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WHEN SHOULD WOMEN START MAMMOGRAPHIC SCREENING

By: Kamilia Kozlowski, MD

It is amazing to me when I am speaking to women that they are surprised and unaware that 80 % of breast cancers that are diagnosed every year are in women that do NOT have a family history of breast cancer. I think the main reason is that family history is stressed so much in the media. Our statistics at KCBC support this fact as well.
So at what age should the average risk women start screening for breast cancer? There has been so much confusion with the recommendations of the U.S. Preventative Task Force under Obama Care stating that instead of starting at age 40, start at 50 and stop screening at 74. I was even surprised when the American Cancer Society changed their guidelines to recommend starting at 45 doing yearly until 54 and then every other year. Unfortunately, I am seeing physicians not recommending screening for their older patients. We diagnose women in their nineties with breast cancer.
Here is a summary of a study published by the American Journal of Roentgenology In May 2017.

Starting breast cancer screening at 50 means that up to 20% of breast cancers could be missed – offering more proof that women between the ages of 40 and 49 should be screened regularly.
Screening mammography guidelines published by the U.S. Preventive Services Task Force (USPSTF) recommend that women begin biennial screening at age 50, While the American Cancer Society (ACS) recommends annual screening starting at age 45 through age 55, with biennial screening thereafter. Both organizations do state that the decision of when to start screening is up to women and their healthcare providers to discuss.
But these guidelines are dangerous, according to a team led by Dr. Jenifer Pitman of Weill Cornell Medical College in New Your City. Pitman and colleagues conducted a study to determine how many cancers might be missed if women between the ages of 40 and 49 were not screened.
“Women in their 40s would probably be interested in knowing what might happen if they were to choose to follow one recommendation over another,” the authors wrote. We found “that during the study period (2014-2016) women in their 40s overall had 18.8% of screen-detected breast cancers – more than 60% of which were invasive… Increasing the risk of a later stage at diagnosis and thus a poorer prognosis.”

I can support whole heartedly and encourage all women from the age of 40 to have a yearly mammogram. This table is food for thought when reviewing the average risk women in the U.S. that is diagnosed with breast cancer.

Incidence of Breast Cancer
A Woman with Average Risk
(No Family History of Breast Cancer)

1 out of 64 – Forty Year Olds
1 out of 50 – Fifty Year Olds
1 out of 25 – Sixty Year Olds
1 out of 12 – Seventy Year Olds
1 out of 8 – Eighty Year Olds

Average Doubling Time of a Breast Cancer:
1 Year

80 % of women diagnosed every year have NO
Family History of Breast Cancer.
The proper time interval for screening of All
Women over 40:
1 Year

KCBC Testing Novel Freezing Technique On Early Stage Breast Cancer

The Knoxville Comprehensive Breast Center (KCBC) is the first in Tennessee – and is among just a handful of breast centers in the country – to offer an exciting new way to treat breast cancer by freezing the tumor.

This minimally invasive technique, called FROST (Freezing Instead of Resection of Small Tumors), can be done on an outpatient basis at KCBC using local anesthesia.

“There’s nothing better than seeing my patients walk out of the office happy to go home after the procedure because they know that their early stage breast cancer has been taken care of without surgery or a change in the shape of their breast,” said Kamilia Kozlowski, M.D., a clinical breast radiologist and founder of KCBC.

Freezing, also called cryoablation, has been used successfully for decades to treat several types of cancer, most commonly liver, lung and prostate. The process uses liquid nitrogen to freeze tumors and damage the adjacent blood vessels that fuel their growth. “We know that it works in other cancers,” Dr. Kozlowski says.  “That is why we are participating in this clinical trial, to prove that it works in breast cancer.”

The technology uses a probe that channels liquid nitrogen to flow within a precise area of the needle so that it creates a freeze zone. This creates what Kozlowski calls an “iceball” around the tumor that freezes and kills it.

This is a minimally invasive procedure done under local anesthesia and ultrasound guidance in the office.  The procedure can usually be done in under an hour.  Patients can resume normal activity right away.

Kozlowski says FROST offers a safe, effective option for women with early-stage breast cancer (typically with a tumor size of 1.5 cm. or smaller), especially when they are not good candidates for standard treatments (for example, if they have other medical conditions that would make surgery risky). It is also less likely to disfigure the breast because no breast tissue is removed and the aftereffects are “minimal.” Patients receive imaging every six months after the treatment as follow-up.

