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Screening Mammograms vs Diagnostic Mammograms

A mammogram uses x-rays to examine the interior structure of the breast. Mammograms can be performed either as screening procedures or as diagnostic procedures. A screening test is a test given to an asymptomatic, apparently healthy person. A screening test is intended to identify those few individuals in the general population who might have a disease or condition. A diagnostic test is a test given to an individual exhibiting signs or symptoms in an effort to figure out the cause of the symptoms.

At Knoxville Comprehensive Breast Center we offer both screening mammograms and diagnostic mammograms. It is our mission to save lives from the disease of breast cancer, and that means being of service to our patients through every stage of the treatment process. While we strive to prevent breast cancer, we also work with patients to diagnose and treat breast cancer before it reaches advanced stages. Contact Knoxville Comprehensive Breast Center today to schedule your appointment.


Breast cancer has no symptoms at all until it is quite advanced, and therefore trying to identify women with breast cancer on the basis of symptoms is a somewhat futile endeavor. However, mammograms can identify signs within the breast that are suggestive of the presence of breast cancer in asymptomatic women.

If a woman decides to participate in mammogram screening, she will be x-rayed periodically. The films will be examined by an expert radiologist looking for any signs or symptoms suggestive of breast cancer. Every diagnostic test has to be interpreted as either positive or negative. The cut-off level at which the test is declared to be positive is called a “threshold.” Thresholds can vary depending on circumstances. Because the goal of screening is to identify all cases of possible breast cancer, radiologists have set their threshold for recalling women at a low level.


The same logical thinking and principles are applied to screening tests. The goal of a screening test is to catch any and all possible cases of cancer, so the threshold of declaring a screening test “positive” is very low indeed. In fact, it’s so low that around one-third of women participating in a screening program will have a “positive” finding at some point. Many women become very distressed because they think a “positive” finding on a screening mammogram means they have been diagnosed with cancer. No, they have had a positive finding on a screening test.

Diagnostic Test

A woman who has a positive finding on a screening mammogram is almost always sent for a diagnostic mammogram. The procedure is much the same – the breast is x-rayed. However, the interpretation of the films is different for a diagnostic mammogram. Instead of looking for any sign suggestive of cancer, the film is carefully examined for signs that indicate possible other causes of the prior findings, such as cysts. The threshold for declaring a diagnostic mammogram as positive for cancer is much higher than that for a screening mammogram. Other studies such as ultrasound and biopsy are performed before deciding on an actual diagnosis. Some women found to be positive on a screening mammogram are found to be negative for cancer after a diagnostic workup.

Most Diagnosed With Breast Cancer, Don’t Have a Family History

It is estimated that 12 percent of women will be diagnosed with breast cancer in their lifetime. Family history is one of the factors that increase a woman’s chance of developing this condition. In fact, women who have a mother, sister or daughter with this condition are twice as likely to develop it. A woman with an identical twin that has breast cancer has a one in three chance of developing it herself.

Even though family history plays a role in the development of breast cancer, it is important to note that many women who have a family history of this condition never develop it. In fact, it is estimated that 85 percent of women who are diagnosed with breast cancer do not have a family history of this condition. There are several other factors that increase a woman’s chance of developing breast cancer.

At Knoxville Comprehensive Breast Center it is our mission to save lives from the disease of breast cancer. We stress the importance of prevention and early diagnosis to be able to treat the signs of breast cancer before they develop into advanced stages. Contact Knoxville Comprehensive Breast Center today to schedule your appointment. We offer mammograms, screening ultrasounds, genetic counseling and many other services for the prevention and treatment of breast cancer.

Increasing Age

Simply getting older puts a woman at risk for breast cancer. The vast majority of women that are diagnosed with breast cancer are diagnosed after they go through menopause. However, breast cancer is becoming more common in women who are under the age of 50. In fact, it is estimated that as many as 20 percent of women who develop breast cancer are under the age of 50.

