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Understanding
DCIS
- Causes of
DCIS
- Genetic
Testing
- Self
Advocacy
- Decisions
- Screening
- Getting a
Biopsy
- When DCIS
is Diagnosed
- Getting
a Second Opinion
- Psychological
Impact
- Understanding
Risk
- Treatment
Screening
There are two methods of breast imaging for screening: mammogram and ultrasound. Ninety percent of DCIS is found on a mammogram and is seen as microcalcifications. Mammograms are X-rays of the breast and are used to screen for breast abnormalities. There are two kinds of mammograms — screening and diagnostic. Mammograms are read by specialists called radiologists.
A screening mammogram takes two views (X-ray pictures) of each breast and is used to determine whether everything looks as it should. A magnification mammogram provides a magnified view of a small part of the breast. This type of mammogram is used to examine an area of picked up concern on the screening mammogram. Sometimes several pictures are taken from different angles. The magnified view allows a better look at the area of concern.
Digital mammography
Digital mammography records X-ray images in computer code instead
of on film. The radiologist uses computer software to view the images
and to magnify them; magnification makes it easier to spot a problem.
Digital mammography can also be sent electronically (called telemammography)
for additional consultations. Studies show that film mammography compares
equally to digital mammography.
What the radiologist looks for
The radiologist reviewing a mammogram is looking for several
things: unusual shadows, clusters of white specks (micro calcifications),
distortions, special patterns of tissue density, any mass and its shape,
and differences between the images of both breasts. The radiologist also
looks at your previous
mammograms and compares them to your most recent film(s).
Mammograms are easier to read in older women because their breast tissue has more fatty tissue than that of younger women. It's easier for an X-ray to go through fatty tissue than dense tissue. This is one of the reasons that mammogram screening is not routinely recommended in women under 40 years of age. Another reason is that women under 40 are less likely to have breast cancer.
Microcalcifications
Microcalcifications — tiny specks of calcium in the breast
— are very common and are usually associated with a benign condition.
They cannot be felt, but do appear on a mammogram. Microcalcifications
form patterns or clusters, and radiologists look for certain patterns
of microcalcifications that can signify that the surrounding tissue may
be cancerous. Benign calcifications tend to be round or oval, uniform
in density, and scattered in the breast tissue. Suspicious microcalcifications,
on the other hand, vary in shape, size, form and density and are usually
clustered in a linear or segmental pattern. Most DCIS appears as microcalcifications
on a mammogram. While microcalcifications are not DCIS, they can be an
indication that DCIS is present.
Please note that taking calcium supplements has nothing to do with calcifications in the breasts.
The radiologist looks very carefully at the mammogram and may request a magnification mammogram to get a better look at the area of the breast that is in question. If microcalcifications are found or a lump is present, the radiologist can determine what next steps are required. The radiologist can categorize the calcifications as benign (not cancerous), probably benign, indeterminate (not sure) or suspicious (might be cancer).
Mammograms cannot diagnose DCIS; only a biopsy can do that.
If the radiologist says that the finding is "probably benign," close surveillance may be recommended. This includes a follow-up diagnostic mammogram at six months. While we don't advocate unnecessary biopsies, we also know that many women have been asked to "wait and see", later to find that the area in question is cancer.
If you are uncomfortable about the wait, you may want to get a second opinion or request that a biopsy be done right away.
What happens after the mammogram is very important. It is critical to find the best possible care and to reduce your understandable anxiety about your future. You must be your own health advocate by understanding your treatment options and knowing what questions to ask and what kinds of doctors to see for second opinions.
Note: Your mammogram history is important. If possible, have your mammograms done at the same place. If you move or change mammography facilities, make sure all your mammograms are taken to the new place/doctor.
Be sure that your mammography facility has the highest standards. You may wish to contact the American College of Radiology (www.acr.org) to determine whether your facility meets all of their standards. You might also look for the ACR Accreditation Seal at your local facility.
You want a facility that has a staff radiologist who specializes in breast imaging and reads many mammograms daily.
Ultrasound/sonography
Ultrasound, or sonography, uses sound waves to define a mass.
Because DCIS does not usually present as a mass or even distend the breast
duct, ultrasound has a limited role in DCIS. For some DCIS cases, however,
it is very useful for defining size, shape and extent of DCIS. For patients
whose DCIS presents as dense soft tissue with no calcifications, ultrasound
can be very helpful, and it is useful in DCIS cases that are palpable
(can be felt).
Ultrasound is a test that uses reflected sound waves to produce pictures of the inside of the body. It does not use X-rays or other types of possibly harmful radiation. A special kind of instrument called a transducer is rubbed back and forth over the area to be examined. It gives off high-pitched sound waves that show on a special screen. The pictures produced during an ultrasound are called sonograms, echograms or ultrasound scans. An ultrasound of the breast can show all areas of the breast, including the area closest to the chest wall, which is hard to see with a mammogram.
While ultrasound can help locate breast problems, it is not a substitute for a mammogram. It is often used in addition to a mammogram to evaluate a breast problem.
MRI
MRI (Magnetic Resonance Imaging) is useful in
women with positive BRCA1 and BRCA2 genes. MRI is not a screening test.