Currently, the standard of care for early-stage breast cancer is surgery (lumpectomy or mastectomy) followed by radiation and/or chemotherapy. A major drawback of surgery is cosmetic and functional impairment of the breast.

An important added bonus of the FROST treatment is that it may stimulate an immune response in the body that will keep it on the lookout for any stray cancer cells, even after the tumor is destroyed.

“The thinking is that once we freeze the tumor cells and the dead cells enter the blood to be eliminated, the body will perceive them as abnormal and begin creating antibodies to them,” adds Lusi Tumyan, M.D., a diagnostic radiologist and assistant clinical professor in the Department of Diagnostic Radiology at City of Hope who is also participating in this clinical trial. “So not only do you get this freezing effect, you also get this immunological effect. It’s exciting and we should be looking at that effect also.”

An initial five-year, multicenter study of cryoablation to treat early-stage breast cancer sponsored by the National Cancer Institute found it to be 92 percent effective for complete ablation of invasive breast tumors smaller than 2 centimeters and 100 percent effective for complete ablation of invasive ductal breast cancer tumors smaller than 1 centimeter.

Results from this study led to the current FROST trial, for which Dr. Kozlowski is actively recruiting patients. The FROST Clinical Study is currently enrolling women age 50 and older with core needle biopsy proven clinical stage I, T1, (≤1.5 cm.) clinically node negative (N0), unifocal, hormone receptor positive and HER2/neu-negative invasive ductal carcinoma. For more information, please go to www.clinicaltrials.gov.

“This is the future.  It offers a noninvasive treatment of breast cancer. Patients can come into our office and they go home the same day. It’s so rewarding to offer this advanced technology to our patients with early stage breast cancer, when appropriate,” said Dr. Kozlowski.

About KCBC

Since its inception in 1983, the Knoxville Comprehensive Breast Center was the first independent breast center of its kind in Tennessee.  At KCBC Dr. Kamilia Kozlowski has developed Clinical Breast Radiology, a specialty which differs from traditional radiology in that clinical breast radiologists manage both the diagnostic and clinical aspects of care. Patients are not burdened with visits to multiple specialists, as clinical breast radiologists can diagnose and direct treatment in one setting.

KCBC is a multidisciplinary practice that delivers streamlined, cost-effective care in a comfortable setting.  Specialists include clinical breast radiologists, a dedicated breast surgeon, medical oncologists, radiation oncologists, a breast pathologist, plastic and reconstructive surgeon and lymphedema specialist. Find out more by visiting http://www.knoxvillebreastcenter.com.

KCBC’s CONTINUED SUPPORT ON ULTRASOUND SCREENING IN DENSE BREAST

In last month’s newsletter, I discussed KCBC’S position on “3D Mammography” there are advantages of breast ultrasound screening over “3D Mammography” despite the current craze over this 3D technique. First, to review “3D Mammography” it is not 3D imaging as it purports in its name. It cannot radiographically image the breast in all 3 dimensions. It still is 2D Mammography but takes multiples slices radiographically in 2 dimensions.

Secondly, the European trial, “ASTOUND Study” demonstrated that standard 2D Mammography which we are all familiar with and breast ultrasound screening found more breast cancers than “3D Mammography” alone.

A study was published in August in Radiology, one of the leading, well-respected monthly radiology journals, by Dr. Soo-Yeon Kim and colleagues from South Korea. The study commenced in January 2004 and was completed in March of 2011. The study included 501 women with breast cancer identified with breast screening ultrasound. Only 15.8% * of these women had high-risk factors for breast cancer. Their results showed that women with dense breasts whose mammograms were negative were also found to have their breast cancers detected on breast ultrasound screening, and had a five-year survival rate of 100% and a recurrence-free survival rate of 98%. They concluded that these results cement breast ultrasound’s important place in the arsenal of breast cancer screening tools. This is because the breast cancers were found when they were small and as a result a significant number of the breast cancers had not spread to local lymph nodes (90.8%) in the axilla. This is key to preventing spread of disease. These results have also been shown in American based studies as well. Keep in mind that women do not succumb to a breast cancer in the breast. This happens when the breast cancer spreads beyond the breast to vital organs.  Therefore, it is important to find the breast cancer when it is small.

Additionally, 89% had a less aggressive breast conservation procedure due to the small size of the breast cancer.

It is important to screen women with mammographically dense breasts with breast ultrasound. There is no radiation exposure with breast ultrasound.  These two imaging tools find significantly more numbers of breast cancer than “3D mammography” alone. “3D Mammography” has not proven itself to find small node negative breast cancers as of this date.