Menstrual History

Studies have shown that women who have their first menstrual before the age of 12 are more likely to develop breast cancer. Women who go through menopause after the age of 55 are also at an increased risk for developing breast cancer. Researchers believe that early menstruation and late menopause increases lifetime exposure of estrogen and progesterone, which in turn increases breast cancer risk.

Lifestyle Factors

There are a number of lifestyle factors that affect a woman’s risk of developing breast cancer. For example, drinking alcohol can increase the risk of breast cancer. Women who have two to five drinks per day are 1.5 times more likely to develop breast cancer than women who do not drink at all. Women who have children later in life or do not have any children at all are also at an increased risk for developing breast cancer.

Exercise can help decrease the risk of breast cancer. In fact, exercising just 1.25 to 2.5 hours per week can decrease the risk of breast cancer by 18 percent. Walking 10 hours per week can decrease of breast cancer the risk even further.

How Can Breast Cancer Genetic Counseling Help Me?

According to the American Cancer Society, between 2013 and 2014, more than 300,000 cases of breast cancer were reported, with more than 39,000 of these cases ending in fatalities. These statistics, along with multiple campaigns to increase breast cancer awareness, have led to increased vigilance on the part of men and women who might be at risk for breast cancer. Those who have a family history of breast cancer have seen the benefits of receiving cancer genetic risk assessment and counseling.

At Knoxville Comprehensive Breast Center we offer high risk assessments and genetic counseling to help patients determine if they are more likely to be diagnosed with breast cancer. It is our mission to save lives from the disease of breast cancer, and we use prevention and early detection practices to help our patients into treatment and recovery. If you’re interested in a high-risk screening, contact Knoxville Comprehensive Breast Center to schedule your consultation. Our medical staff will walk you through the process and answer any questions you may have.

What Is Breast Cancer Genetic Risk Assessment and Counseling?

Genetic counseling is the process of helping people understand the role that family history and genetics play in the transmission of cancer. The goal is to encourage people who have a family history of cancer to take proactive steps and to receive genetic testing. They can then understand risk management, adopt family-planning techniques, and receive support in response to their family history of breast cancer.

Who Would Be a Good Candidate for Breast Cancer Risk Assessment?

Individuals who have a personal or family history that suggest hereditary breast cancer are good candidates for breast cancer risk assessment. Studies have shown that across the United States approximately 5 to 10 percent of women have a first-degree relative or second-degree relative who has battled breast cancer. Risk of breast cancer increases based on the number of relatives a woman has who have already had breast cancer.

Other features that suggest hereditary cancer include unusual presentation of cancer. This means that a family member has a form of cancer that is not usually associated with someone of their age or gender. For example, male breast cancer. Additionally, rare cancers that are linked to birth defects, such as Wilms tumor, is a sign of hereditary cancer being present in a family.

What Are the Benefits of Genetic Breast Cancer Risk Assessment?

Genetic breast cancer risk assessment provides an individual with the education and the counseling that they need to make good decisions before they are even diagnosed with cancer. They are informed about their higher level of risk, and they are given things that they can do in order to minimize their risk of developing breast cancer. Additionally, genetic education and counseling give an individual who has a hereditary disposition towards breast cancer time to consider in advance any medical uncertainties, medical diagnosis, or medical treatments that may arise in the future.

The end goal of genetic breast cancer risk assessment is to allow an individual time to think, plan ahead, and prepare a course of action that is right for them based on the hereditary risk that they face for developing breast cancer.

What to Expect During Breast Cancer Biopsy

After coming in for your mammogram, women who have abnormal results sometimes require a biopsy. A breast biopsy is a procedure that involves removing a small amount of breast tissue for testing. It is used to determine the presence of breast cancer.

At Knoxville Comprehensive Breast Center we know how scary it can be to get results that are anything but normal. Finding out that further tests are needed can be a mentally taxing. Our medical staff is here to make sure that we are available to you every step of the way. Patient comfort is our top priority in our mission to save lives from the disease of breast cancer. If you’re ready to schedule your appointment, contact Knoxville Comprehensive Breast Center. We’re here to guide you through to your recovery.

