Frequently Asked Questions about Breast Cancer and Breast Health (place your mouse over the question and click to be taken to the response) What are the different types of breast cancer? How is breast cancer treated? What is a sentinel lymph node biopsy? Are are all breast lumps cancer? I have been told I have fibrocystic breasts.  What does this mean? Is nipple discharge a sign of breast cancer? My mammogram showed calcifications that are worrisome.  What kind of biopsy do I need? Are all calcifications found on mammograms related to breast cancer? Is it really necessary to have a mammogram every year? Are annual screening ultrasounds performed? My Doctor ordered a Diagnostic mammogram.  How is this different from a screening mammogram? How is digital mammogram different from traditional mammograms? My mother had breast cancer.  Do I need to have genetic testing? Should I have an MRI every year in addition to a mammogram? Most Common Types of Breast Cancer: DCIS: Ductal Carcinoma In Situ: Begins in duct of the breast and does not invade surrounding tissue.  This is a noninvasive breast cancer and does not spread to other locations in the body. Most common type of noninvasive breast cancer. IDC:  Invasive Ductal Carcinoma: Begins in the duct of the breast but breaks through the cell wall to invade surrounding tissue.  Has the ability to   spread to other locations in the body.  Most common type of invasive breast cancer. LCIS: Lobular Carcinoma In Situ: Begins in the lobe of the breast and does not invade surrounding tissue . Thought of as a "marker" for high risk rather than a breast cancer. ILC: Invasive Lobular Carcinoma:  Begins in the lobe of the breast but breaks throught the cell wall to invade surrounding tissue.  Has the ability to spread to other locations in the body. Breast Cancer Treatments: Lumpectomy or Breast Conservation:  Removal of the breast cancer "lump" with a surrounding margin of normal tissue. Simple or Total Mastectomy:  The entire breast and nipple is removed. Sentinel Lymph Node Biopsy:  The sentinel node is the first lymph node a breast tumor drains to.  This node is removed to determine if cancer has spread beyond the breast.  If the sentinel node has no tumor cells, an axillary dissection is NOT performed. Axillary Dissection:  This is the removal of the lymph nodes in the armpit. Chemotherapy:  Also referred to as "systemic therapy" and involves administering drugs into the bloodstream to reach and destroy cancer cells that may have spread beyond the breast. Neoadjuvant Chemotherapy:  Chemotherapy given before surgery to shrink a large tumor. Radiation Therapy:  Also referred to as "local therapy".  Beams of radiation target the breast and possibly the armpit to destroy any cancer cells that may remain in the breast.  This is to prevent local recurrence of the breast cancer. Mammosite Radiation Device:  A newer method to receive radiation which involves placing a "balloon" into the lumpectomy cavity and administering radiation from the "inside-out".  Traditional radiation involves treating the breast with external radiation beams. Hormone Therapy:  Medications taken by mouth to reduce the risk of breast cancer recurrence or the development of a new breast cancer.  Also indicated for women at high risk for breast cancer. Benign Tumors In The Breast Fibroadenoma: Benign tumors made up of normal breast tissue and common in young women.   Phyllodes Tumor: A very rare, benign tumor in the breast. In some cases this type of tumor may be malignant. Lactating Adenoma:  A benign tumor which may form during lactation (breast feeding). Lipoma:  A benign tumor made up of fat cells.   Common Breast Conditions: Nipple Discharge:  Very common BUT bloody discharge and/or profuse white wine colored discharge must be evaluated. Breast Pain:  Very common and may be cyclic (associated with your menstrual cycle) or noncyclic in nature. Fibrocystic Condition:  Not a disease but a description of normal breast tissue that may feel fibrous or bumpy. Fluid Filled Cysts:  Very common and normal in the breast.  Cysts are aspirated if they are symptomatic. Galactocyle:  A cyst which contains milk and is associated with lactation (breast feeding). Mammography:  A screening tool used to look for breast cancer.  A mammogram involves taking an Xray picture of the breast which is then converted into a digital image.  A Radiologist reads your mammogram to look for signs of breast cancer.  All women should begin annual screening mammograms at 40 years of age. Ultrasound:  Ultrasound is used as a TARGETED exam to image an area in the breast where there may be a mammogram abnormality or a palpable (felt) abnormality.  Ultrasound is NOT a screening tool. Breast MRI:  An MRI may be indicated to assist us in looking for breast cancer which may not be seen on mammogram or ultrasound. Types of Breast Biopsy's: Ultrasound needle core biopsy:  Ultrasound is used to locate and target a mass for biopsy.  This is an in-office procedure and referred to as a minimmaly invasive procedure. Stereotactic needle core biopsy:  A special mammogram table is used in tandem with specialized computer software to locate an area in the breast which is seen only on a mammogram. This too, is a minimmaly invasive procedure and performed in our office. Surgical breast biopsy:  This type of biopsy involves making a small incision in the breast and is performed in a hospital setting.  You are able to go home after this type of biopsy. What is a Diagnostic Mammogram?  If a women is not experiencing any new problem in her breast, an annual SCREENING mammogram is ordered and performed.  If a woman has found a new lump and an order is given for a mammogram, a DIAGNOSTIC mammogram would be ordered and performed.  Any time a new problem in the breast is investigated with mammogram, the study becomes DIAGNOSTIC.  If a women is having her annual screening mammogram and a new problem is found on the mammogram and additional images must be made, the mammogram becomes DIAGNOSTIC.  Because we are a breast specialty practice, most of the mammograms we perform will be diagnostic mammograms. What are mammogram calcifications?  Calcifications are a fairly common finding on mammograms. The only time calcifications must be investigated are those which are tightly clustered and of varying shape.  When a biopsy is found to be necessary, 85% of the time the calcifications will be related to fibrocystic changes and NOT represent cancer.  When calcifications do represent cancer, it is typically a very early type of breast cancer which is confined to the milk duct. This is call Ductal Carcinoma In Situ. What is the difference between a Digital mammogram and a Film mammogram?  Both types of mammograms require and XRay of the breast and compression of the breast.  With traditional mammograms, the XRay is imaged on film.  Digital mammogramy involves converting the XRay image into a digital image.  Think of the difference between a film camera and a digital camera.  With digital mammography, the images are sharper and thereby more detailed.  We are using digital mammagraphy at Advanced Breast Care. When should genetic testing be performed?  Only aproximately 10-12% of all breast cancers are related to a genetic mutation.  This genetic mutation is suspected if there are multiple blood relatives with a breast and/or ovarian cancer history, there is an early onset of breast cancer (<40 years of age), breast and ovarian cancer occur in the same individual, and if there is a family history of  being of Ashkenazi Jewish decent with a family history of breast cancer or ovarian cancer.  If we suspect a genetic mutation may be present, we send the individual for genetic counseling and testing. Who should have a breast MRI?  New guidelines for MRI screening were presented by the American Cancer Society. They recommend annual screening with MRI for women who:  1)  have a positive BRCA1 or BRCA2 gene mutation, 2)  have a family member with a positive BRCA1 or BRCA2 genetic mutation, 3)  have a lifetime risk of breast cancer which has been scored at 20-25% or higher, and 4)  have had radiation to the chest wall between the ages of 10 and 30.