*15.8% the women in this study had high-risk factors for the developing breast cancer. This means that 84.2% of women were at low risk for developing breast cancer. Just as a reminder, breast cancer screening yearly for all women beginning at 40 is important because it is such a prevalent disease and is the number 1 cause of cancer in women in the U.S.

 

IS DCIS A BREAST CANCER?

kozlowskiIn the last few years, some experts have questioned whether DCIS

(ductal carcinoma-in-situ) is a breast cancer.

DCIS means that the cells that line the milk duct have become cancerous which is where most breast cancers begin. As time passes, the entire lumen of the ducts can be filled with the cancer cells. The duct wall then becomes weakened and the DCIS can break through the duct wall and involve the supporting tissues surrounding the duct which contains blood vessels and lymphatics. Now, the breast cancer is a locally invasive breast cancer. This situation can provide the stage when these cancer cells have the opportunity to travel by these conduits to the local lymph nodes in the axilla. This is analogous to sludge within a water pipe. As the sludge begins to accumulate with time, the sludge fills the entire diameter of the pipe which increases the pressure within the pipe and the pipe bursts with water gushing out.

Some experts believe that some DCIS reverts back to normal cells. However, no one has ever proven this theory! The naysayers who state that DCIS is not a cancer feel that women are being over-treated with lumpectomies and radiation therapy or mastectomies and therefore, increase the cost of medicine. Some of the disbelievers feel at the very most we should follow the DCIS with mammography as these cancers are never destined to bother them. These claimed “medical experts” are not dedicated breast radiologists who have read and followed thousands of women with their mammographic studies and other breast imaging techniques for years to know what they espouse to be true, is in fact, true.

With the advent of modern day mammography in the late seventies, DCIS diagnosis has increased yearly from an average of 3% to an average of 20-30% of all breast cancer diagnoses. This is wonderful news for women because women do not die from the DCIS within the breast. However, we all know this can happen but only when the breast cancer becomes locally invasive breast cancer that spreads beyond the breast to the axilla at which time the cancer could spread to vital organs.

Having been a clinical breast radiologist for over 30 years, I have diagnosed many cases of DCIS. There are some women who have chosen not to have surgery at the time of their diagnosis. It may take years; however, I can attest that all of these cancers progressed to locally invasive breast cancer.

So this monthly KCBC newsletter includes an article about a study recently presented at the American Society of Breast Surgeons annual meeting that negates the naysayers of medical experts who state that DCIS can be followed with mammography as DCIS is never destined to bother them.

Kamilia Kozlowski, M.D.

Medical Director of KCBC

 

ASBrS: No, we’re not overtreating DCIS

By Kate Madden Yee, AuntMinnie.com staff writer

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April 15, 2016 — More than 50% of women diagnosed with ductal carcinoma in situ (DCIS) that is inadequately excised will develop a recurrence of the disease or invasive breast cancer within 10 years. This finding indicates that DCIS isn’t being overtreated, according to research presented at the American Society of Breast Surgeons (ASBrS) meeting in Dallas.

 

The study addresses a key question in the mammography screening debate: whether DCIS is being overdiagnosed and overtreated, Dr. Sadia Khan of the University of Southern California said at an ASBrS press conference. Some have suggested that DCIS should simply be tracked with regular mammography, but this approach could be dangerous, she said.

“DCIS mortality rates tend to be low, but recurrences may lead to more advanced breast disease and therefore more aggressive treatment later,” Khan said. “Given our results, a ‘watch-and-wait’ strategy would be harmful for many women.”

Watch the margins

Khan and colleagues included 1,919 pure DCIS cases, 720 of which were treated with tumor excision alone. Patients were classified into two groups based on the margin of disease-free tissue surrounding the excised tumor.

Women with margins smaller than 1 mm were advised to have a repeat surgical procedure; of these, 124 refused the additional surgery and were considered undertreated DCIS patients for the purpose of the study. The remaining women, 596, had cancer-free margins of at least 1 mm and were considered adequately treated.

The researchers also categorized women by severity of disease: grades I and II (low) or III (high).

Women with low-grade or high-grade DCIS and inadequate disease-free excision margins had a higher probability of recurrence at five and 10 years postdiagnosis than women who had adequate excision margins, Khan and colleagues found.

