A diagnostic mammogram is used when there is a breast complaint or symptom, or when an abnormality has been discovered on a routine screening mammogram. Once someone has been diagnosed and treated for breast cancer, they may also be told to have a diagnostic mammogram annually for the first five years after their diagnosis. A diagnostic mammogram is a series of pictures used to evaluate the area of concern. This may involve pictures with special paddles or magnification to better examine the tissue. It may also require the additional step of performing an ultrasound for a complete evaluation. The radiologist will speak to you directly about the findings and recommendations. A biopsy may be required if there is something still of concern.
An ultrasound is a painless test where you will be comfortably lying on your back, and the technician in will rub a handheld probe covered in gel over your breast. Biopsies frequently can be done under the guidance of breast ultrasound.
Screening breast ultrasound can be a useful backup tool in evaluating dense breast tissue. Dense breast tissue can result in poorer detection of cancers by mammography. In addition, it is now believed that dense breast tissue slightly increases a woman's risk for developing breast cancer. For these reasons, additional imaging studies, such as ultrasound or MRI, may be indicated depending on your particular risk factors. In this case, all areas of both breasts will be evaluated with the sound wave probe. It is important to remember that there are pros and cons of this additional screening test. While ultrasound may detect cancers not found on mammography, it is possible that additional findings may require additional imaging follow-up or biopsy.
MRI (Magnetic Resonance Imaging)
Appropriate patients for high-risk screening by breast MRI include:
- Known BRCA mutation carriers or people with a first-degree family history of a BRCA 1-2 gene mutation.
- Strong family history (lifetime risk of >20-25 percent by BRCAPRO or similar risk assessment model).
- Prior chest wall radiation given between the ages of 10 to 30 years.