Breast Cancer Diagnosis

Unlike the majority of radiologists who simply interpret mammograms, the all-women radiologists at the GW Comprehensive Breast Center are dedicated exclusively to breast imaging. Their dedication to the diagnosis of breast cancer, as well as their expertise, make them uniquely qualified in the Washington DC area, as well as regionally, to interpret and detect the earliest cancers. For these reasons, many women obtain their mammograms at George Washington University Hospital or contact the Center for a second opinion for evaluation of their mammogram.

Mammography

The most widely used and recognized imaging method for the detection of breast cancer is a mammogram. This low radiation x-ray often can detect abnormalities in the breast before anything can be felt. Women who are age 40 and older are strongly advised to have a yearly mammogram. GW's Comprehensive Breast Center also offers 3-D mammography, also called tomosynthesis or digital mammography, which is particularly useful for evaluating dense breast tissue. Though mammography is an effective method for detecting breast cancer, in certain situations, such as women with dense breast tissue and those at increased risk of breast cancer, additional imaging tests (ultrasound, MRI or molecular breast imaging) may be needed for complete evaluation. 

Ultrasound

Ultrasound is a technique in which sound waves are used to create an echo and the echoes are transformed into a picture that can be read on a video screen. Ultrasound can be effective in distinguishing certain abnormalities in the breast such as lumps, solid masses and cysts. Ultrasound can also detect certain characteristics such as contour, shape and size of the breast abnormality. It can also be used to guide procedures, such as biopsy or aspiration. The GW Breast Imaging Center utilizes high-resolution ultrasound in all of its studies, including Automated Breast Ultrasound (ABUS), a new approach to finding up to 30 percent more cancers in women who have dense breast tissue.

Molecular Breast Imaging (MBI)/Breast-Specific Gamma Imaging (BSGI)

With MBI or BSGI, a low-dose radioactive compound, called a tracer, is injected into a vein in much the same way that a blood test is performed. The tracer adheres to a tumor as it absorbs more of the compound than the surrounding breast tissue. A special camera then identifies whether there is evidence of an abnormal area. In this test, the tissue in the breast is evaluated in a physiologic approach (the way the tissue functions) compared to the anatomic approach (the way the tissue looks) of mammography and ultrasound. The GW Comprehensive Breast Center has a unique high-resolution nuclear medicine camera, called the Dilon 6800 gamma camera, which can be used to detect the earliest breast cancers. This may be most advantageous for women who have dense breasts, or for whom physical examination or mammography is difficult to interpret, such as those who have previously had breast surgery. The GW Comprehensive Breast Center is the only place in the region where this technology is available.

Magnetic Resonance Imaging (MRI)

An MRI measures the normal electromagnetic signals that everyone has by using magnet and radio waves. Signals are then converted into exact images of the body to detect abnormalities including cancer. MRI is used as a problem-solving tool to evaluate either a lump in the breast or something found on a mammogram. MRI is also the optimal imaging technique for detecting cancer among women who have had breast implants. The decision to use MRI should be made jointly by you, your physician and the radiologist.

MRI can be used to screen women who are at an increased risk of breast cancer and can detect additional areas of breast cancer in women who have newly diagnosed breast cancer. MRI can also be used also as a problem-solving tool if there is suspicion of an abnormality that cannot be fully evaluated by mammography and ultrasound. The staff at the GW Comprehensive Breast Center has extensive experience with breast MRI, as well as MRI guided minimally invasive breast biopsy.

The staff at the GW Comprehensive Breast Center believes that knowledge is an effective tool in optimizing a women’s experience and outcome. As a result, all women with newly diagnosed breast cancer should undergo BSGI/MBI or MRI prior to definitive breast therapy to identify all possible abnormalities in the breast.

Recommendations for Breast Cancer Screening

Rachel Brem, MD, Director of the GW Comprehensive Breast Center, recommends that women continue to have mammograms beginning at age 40, regardless of family history, to optimize their chances for early detection and treatment. Dr. Brem recommends that women follow the American Cancer Society guidelines for early cancer detection.

American Cancer Society Guidelines for Early Cancer Detection

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exam (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women age 40 and over.
• Women should know how their breasts normally feel and promptly report any breast change to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.