Cancer recurrence in women with DCIS
  Women with adequate margin excision (≥ 1 mm) Women with inadequate margin excision (< 1 mm)
Low-grade DCIS recurrence rate
At 5 years 8% 18%
At 10 years 13% 53%
High-grade DCIS recurrence rate
At 5 years 23% 55%
At 10 years 36% 67%

“These recurrence rates even for excision alone are too high, regardless of grade — and the rates for women with inadequate excision are worse,” Khan said. “It’s unacceptable. We need to continue with the DCIS treatment standard we have now, which is surgery that results in disease-free margins of 1 mm or more.”

The study results are important because many highly publicized DCIS studies have examined survival rates and not recurrence. But recurrence — especially of invasive disease — leads to more radical treatment than DCIS, which can have a significant negative effect on a woman’s life.

“Treatment for invasive breast cancer recurrence might include lymph node dissection, extensive radiation, or mastectomy, which could significantly lower a woman’s quality of life going forward,” Khan said in a statement released by ASBrS. “Preventing women from living with the aftermath of a subsequent treatment for invasive cancer is as important a goal as saving a life.”

 

What Is Lymphedema

lymphedema

Lymphedema is an incurable but treatable medical condition caused by injury, trauma or congenital defects in the lymphatic system.

When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, swelling results as an abnormal amount of protein-rich fluid collects in the tissues of the affected area.

Over time, lymphedema (especially if poorly treated) often results in number of complications including infections, disfigurement, pain, and disability. In fact, it may occasionally prove fatal to its sufferers. But while lymphedema cannot be cured, it can be very effectively managed, thus significantly reducing risk. 

The recognized standard of care for lymphedema is Complete Decongestive Therapy (CDT). CDT comprises four interacting elements applied in two phases (acute and ongoing): manual lymph drainage (MLD), compression therapy, lymph drainage exercises, and skin care. Each of these four elements are interdependent and imperative to the overall success of treatment however the most basic element is the application of compression to the swollen body part. 
Compression is to lymphedema what medication is to many other diseases – indispensible!  

It is estimated that two to three million Americans suffer from lymphedema, possibly more. Due to a lack of awareness, information, and education (even within the medical community), lymphedema is often misdiagnosed or undiagnosed. Delays in diagnosis or treatment can result in rapid and unchecked progression of the disease. 

Why This Legislation Is Needed

Currently, Medicare, and consequently many other policies, do not cover one of the critical components of lymphedema treatment, the medically necessary doctor-prescribed compression supplies used daily in lymphedema treatment. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition. 

Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in Medicare statute (law). The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, hence the need for this legislation. Please visit and help support:

www.lymphdematreatmentact.org

Lymphedema Treatment Products, Manufacturers we carry at KCBC:

 

BiaCare – JUZO – LympheDIVAs – Solaris 

Mammographic Screening Guidelines

The US Protective Services Task Force (USPSTF) was created in 1984 as an independent panel of experts in prevention and evidence- based medicine. The members come from the fields of primary care and protective services. The USPSTF is supported by the U.S. Department of health and human services agency. Their purpose is to evaluate scientific evidence to determine whether medical screenings, counseling, and preventative medication works for adults and children who have no symptoms.
The Obama Affordable Care Act was passed in 2009. The USPSTF was engaged to review the screening recommendations previously established for various types of cancer that were already in existence and recommend any changes.

The American Cancer Society (ACS), a grassroots nongovernmental organization was the first organization to recommend mammography screening in 1976. The ACS guidelines were modified several times as increasing evidence worldwide mounted that yearly mammography screening saves lives. This was proven by the decreasing death rates from breast cancer. In 2003, the ACS recommended yearly mammography screening for all women. Breast Cancer was no longer a death sentence due to early detection of smaller cancers. Women also had the opportunity to have conservative breast surgery rather than a mastectomy, and preserve the breast. Mastectomy results in a physical image-altering surgery. Oftentimes, knowing they have physical changes from surgical treatment, women did not seek medical treatment of any other visible changes of her breast, which is generally a sign of an advanced breast cancer. This results in a significant cost of life.
Before 2009, the USPSTF recommended mammography screening every 1-2 years beginning at 40. However, their guidelines changed after the passage of the Affordable Care Act. Now they recommend yearly screening beginning at age 45, and at 55 screen every other year until 74. They considered the anxiety of having an indeterminate screening mammogram report and a resultant call back for further evaluation, or possibly undergoing an in-office needle biopsy with benign results, a harm. To the patient the USPSTF felt that while saving a life is important, there are much fewer lives saved in this age group (40-49) than in the other age groups. Additionally, the task force concluded that there was insufficient evidence to recommend for or against screening women 75 or older.

