Breast Cancer Screening and Diagnosis
At Mount Sinai, we use the latest and most accurate diagnostic technologies to manage breast health and detect breast cancer. Our tools range from 3D mammography and breast magnetic resonance imaging (MRI) to image-guided biopsies. In addition, our genetic counseling and testing services can help you assess your risk. If you are at elevated risk, we can help you develop habits to lower your risk.
Types of Breast Exams
Breast imaging is an important part of diagnosis. It allows us to see what is happening inside your breast. We use a variety of breast imaging services, including the following:
- 3D mammography is a low-dose digital mammography. It takes many pictures of the breast, allowing doctors to see even more clearly than traditional mammography. The approach is also known as digital breast tomosynthesis.
- Breast ultrasound evaluates problems found during a physical exam, screening, or mammogram. Some women routinely receive a breast ultrasound, in addition to a mammogram, for screening.
- Breast MRI produces clear, highly detailed images of breast tissue use magnets and radio waves. It does not use radiation, like an X-ray does. We often use it for particularly high-risk groups of women, in addition to mammography.
- Bone scans detect areas where abnormal bone growth may indicate tumors, fractures, or infection. We use this test when your doctor suspects that breast cancer has spread.
- Multiple-gated acquisition (MUGA) scans evaluate how well your heart pumps and moves blood around your body. We typically use this scan before chemotherapy and during the course of chemo treatment.
- Positron emissions tomography (PET/computed tomography (CT) scans take 3D images of your breast to help us see if the cancer has spread (metastasis). We use this test for women already diagnosed with breast or other cancers when we are concerned about spread.
Fine Needle Aspiration
This approach is useful when a lump in your breast is obvious to the touch and easily located. Our doctors use a thin, narrow needle to extract a tiny amount of breast tissue. Then we examine the tissue under a microscope for diagnosis.
Types of Core Needle Biopsies
To accurately diagnose a suspicious area, the medical team may perform a breast biopsy. This involves extracting a small sample of cells and examining them under a microscope. To be sure that we sample the suspicious cells, we use imaging to guide the extraction. Your medical team may have you remain awake during the biopsy under a local anesthetic. Core needle biopsies are the standard of care and best way to make a breast cancer diagnosis. They do not spread cancer. There are various types of core needle biopsies, including:
- Stereotactic breast biopsy uses mammogram images taken from different angles to guide the radiologist’s instruments.
- Ultrasound-guided breast biopsy uses ultrasound imaging to guide the radiologist's instruments.
- MRI-guided breast biopsy uses magnetic resonance imaging (MRI) to guides our extraction.
Pathology and Staging
Once we have a tissue sample of your tumor, we send it to our lab. Specialized breast pathologists analyze the tissue to diagnose the cancer and the specific sub-type of breast cancer you have. Like with other cancers, we use staging to describe your cancer’s specific characteristics. We categorize breast cancer from stage I to stage IV. Stage I is a very localized cancer while stage IV indicates it has spread to other parts of the body. Within each stage, there are different sub-types that need different treatment. We may also use a letter designation in your diagnosis to denote the size of the tumor (T), any spread to nearby lymph nodes (N), and whether the cancer has spread (metastasized) to other organs (M).
The main purpose of staging the cancer is to help guide your treatment options. The stage does not define your prognosis. Your doctor will be happy to discuss with you your treatment options and your prognosis for recovery and survival. In addition to staging information, most biopsies of invasive cancer will determine whether the tumor is being fed by estrogen, progesterone, or Her2-neu (receptor status). All of these factors are important in determining the best course of treatment for you.
Genetic Counseling
Genetic counseling can tell you if you have a gene that puts you at risk for breast cancer. If you have already been diagnosed with breast cancer, it can tell us about your risk for future breast or other cancers. When our doctors determine the best way to screen you for breast cancer, we consider your medical history as well as your family’s medical history. If your family has a history of breast or ovarian cancer, this may be considered a strong risk factor for you. To understand your genetic risks of developing cancer and to discover ways to help reduce your risk, you may choose to participate in a genetic counseling program. This program may or may not include genetic testing. You may want to discuss this option with your doctor before scheduling genetic counseling. To make an appointment, call our main number at 1-844-MD-CANCER. We offer genetic testing and counseling services at all our locations.