Fine-needle aspiration biopsy is the simplest procedure and may be used to examine a lump felt during a clinical breast exam. A fine needle, thinner than the type of needle used to draw a blood sample, is inserted into the lump to collect fluid or cells. It is a quick way to tell the difference between a cyst fill of liquid and a solid mass. It is also less invasive than the other procedures. If the mass turns out to be solid, it will need further examination.

Core needle biopsy is used on a lump found through ultrasound, mammogram or breast MRI. The doctor is able to collect a tissue sample from the lump for further testing. Core needle biopsy is sometimes used in conjunction with other imaging techniques like MRI or mammography.

Stereotactic biopsy is used along with mammograms. The radiologist takes mammograms to find the exact location for the biopsy. He or she then makes an incision about 1/4 inch long in the patient’s breast and collects tissue samples with either a needle or a vacuum-powered probe.

Ultrasound-guided core needle biopsy requires the patient to lie on an ultrasound table. The doctor holds the ultrasound device against the patient’s breast to locate the mass. He or she then makes a small incision, inserts a needle into the cut, and collects the samples.

MRI-guided core needle biopsy is done on a padded scanning table. The MRI will take multiple cross-sectional pictures of the patient’s breasts that a computer will then combine into 3D pictures. The doctor will then use the pictures to determine the location of the mass and use a needle to collect a sample.

Surgical biopsy is the most invasive procedure. The doctor will surgically remove the entire breast mass. It is done in an operating room and the patient is given local anesthetic to numb the breast.

Your biopsy results will determine if any follow-up treatment is necessary. Depending on the type of biopsy performed, we will usually have your results within 24-48 hours. After any biopsy procedure, we will go over all of the necessary post-treatment care instructions with you. We will make sure you understand all of the next steps. We are always available to answer any questions and address any concerns you may have.

When to Start Getting Breast Cancer Screenings

Many women have heard about the importance of getting breast cancer screenings, but not everyone knows when to start. While breast cancer can affect anyone, there are certain women who are at higher risk than others. Knowing when to start getting your annual screenings can help in the prevention and early detection of breast cancer.

At Knoxville Comprehensive Breast Center, we offer breast cancer screenings to help in our fight to save lives from the disease of breast cancer. Our state-of-the-art medical facility offers the most innovative breast health care system in the area. Our medical staff is dedicated to helping our patients through every step as they journey toward recovery. Contact Knoxville Comprehensive Breast Center today to schedule your breast cancer screening.

Age 40 is the time to start your yearly mammogram screening. Women who are younger than 40 can benefit from clinical breast exams about every 3 years. Often, early stages of breast cancer development show no signs or symptoms. With yearly screenings, our staff can find abnormalities that you may not catch in at-home check.

If you have a family history of breast cancer, you are at a higher risk for developing it, yourself. If a first-degree relative (parent, sibling, etc.) was diagnosed with breast cancer, your screening should begin 10 years earlier than when that relative was diagnosed. For example, if your mother was diagnosed at age 45, your screenings should begin at 35. These early screenings can help determine if you are pre-disposed to developing breast cancer, and increases the chances of early detection.

If you are under age 40 and do not have a family history of breast cancer, you can still benefit from at-home breast checks. Monitor the size and shape of your breasts and note any abnormal changes. These can be early warning signs of breast cancer, and should be addressed by your doctor. Also feeling for lumps and bumps in your breasts and around your armpit can help determine if there are any changes. Also talk to your doctor if you notice any changes or feel any lumps in your breasts. He or she can recommend further screening if necessary.

Breast cancer is a deeply personal disease that can affect anyone, not just women over 40. Our medical staff is here to answer any questions you may have, as well to offer treatment options. We know that all patients are different, and we with work with each patient individually to determine the most effective treatment plan for his or her needs. Contact Knoxville Comprehensive Breast Center today to schedule your appointment.

The Truth about Mammographic Radiation and Breast Cancer

Recently, there was another national TV network series story on medical imaging and radiation. The media loves to create controversy because that is what increases viewership, sells newspapers and promotes heated conversations in the social media. No medical advocacy group wants to sue them for libel.