Keep in mind:
The chances of an “at average risk” woman (a woman with no family history of breast cancer) increases as we get older

1 out of 64 forty year olds is diagnosed with breast cancer
1 out of 50 fifty year olds is diagnosed with breast cancer
1 out of 25 sixty year olds is diagnosed with breast cancer
1 out of 12 seventy year olds is diagnosed with breast cancer
1 out of 8 eighty year olds is diagnosed with breast cancer

What a lot of women and doctors do not know is that 80% of women diagnosed with breast cancer every year do not have a family history of breast cancer; 5-10% of breast cancers are genetically linked! One can also conclude that the average at risk woman is also at high risk.
When the USPSTF draft guidelines were released, there was a very important reason for women to be concerned. If the USPSTF draft recommendations were to be finalized as the new guidelines, this could give the private health insurance companies leeway to restrict or deny screening mammography reimbursement. After the new guidelines of the USPSTF were released, there was such an outcry by medical professional organizations and women, that these guidelines were not imposed. However, in the later part of 2015, after allowing time for people to voice their opinion to the task force recommends, the guidelines are likely to be implemented.

Fortunately, through the support of participating organizations such as:
National Consortium of Breast Centers
American Congress of Obstetricians and Gynecologist
American College of Radiology
American Women Unite for Breast Cancer Screening
Black Women’s Health Imperative
Bright Pink
Don’t be a Chump! Check for a Lump!
Force (Facing our Risk of Cancer Empowered)
Living beyond Breast Cancer
Men against Breast Cancer
National Association of Nurse Practioners in Women’s Health
National Hispanic Medical Association
National Patient Advocate Foundation
Prevent Cancer Foundation
Sharsheret
Society of Breast Imaging
Susan G. Komen
Tigerlily Foundation

As well as people responding resoundingly to the Change.org petition on the web.

Congress responded to include the Protecting Access to Lifesaving Screenings (PALS) Act in the omnibus spending bill to delay implementation of the USPSTF draft. The act would protect women’s access to mammograms by placing a two-year moratorium on the USPSTF draft recommendation for breast cancer screening. The USPSTF draft recommendations conflict with other key clinical organizations which would result in widespread confusion and put more than 22 million women at risk of losing insurance coverage for mammograms with cost sharing.

7 Facts About Breast Cancer Screening

Debra L. Monticciolo, MD, FACR, shares this list with patients, colleagues, family, and friends.

1.  The most lives are saved with annual mammography beginning at age 40. Women in their 40’s account for about 40 percent of the years of life lost to breast cancer.

2.  Screening saves more years of life for women who get screened every year rather than every other year.

3.  The reduction in breast cancer mortality from mammography is significant and has been proven in multiple studies involving millions of women yet it is routinely understated in the press.

4.  When presenting research results, being invited to screening is different from being screened. Not all women who are invited to screening actually go through with it. Population-based studies show that breast cancer death decreases by 25–31 percent among women invited to screening, but women who are screened will reduce their chances of dying of breast cancer by 36–48 percent.

5. Entities like the U.S. Preventive Services Task Force underestimate the benefits of mammography and overstate the risks. Radiologists are interested in saving the most lives.

6. Most false positives from mammography are resolved with only additional imaging. Less than 2 percent of women will be recommended to have minimally invasive needle biopsy as a result of screening.

7.  Over-diagnosis has been overstated. Studies that properly account for lead time and underlying incidence trends show that the over-diagnosis rate is 1–10 percent, nearly all of which is ductal carcinoma in situ (the presence of abnormal cells inside a milk duct in the breast). The risk of over-diagnosis is small and is outweighed by the mortality benefits of screening.

 

Breaking News Supporting Regular Mammograms

ACR and SBI Continue to Recommend Regular Mammography Starting at Age 40

 

Both Agree With ACS That Mammography Screening Saves Lives and That Women Ages 40+ Should Have Access to Mammograms

 
WASHINGTON, Oct. 20, 2015 /PRNewswire-USNewswire/ — As our shared goal is to save the most lives possible from breast cancer, the American College of Radiology(ACR) and Society of Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40. New American Cancer Society (ACS) breast cancer screening guidelines, and previous data used by the United States Preventive Services Task Force (USPSTF) to create their recommendations, state that starting annual mammography at age 40 saves the most lives.[pl_button type=”primary” link=”http://www.marketwatch.com/story/acr-and-sbi-continue-to-recommend-regular-mammography-starting-at-age-40-2015-10-20?mod=mw_share_facebook” target=”blank”]Read Full Article[/pl_button]

 

Making Stride against Breast Cancer – KCBC Team

KCBC was proud to be the starting line sponsor at the 2015 Making Strides Against Breast Cancer event at World’s Fair Park on October 4, 2015!

