By age 20, all women are encouraged to do breast self-exams on a monthly basis. Knowing what your body normally looks and feels like can you help you spot any changes.

The American Cancer Society and the American College of Radiology (ACR) recommend annual screening mammograms for women beginning at the age of 40 regardless of breast density.

Here are a few things we recommend doing before you arrive for your appointment:

• Schedule the screening when your breasts are least likely to be tender. If you still get a monthly period, this is likely the week after you finish your cycle.
• Bring any previous mammogram images if this is your first time being screened with us.
• Don’t apply deodorant or powder before your mammogram. Metallic particles from these products could show up your mammogram and create confusion.
• Take an over-the-counter pain medication about 1 hour before your mammogram to ease any possible discomfort from the exam.

3D breast tomosynthesis, also referred to as 3D mammography, is the latest, FDA-approved technology in breast imaging and allows radiologists to examine breast tissue one layer at a time. This type of imaging converts conventional two-dimensional digital images of the breast into a stack of 1 millimeter layers or “slices” to create a three-dimensional image of the breast. Breast tissue detail is then examined using the two-dimensional image as well as the three-dimensional image.

Women’s Imaging Center uses the Selenia® Dimensions® 3D digital mammography system from Hologic. This high-tech system is the first in its class to gain approval from the FDA. The Dimensions® unit features an ergonomic design to maximize patient comfort during the exam. This system offers exceptional diagnostic tools for radiologists that support confident diagnoses.

From a patient’s perspective, a 3D breast tomosynthesis exam is almost identical to a traditional digital mammogram. Just as with a traditional 2D digital mammogram, the mammography technologist positions the patient next to the imaging unit and places the breast to be imaged onto an imaging plate. The breast is then compressed while the imaging equipment captures multiple breast images. During a 3D tomosynthesis exam, the x-ray arm of the mammography machine makes an additional quick arcing movement over the breast, taking a series of images at unique angles. These images are then used to create a 3D rendering of the breast. These additional images only take an extra 4 seconds to capture, making this supplemental screening simple, easy, and painless for the patient.

Because of the enhanced clarity of the 3D breast image, tomosynthesis or 3D breast imaging can detect certain breast cancers that may not be easily detected on a 2D mammogram. In addition, using breast tomosynthesis helps radiologists distinguish benign (non-cancerous) abnormalities from malignant (cancerous) abnormalities. If an area is suspected to be abnormal, the tomosynthesis technology allows our radiologists to better see the size, shape, and location of that abnormality in order to examine that area in further detail. 3D mammograms have reduced the number of women who are called back for additional imaging and biopsies due to false positive screening mammograms.

Although there is a slight increase in radiation exposure with a 3D mammogram, it’s safely below FDA guidelines. The radiation exposure of a 3D tomosynthesis mammogram is about the same as the radiation exposure of traditional film mammography. Some of the benefits of this exam include earlier cancer detection, less call backs for additional imaging, as well as fewer biopsies and additional testing. These benefits far outweigh the risk of a slight increase in radiation exposure.

On April 1st, 2013, the California Breast Density Notification Law (SB1538) took effect requiring any facility performing screening mammography to communicate breast density information to patients who have dense breast tissue. Dense breast tissue is a normal physical attribute and the intention of the law is to give you additional information about your body so you can make informed choices. In fact, half of all women have dense breast tissue.

Breasts are made up of a mixture of fibroglandular tissue and fatty tissue.  The breast is considered to be dense if there is a greater percentage of fibroglandular tissue as compared to fatty tissue.  “Breast density” is a term used to describe the amount of fat relative to fibroglandular tissue that the radiologist sees on a mammogram.

Radiologists subjectively characterize each mammogram into four categories. These categories are listed below in order from least dense to most dense. If you fall into the heterogeneously dense tissue or extremely dense tissue categories, then you are considered to have dense breasts.  Approximately half of the population is considered to have dense breasts.

The following are the four categories of breast density:

• ALMOST ENTIRELY FATTY
• SCATTERED FIBROGLANDULAR TISSUE
• HETEROGENOUSLY DENSE TISSUE
• EXTREMELY DENSE TISSUE

Fatty tissue appears dark on the mammogram, whereas glandular tissue appears white. More white than dark areas on the mammogram equates to a “denser” breast. Tumors also appear white on a mammogram; therefore, it can be more difficult to detect these abnormalities on a dense breast.

According to the American College of Radiology (ACR) and the California Department of Public Health, the recommendation for annual screening mammography remains exactly the same for women with dense breasts as for the rest of the population. Mammography is also the only modality that can detect abnormal calcifications, which remain visible on the mammogram regardless of breast density. These calcifications are often the earliest signs of cancer.

Mammograms remain the gold standard for breast cancer screening. There is no other screening modality recommended to replace mammography. Breast ultrasound or breast MRI may be recommended for certain patients with additional risk factors such as family history. All additional examinations are done in addition to your mammogram, not in replacement of your annual mammogram.

For all categories of breast density, studies indicate that 3D Tomosynthesis is superior to 2D mammography alone.  Because of these findings, Women’s Imaging Center became the first fully accredited imaging center in Orange County to provide this supplemental screening as part of our routine screening exam.

For our Women’s Imaging Center patient population, 2D mammography combined with 3D Tomosynthesis has shown a

• 27% increase in overall cancer detection
• 40% increase in invasive cancer detection
• 15% decrease in false positive findings

If you do not have other breast cancer risk factors, rest assured that your risk remains low. Be vigilant and practice monthly breast self-exams, have an annual physical breast exam performed by a clinician, and continue getting your annual screening mammogram exam. Following these practices can aid in early breast cancer detection.

If you still have questions or concerns regarding your individual risk, you can call Women’s Imaging Center to inquire about Genetic Counseling. Women’s Imaging Center has an established relationship with certified Genetic Counselors who are licensed by the California Department of Public Health and Board certified by the American Board of Genetic Counseling.