Let us set the record straight. Radiation is a concern to all Americans. We are exposed to cosmic radiation just by living on our planet. Did you know that the cosmic radiation dose varies depending on the level of your residence above sea level? As an example, people who live in Denver, CO are exposed to more radiation than those in Fairfax, VA in their daily lives. This is because Denver is one mile above sea level as compared to Fairfax! In parts of China, the background radiation is ten times higher than in a typical U.S. city.

Let’s talk about radiation dose. It is measured in units of Sieverts, just as length can be measured in inches, feet, millimeters, centimeters, etc. Modern day mammography results in a radiation dose of 0.4 of 1000 Sieverts. Described another way, the mammographic dose is 0.4 mSv of radiation. This dose is a little less than the extra radiation a person would receive just by living in Denver for a year.

The FAA considers 20 mSv of radiation annually safe for airline crews working on commercial airlines. That is equivalent to having 54 mammograms per year. The Nuclear Regulatory Commission considers 50 mSV per year safe for nuclear power plant workers.

It is true that a single dose of 500 mSv is associated with causing a number of cancers including breast cancer. However, this dose is similar to the exposure of Hiroshima, and is equivalent to 125,000 mammograms taken consecutively on a single visit. It’s important to keep in mind that a little dose of radiation has an even less damaging effect when it’s not delivered all at once, but only as a small amount every year. As an example, we all know that drinking a gallon of vodka could kill a person, yet a single martini would not do so.

Since the advent of modern day mammography in the 1980’s and the recommendation for yearly mammography screening beginning at age 40, the death rate of breast cancer has decreased by 30%.  Do not be afraid of undergoing a yearly screening mammogram due to concerns of radiation. The benefit of early detection of breast cancer outlays any miniscule risk of radiation causing breast cancer.

The United States Preventive Services Task Force (USPSTF) instituted under Obama Care, advocates mammography beginning at 50 and performing it only every two years. The American Cancer Society and other medical organizations still recommend yearly mammography starting at age 40 due to the results of many controlled clinical trials showing a significant decrease in the mortality rate from breast cancer. If we change mammogram schedules from yearly to biennially in order to receive the supposed benefits of curtailing costs as the USPSTF recommends, then we will ultimately see an overall increase in health costs by treating a significant number of advanced cancers. And how do you place a price on the increased death rate from breast cancer?

Do not let the concerns of radiation dose stand in your way from having your yearly mammogram starting in your 40’s. Another important point to remember – 80% of women diagnosed every year with breast cancer have no family history of breast cancer!

Importance of a Regular Mammogram

Women should have regular mammogram as a prevention and early detection tool for cancer. Even if you have no signs or symptoms of the disease, it’s best to check often and early. The earlier the disease is detected, the sooner you’ll be able to start treatment and hopefully stop the disease from advancing or spreading. Breast cancer screenings can significantly reduce the number of cancer-related deaths in women ranging from ages 40 to 74.

At Knoxville Comprehensive Breast Center, it is our mission to save lives from the disease of breast cancer. Our medical team is dedicated to the prevention and early detection of breast cancer, so we can offer treatment options in our state-of-the-art medical facility. We offer mammogram screening in our office, as we as in our mobile mammography van that is active throughout the community. Contact Knoxville Comprehensive Breast Center today to schedule your appointment.

What is a Mammogram? 

A mammogram is an x-ray picture of each breast used to detect lumps or masses that cannot be felt in a physical exam. Tiny deposits of calcium (microcalcifications) may be detected by a mammogram and could indicate a presence of cancer. Mammograms can reveal many different abnormalities associated with breast cancer including a thickening of the skin. Technicians will magnify a suspicious area, and this allows physicians to make an accurate diagnosis. If you have breast implants, it may be difficult to obtain a screening mammogram.

What are the Benefits of the Screening Mammograms? 

We recommend regular screening mammograms because there are so many benefits associated with them. The most important benefit of screening mammograms is early detection. There is so much that a person can do to remove and eliminate the spread of cancer at the early stages of the disease. The number of deaths from cancer can be reduced significantly in women over 50 with early detection screening mammograms.