Team Photo

Continued Support Needed

Urgent Call For Action!

Recently you will recall Dr. Kozlowski publishing her thoughts on some very harmful legislation that was being proposed.  We would like to thank everyone for their efforts. Last week we at Knoxville Comprehensive Breast Center received the following e-mail from our friends at the National Consortium of Breast Centers Inc.  Please take a few moments to read the letter below and if you are so moved, by all means please sign the petition and help the cause.

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“Late Wednesday night a two year moratorium proposal was introduced in the House against the USPSTF screening mammogram recommendations!

The bill, HR 3339, was introduced by Reps. Renee Ellmers, (R-NC), Debbie Wasserman Schultz (D-FL), and Marsha Blackburn (R-TN).  It is called the Protect Access to Lifesaving Screenings (PALS) Act. We hope you all will help spread the word – we need your networks/membership to contact their members of Congress and ask them to co-

sponsor the bill. The House is in recess until September 8, so we have a little over a month to build sufficient support to improve the chances of prompt action when Congress returns.

We are asking you to act now and forward this petition to your network so we can get even more support. We also wanted to mention that several members of the Senate are also discussing sponsoring the bill, and we may have news about a Senate bill before the Senate departs for the August recess next week.

We are  are also getting some great press about our work on this initiative.  Here is a story carried in Bloomberg and it includes quotes from the sponsors, attached is the pdf of full bill for you to share.

Thank you for all you have done. It is hard to believe that all of this has happened in the three weeks since the petition was launched.  Thank you to all of you who joined our April “call to action” urging you to make a public comment in opposition to the United State Preventative Service Task Force (USPSTF) recommendations on breast screening guidelines and to share your concerns with your congressional representatives.  We also thank our 30 Washington Fly-In participants, who met with 90 congress people from 15 states over a very short period of time. Much progress has been made in a very short period of time, so finally and most importantly we must thank Hologic and the staff of Alston and Bird for their support and planning of this initiative.

 

 

 

When do I Need a Screening Breast Ultrasound?

While a mammogram is still the standard for breast cancer diagnosis, a screening breast ultrasound may be used in certain circumstances, either alone or in combination with a mammogram. Read on to learn more about when a screening breast ultrasound may be necessary and what you can expect when you undergo this procedure.

What Can I Expect During This Procedure?

An ultrasound, which you may have already experienced if you’ve ever been pregnant, is a quick and painless procedure. The technician will lubricate your skin with ultrasound gel before moving a microphone like instrument (called a transducer) on the breast tissue. The transducer emits sound waves that bounce off the tissue and produces images of the inside of the area on an attached screen. Our doctors use these images to diagnose potential breast masses and other issues. The test usually takes about 30 minutes to complete.

When Do I Need a Screening Ultrasound?

Most often, a screening breast ultrasound is ordered after abnormal findings are detected on a mammogram. This imaging test can help distinguish cysts or fatty deposits that are benign from masses that may need biopsy (an invasive procedure) in order to determine whether they are cancerous. In addition, while screening ultrasound may produce false positives and false negatives when used alone, it is often used in combination with a mammogram in women who have very dense breast tissue or who have silicone breast implants, as well as for those who are considered at high risk for developing breast cancer.

If you already have a cyst, you may need regular ultrasounds to ensure that it doesn’t grow or spread. If you’re experiencing strange symptoms in your breast, such as swelling or redness, your doctor may order an ultrasound to diagnose the cause. This modality is also sometimes used in combination with other procedures; for example, to guide the needle into a mass if you’re having a biopsy done.

When Do I Need Breast Cancer Screening?

Most experts recommend that women begin to have yearly mammograms starting at age 40. If you are at high risk for breast cancer, however, you may need to begin screening sooner. Our doctors can consult with you to recommend the frequency of screening as well as the type of screening test that works best for you. In addition to mammogram and ultrasound, doctors sometimes request a breast MRI.

