce
you ha(e all the information& you will feel prepared to ma'e the best decision.
Radiation
6adiation therapy minimi*es damage to healthy cells while using high le(els of radiation
to
'ill cancer cells
slow the growth of cancer cells
Ho' does it 'or#
6adioacti(e beams of energy tra(el directly to the site of your tumor& targeting the
unhealthy cancerous cells and destroying them. )his is accomplished without damaging
the healthy cells surrounding your tumor.
When is radiation therapy necessary#
6adiation therapy is usually gi(en after breast surgery and sometimes after a mastectomy
to reduce the ris' of cancer recurrence. 9our doctor may also recommend a course of
radiation therapy before surgery to shrin' the tumor so that it can be remo(ed more
easily.