Mammogram

If you are found to be at high risk for developing breast cancer, it does not mean that you have breast cancer, or that you will develop it in the future. It means that your risk is higher than that of the general population and you should investigate ways to reduce and manage your risk and intensify your screening so that if cancer develops it can be caught at the earliest possible time. A consultation at the Riverside’s High Risk Breast Clinic will provide you information to understand your risk as well as ways you may detect breast cancer at an earlier stage, when it is easier to treat.

While not all risk factors can be modified, you can empower yourself and make sure your breast cancer risk is as low as possible by choosing the healthiest lifestyle options, including:

• Avoiding tobacco products
• Remaining at a healthy weight- especially avoiding postmenopausal weight gain
• Eating a healthy diet
• Being physically active
• Limiting alcohol use
• Getting regular health screenings, including mammograms, preferably 3D
• Considering the risks vs. benefits of hormone replacement therapy and discussing them with your doctor
• Discussing with your provider risk reducing strategies if you are considered high risk

Your investment in answering questions around your breast imaging and health history is of immense value to you, and each year after you will only need to update if anything has changed.

You will be asked several questions around your medical history, prior breast procedure history and your family history. If a family member has a history of certain cancers you will provide which family member this is to you (sister, mother, grandmother, aunt, father, grandfather, uncle). Knowing the age the family member was at time of their diagnosis will also be helpful information to have available.

Wear a blouse, sweater or two-piece outfit when you come for your mammogram. You will need to remove clothing from the waist up.

Do not use deodorant, powder, perfume, ointment, or cream on your breasts or underarms. This can leave residue that interferes with the test results.

For some women, caffeine causes breast tenderness. One to two weeks before your exam, cut back or stop consuming products with caffeine (for example, coffee, tea, chocolate, cola).

If you have any special health needs or considerations, please feel free to call and notify the appropriate Diagnostic & Imaging Center.

If there is any chance you may be pregnant, please inform the technologist before the exam.

Riverside uses the Tyrer-Cuzick and other models to assess your risk of breast cancer. The models ask a series of questions and from your responses a score will be provided indicating your personal risk versus that of the general population for women of the same age, race and ethnicity.

The Tyrer-Cuzick model calculates your risk of breast cancer developing within the next 10 years as well as within your lifetime.

The tool uses the following factors to determine risk:

• Age
• Age of first menstrual cycle
• BRCA gene mutation
• Childbirth history
• Family history
• Height and Weight (BMI)
• History of breast biopsies
• Specific pathology of breast biopsies (e.g. atypia and LCIS)
• History of ovarian cancer
• Menopausal status
• Use of hormonal therapy
• Breast density
• Ashkenazi inheritance

Tyrer-Cuzick results fall under one of three categories: average lifetime risk (less than 15 percent), intermediate lifetime risk (15 to 19 percent) and high lifetime risk (more than 20 percent). If the results demonstrate a lifetime risk of 20% or greater, you would benefit from a consultation at the High-Risk Breast Clinic.

Based on your personal and family history, if you are determined to be at higher risk of breast cancer, this does not mean you have breast cancer or will develop it in the future. It means your chances are higher than that of the general population.

Your mammogram results will be available for you in your MyChart. If you don’t have MyChart, sign up here. A copy of your mammogram results will be sent to your primary care provider or referring provider and a letter will also be mailed to you with your results.

Riverside is an accredited breast center through National Accreditation Program for Breast Centers (NAPBC), a quality program of the American College of Surgeons.

As an NAPBC-accredited center, Riverside Cancer Care Network is committed to maintaining levels of excellence in the delivery of comprehensive, patient-centered, multidisciplinary care resulting in high-quality care for patients with breast disease. Patients can be confident that their breast care team includes healthcare professionals from a variety of disciplines who are committed to working together to provide the best care available through their entire course of treatment. Patients receiving care at an NAPBC-accredited center can also access information on clinical trials and new treatment options, genetic counseling and patient-centered services, including psychosocial support, rehabilitation services and survivorship care.

Accreditation by the NAPBC is granted only to programs committed to providing the best possible care to patients with breast cancer. Patients receiving care at this NAPBC-accredited center have access to the following:

Comprehensive care, including a full range of state-of-the-art services

Multidisciplinary team approach to coordinate the best treatment options

Information about ongoing clinical trials and new treatment options

When at all possible, the radiologist should have the X-ray films from your previous — or at least most recent — mammograms (not just the written report) for comparison. This helps the radiologist find small changes and detect a cancer as early as possible. Because getting the X-ray films from previous mammograms can be a challenge, it is best to find a facility that you are comfortable with and plan to get your regular mammograms there each year. That way, your prior films are easily available.

An abnormal finding does not mean you have breast cancer. About 12% of women who are screened have abnormal results that require further testing, but only 4% of women with an abnormal mammogram have breast cancer.

If a concern is suspected as seen on the screening mammogram, a diagnostic mammogram will be done that will take additional views.

When you have your further imaging performed, your images are reviewed by the radiologist while you are there so that more pictures can be taken if needed to look more closely at an area of concern.

The radiologist may also order a breast ultrasound or breast MRI to get better visualization of the area if needed.

Breast MRI (magnetic resonance imaging) uses radio waves, strong magnets and a computer to create detailed images of the inside of the breast.

Breast MRI is usually not recommended for women at average risk of developing breast cancer, as it is more likely to yield “false positive” test results than mammography. False positive test results may lead to additional testing and create anxiety unnecessarily.

An ultrasound may be recommended to be added as part of breast cancer screening for high-risk patients, or for those with dense or fibrocystic breasts.

It matters where you go for a mammogram. “Choosing a diagnostic facility that is accredited by the American College of Radiology (ACR) for mammography matters”, says Riverside’s fellowship trained mammographer, Benjamin Pettus, M.D.

The ACR is the leader in quality programs for breast imaging. Riverside is accredited by the ACR for screening mammography. Our ACR-accredited centers offer advanced screening and diagnostic services close to home.

The Riverside Diagnostic & Breast Imaging Center in Newport News, Williamsburg, and Gloucester are designated as a Breast Center of Excellence by the American College of Radiology (ACR) due to its accreditation in all available forms of screening and diagnosis which are used to help detect breast cancer earlier when the chance for cure is greatest. To receive this designation, a Breast Center of Excellence must meet the following criteria:

• Mammography by the ACR (or an FDA-approved state accrediting body)
• Stereotactic Breast Biopsy by the ACR
• Breast Ultrasound by the ACR (including the Ultrasound-Guided Breast Biopsy module)
• Breast MRI by the ACR or within the ACR network
• Advanced screening and diagnostic services close to home.
• Riverside’s ACR Breast Center of Excellence locations:
• Riverside Diagnostic & Breast Imaging Center Newport News
• Riverside Diagnostic Center Williamsburg
• Riverside Walter Reed Hospital

For patients that may require diagnostic imaging, Riverside’s ACR Accredited Diagnostic Centers offer contrast enhanced mammography, BSGI (breast-specific gamma imaging), and breast ultrasound.

• Riverside’s ACR Accredited locations:
• Riverside Diagnostic Center Hampton
• Riverside Shore Memorial Hospital
• Riverside Diagnostic Center Smithfield