Schedule Your Consultation

At Knoxville Comprehensive Breast Center, it is our mission to save lives from the disease of breast cancer. As such, we offer a number of different services for prevention, early detection, and treatment of breast cancer. Our medical team will work with you to determine the most effective treatment plan for you and your needs. Contact Knoxville Comprehensive Breast Center today to schedule your consultation and we can answer any questions you may have.

What to Expect during Your First Mammogram

Experts recommend that most women begin receiving annual screening mammograms for breast cancer at the age of 40, or earlier for those at high risk for developing the disease. If you’ve never had a mammogram before, you may feel apprehensive about undergoing this procedure. Read on to learn more about what to expect.

What Is a Mammogram?

Simply put, a mammogram is an X-ray image of the breast tissue. It’s used to identify potential areas of concern, such as lumps or abnormal tissue. If a cyst or other mass is identified during the mammogram, your doctor will order follow up tests to determine whether the mass is cancerous.
What Is Involved in a Mammogram?

For this procedure, your breast will be compressed between two surfaces so that the breast tissue is spread out and evenly distributed. During the compression, the technician will take X-ray images of the breast. A thinner layer of breast tissue allows for more clarity in the images. These pictures are then examined by one of our doctors, who will identify any abnormalities and recommend a further course of action if necessary. The test tends to last about 15 or 30 minutes and is done on an outpatient basis, without anesthesia.

Although the compression may cause some discomfort, technicians try to minimize this as much as possible. If you are in pain, let her know so that she can try to reposition you to alleviate the discomfort. The actual compression lasts about 10 to 15 seconds on each breast. You may want to take ibuprofen or another pain reliever prior to your mammogram appointment. Also, try to schedule your test for just after your period, when your breasts tend to be less sensitive.

How Should I Prepare for This Test?

Do not wear any deodorant, lotions, powders, or creams on or around your chest the day of your mammogram. These substances can interfere with the imaging. You should also let the technician know if there’s a chance you may be pregnant. Plan to wear a two-piece outfit, since you’ll have to remove all clothing above the waist during the test.

Are There Risks to This Procedure?

Though you will be exposed to radiation during a mammogram, it’s a very small amount. The benefits of this procedure far outweigh the risks. While a mammogram can be slightly uncomfortable, it is an important part of early detection of breast cancer. This disease is much more treatable when found early.

Schedule Your Appointment

If it’s time for your first mammogram, our team at Knoxville Comprehensive Breast Centerwill work with you to ensure you are comfortable throughout the process. During your consultation, we’ll review the entire process with you and make sure you are prepared for your mammogram. Contact Knoxville Comprehensive Breast Center today to schedule your consultation.

Feel Like Yourself Again with Virage Breast Forms!

It’s important for every woman to feel comfortable in her own skin. If you have had a mastectomy, lumpectomy, reconstruction or Poland Syndrome, you deserve to feel at peace with your body. Virage Breast Forms are custom-fitted and lightweight, which will allow you to return to the everyday activities you love and will help you feel like yourself again – confident and comfortable. Virage Breast Forms are custom-fitted, lightweight breast forms that allow you to return to the everyday activities you love. They are custom-made and personalized to ensure a perfect fit despite healing patterns and surgical depth. We support you and all breast cancer survivors by providing the support and products you need to adapt to life after cancer. Virage Breast Forms give you peace of mind after your recovery and help you get back to your normal self and routines effortlessly.

VirageBreastForms_ProductShotGrayV4The Technology

When it comes to the technology involved in creating breast forms that are meant to restore your self-confidence, we have implemented the safest and most advanced measures to ensure comfort and good fit. Virage Breast Forms creates the most life-like custom breast prostheses in the world by harnessing state-of-the-art laser scanning and 3-D CAD/CAM technology with our patented handcrafted processes. The chest wall contour is captured through laser scanning so the breast form fits like a puzzle piece and hugs the chest wall. It is our opinion that breast cancer survivors deserve the best, most life-like breast prostheses created with unparalleled technology. Our purpose is to use this technology to help women who have gone through a mastectomy or related procedure and help them transition back to their normal body and routine.

VirageBreastForms_ProductShotPinkV2Custom Breast Forms

Virage Breast Forms custom products include complete and partial breast prostheses in various styles and colors individually handcrafted giving each woman a natural, custom fit. The back of the breast form wicks away moisture and lifts it above the skin, creating a mold free environment. With different colors and sizes to choose from, you have the ability to help create the right breast form for yourself. Your custom breast form will feel and look natural, allowing you to return to your daily activities without pause. Whether you’ve undergone a mastectomy or lumpectomy, our mission is to provide you with high quality breast prostheses that allow you to live life to the fullest.