There are all types of new technology available to help people detect breast cancer. From digital mammography to breast ultrasound technology, there’s a solution to fit every patient’s particular needs.

If you are unable to schedule your mammogram in our office, we offer a mobile mammography service that caters to your schedule. We bring our mobile mammography van out into the community to serve our patients where it’s convenient for them. Our mobile unit brings digital imaging mammograms to under-served areas, so that more women can benefit from early screenings.

Get Your Annual Mammogram

If you’re between 35 and 39, now is the time to schedule your first baseline mammogram. Once you obtain your baseline exam, you can continue getting an annual exam after the age of 40. It’s an excellent preventative medicine tool that has proven to be effective in the healthcare industry. Don’t forget to get your annual mammogram this year!

Provision’s first breast cancer patient completes treatment

KCBC patient is the first patient to complete breast cancer treatment at Provision’s Proton Therapy Center. Read story here.

Double Mastectomy Doesn’t Boost Survival for Most

Research published in the Journal of the American Medical Association reported by the AP suggests that “removing both breasts to treat cancer affecting only one side doesn’t boost survival chances for most women, compared with surgery that removes just the tumor.” To read this article click here

Screening Mammography in Women 75 and older

A recent study discussed the benefits for women 75 and older continuing screening mammography.  To read the article click here.

Study Confirms Mammography Reduces Late-Stage Breast Cancer.

An American College of Radiology press release announced that research confirms that screening mammography finds breast cancers at earlier stages.   Barbara Monsees, MD, chair of the American College of Radiology Breast Imaging Commission, said, “The findings confirm what breast cancer experts have long known – that widespread mammography screening has positively impacted the lives of women nationwide.”  Click here to read more.

Myriad myRisk™ Hereditary Cancer Panel is now available at the Knoxville Comprehensive Breast Center

Clinical genetic testing for assessing risk of eight inherited cancers offered by Imelda G. Margulies, MSN, FNP-BC

Knoxville, TN, April 7, 2014: Imelda G. Margulies, MSN, FNP-BC, Coordinator for the High Risk Assessment Clinic at the Knoxville Comprehensive Breast Center, has been selected one of the few cancer risk genetic counselors in the country by Myriad Genetic Laboratories, Inc. to offer patients the Myriad myRisk™ Hereditary Cancer Panel that offers more than just BRCA testing. Myriad myRisk™ Hereditary Cancer Panel represents a new paradigm for clinical genetic testing for inherited cancer risk. The previous model was based on the analysis of one or a small number of genes for individual syndromes, with the choice based on consideration of the patient’s personal and family history. The new model encompasses the simultaneous analysis of a larger number of genes combined in a panel to broadly target specific cancer sites. myRisk is a 25-gene panel for the identification of clinically significant mutations impacting inherited risks for eight important cancers: breast, colorectal, ovarian, endometrial, gastric, pancreatic, melanoma and prostate.

Imelda G. Margulies, MSN, FNP-BC, Family Nurse Practitioner, received advanced training in hereditary cancer risk assessment and cancer prevention at the City of Hope in Duarte, CA, having graduated from the Intensive Course in Cancer Risk Assessment in 2010. Mrs. Margulies is one of only two practitioners in the state of Tennessee to have graduated from the course.

myRisk offers patients a clear insight into their personalized risk of developing cancer and will provide those patients with clear direction of risk reduction based on recommendations from the National Comprehensive Cancer Network guidelines.

Imelda G. Margulies, MSN, FNP-BC, is available for consultation to see if Myriad myRisk™ Hereditary Cancer Panel is the right test for you and your family. Please call 865-583-2922 to schedule an appointment.

For more information, please contact Imelda G. Margulies at 865-583-2922.

Tennessee Breast Density Bill Effective January 1, 2014

Dr. Kamilia Kozlowski has worked for the past three years to have the bill passed that requires physicians to tell patient if they have a dense breast pattern.  Read the full story.