Breast Imaging

When should I have a screening mammogram?
We at Hemet Valley Imaging, along with the American Cancer Society and the American College of Radiology, recommend annual screening mammography starting at age 40. If you are high risk for breast cancer (if your mother or sister had breast cancer before the age of 50), then we recommend beginning screening 10 years before the age at which your mother or sister was diagnosed. For instance, if mom found out she had breast cancer at age 45, we would recommend starting screening at age 35.

How is it performed?
A screening mammogram consists of two views of each breast. In order to see through the breast tissues, it must be compressed. Our female technologists are very experienced in positioning the breast as gently as possible, and the compression lasts only seconds while the mammogram is obtained and then the compression is released. It takes an average of about 15-20 minutes to take the four views. The technologist will then check the films to make sure they are of good quality. After that you are free to leave.

How is my mammogram read and who reads it?
When the technologist has finished your exam, the mammograms are automatically sent through a computer-assisted detection system or CAD. This system is a second look for the radiologist that provides additional analysis of the images.  The radiologist then interprets the digital images.

Our radiologists are specialists in Breast Imaging who read a large volume of mammograms and perform breast interventional procedures.  We do not read your screening mammogram while you are there. This is because we know that the best way to detect breast cancer is to read screening mammograms at a quiet time, with no interruptions when we are fresh and maximally alert. We read these studies in batches with the aid of the CAD software. Because of this, we have the best chance of finding a cancer if there is one there.

What is Computer Aided Detection (CAD)?
Computer Aided Detection (CAD) is a sophisticated computer program that marks potential areas of concern on the mammogram. CAD has been shown to improve radiologists’ accuracy when reading mammograms. All mammograms at our center are read using CAD technology.

How does CAD work?
CAD is a tool for the radiologist to use as he/she reads your mammogram. Like a spell-check tool in a word processing program, CAD points out areas on a mammogram that may indicate a pathological process. It’s up to the doctor to decide if the area is truly of concern and needs additional attention, or not.

CAD does have some limitations:

  • CAD cannot say what is or is not a cancer, (only a biopsy can do that) but it does mark areas that may potentially be cancer.
  • The CAD device cannot detect all visible cancers.
  • The CAD places an average of 2 marks per mammogram. The majority of these marks are not cancer; for example, out of 16,000 marks, only 110 resulted in cancer. It is up to the doctor to decide if a marked area needs additional follow-up.
  • In order for the CAD to mark a cancer, the cancer must be visible on the mammogram. A very small percentage of cancers are not visible on the mammogram; CAD cannot help in these cases, so it is still important to do self-breast exams and see your doctor regularly for a routine breast exam:- if you feel a lump and it is getting larger, even if you were told the mammogram is normal, you need to call your doctor.

How much radiation is involved?
Mammography uses radiation to form images of the breast. The dose is extremely low, much lower than any other X-ray exam or CT scan. The amount of radiation from a mammogram is comparable to the amount you would receive on a cross-country flight.

What should I wear?
You will be asked to undress from the waist up for the exam. We provide robes to cover up. Any comfortable clothing is appropriate.

What preparation is needed?
We ask that you do not apply deodorant the morning of your mammogram, or that you wash this off thoroughly prior to your appointment. The flecks of deodorant can show up on the films and be confused for abnormalities.

How long will it take?
The exam should take less than 20 minutes.

What is a Call-Back?
In about 10% of cases, a question arises as a result of the screening mammogram. This does not mean that you have breast cancer. Most of these turn out to be entirely normal. But whenever there is a question, we will “Call Back” the patient for more views, and possibly an ultrasound. If this happens we will call you to arrange an appointment. We also send a letter to your home so that we will be sure to contact you.

When will I get results?
We read screening mammograms within 24 hours of your appointment. We send a letter to your home and to your doctor as soon as possible, always within three days of your appointment. If there is any finding on the images, we will call you immediately in addition to sending you a letter.

What if I have had mammograms at another facility in the past?

We would very much like to see your old films to compare with your current mammogram at Hemet Valley Imaging. This is very helpful in showing the pattern of breast tissue has not changed over time. It would be best if this can be arranged before your appointment so that you can bring the old films in yourself, but we would be happy to facilitate the process at the time of your exam.

Diagnostic Mammogram

How is a Diagnostic Mammogram different from Screening?
Diagnostic mammograms are specialized mammograms to solve a particular problem. The radiologist interprets each exam in order to answer the particular question at hand.

Reasons to have a diagnostic mammogram:

  • Question arising from a screening mammogram
  • Breast symptom such as a lump, focal breast pain or nipple discharge
  • Follow-up exams
  • Personal history of breast cancer

In addition to the four views obtained in a screening mammogram, there are many specialized views that are possible to further investigate a finding. The most common view is called a “spot compression magnification” view. This is a magnified view of a particular area of the breast. The radiologist may also want to do an ultrasound.

Breast Ultrasound
Ultrasound uses sound waves to generate a picture of the breast tissue. No compression is necessary. Ultrasound is particularly useful in telling cysts from solid masses in the breast. Cysts are very common and totally benign; about half of all women have some cysts in their breasts at some point. Ultrasound is also very helpful in characterizing masses and lumps.

What happens if they find something in my breast?
Sometimes we do find a lesion that requires a biopsy to find out what it is. Fortunately, the vast majority of breast biopsies can be accurately performed with a needle and do not require surgery. Depending on the finding, a needle biopsy is performed, using stereotactic (mammogram), or ultrasound guidance.

Breast Biopsy

How is a Breast Biopsy done?
Stereotactic-Guided Breast Biopsy –
The stereotactic table is specially designed so that you can lie face-down with one breast positioned through a hole in the table. Two digital x-ray images are taken from different angles, allowing the radiologist to precisely localize the area to biopsied. Once the area has been located, the radiologist numbs the area with a local anesthetic, and then uses computer guidance for precise needle placement and collection of small tissue samples.

Ultrasound-Guided Breast Biopsy – The radiologist uses ultrasound to locate the area for biopsy and to direct the needle used in collecting breast tissue samples.

Both methods are as accurate as a surgical biopsy and are performed on an outpatient basis, taking less than 40 minutes to perform and requiring no stitches. Furthermore, the patient can resume normal, non-strenuous activities immediately after the procedure is done. The samples are sent to the pathology lab for analysis. Results are usually available within 48-72 hours.