Available for purchase in the complementary boutique located in the lobby of the Breast Center

Know Your Odds with a Breast Cancer Risk Assessment

Breast cancer is a disease that affects many people – both men and women – in the United States. It is estimated that about 12 percent of women in the United States – or 1 in 8 – will develop invasive breast cancer over the course of her life. Second only to skin cancer, breast cancer is one of the most commonly diagnosed cancers among American women. At Knoxville Comprehensive Breast Center, it is our mission to save lives from the disease of breast cancer. For many, that can start with at our High Risk Assessment Clinic.

Getting your breast cancer risk assessment with us is a great step for the future of your health. We employ some of the best doctors and surgeons in the medical field, and our breast cancer risk assessment considers all factors to give you the best prognosis for your future health.

What Are the Risk Factors for Breast Cancer?

There are several risk factors that our medical team looks for when assessing a patient for breast cancer. First, our doctors will look at your family history. The truth is that women who have breast cancer in the family have a higher likelihood of contracting the disease. In addition, those women who are most at risk may have breast cancer within one generation. In other words, their mothers or sisters might have the disease, and this will put them at greater risk.

There are other factors at play here as well. For example, overall health will be assessed. Women who might be at risk are always encouraged to take care of their health by eating well, exercising on a regular basis and avoiding excess alcohol and smoking.

Get Your Breast Cancer Risk Assessment at KCBC

KCBC is one of few facilities in the country that offers the Myriad myRisk™ Hereditary Cancer panel. This panel is comprised of 25 genes and analyzes elevated risk for eight important cancers. It also identifies up to 50 percent more mutation carriers than the panels developed for hereditary uterine and colorectal cancers.

Schedule Your Consultation

If breast cancer runs in your family, contact Knoxville Comprehensive Breast Center to schedule your high risk assessment. We’ll work with you to determine your risk factors for breast cancer. Our calm, spa-like facility provides a safe and comfortable atmosphere for all of our patients. Together we can take preventative measures to keep you safe from breast cancer.

What to Expect During a Breast MRI

A breast MRI, or magnetic resonance imaging, takes pictures of the breast with radio waves and a magnetic field. It does not use X-rays, and it can catch problems within the breast that mammograms, CT scans and ultrasound cannot.

A breast MRI typically takes 45-60 minutes, but the patient should plan on spending 1 1/2 hours on the procedure and associated preparations. Several dozen pictures will be taken during the breast MRI.

Beforehand, the patient will be asked to remove any personal items like watches, jewelry, and money. Hearing aids, piercings and credit cards with magnetic strips especially must also be removed, as the MRI will damage them. A hospital gown will be provided for the patient to change into.

During the breast MRI, patients typically lie on their stomachs on a table that is part of the scanner. The technician may use straps to keep the patient’s body in the desired position. They may also put a device called a coil over the breast area. The patient will then be slid into the part of the machine containing the magnet.

Once inside the scanner, the patient will hear the sounds of a fan plus thumping or tapping noises as the pictures are taken. Earplugs or headphones may be provided to help cope with the noise. The patient must stay completely still during the scans, or repeat scans may have to be taken. The patient may be alone in the scanner room, but the technologist will be watching from a window, communicating through a speaker.

Does a Breast MRI Hurt?

The MRI itself does not hurt, although lying on a hard table in one position may get uncomfortable. Claustrophobic patients may have the option of a sedative to help them relax. Patients with metal fillings may feel a tingling sensation in their mouth, and others may feel their breasts heat up. This is normal, and any discomfort experienced with these sensations is temporary.

A patient undergoing a breast MRI should discuss the following symptoms during their appointment:

  • Breathing problems
  • Nausea
  • Headache
  • Itchiness
  • Dizziness
  • Pain
  • Burning sensation

Other things to bring to the attention of the technician prior to the breast MRI are:

  • Pacemakers or other medical devices containing iron
    Metal fragments in the eyes
  • Gadolinium may cause serious problems in people with kidney failure.
  • Extreme obesity. A very large patient simply won’t be able to fit in the machine.
  • Metal anywhere will interfere with the scanners.

After the MRI, the patient will be able to return to normal activities. The period of getting the results will be discussed prior to the breast MRI. Contact Knoxville Comprehensive Breast Center today to talk to one of our breast cancer specialists or schedule your breast MRI. We offer services dedicated to screening, diagnosing and treating breast cancer, and your comfort is our top priority.