Category: Mammography

I Have Breast Pain – What Should I Do?

Breast pain (especially dull, aching, itching, or sharp), soreness, discomfort, and tenderness are common complaints, however, not likely related to a serious concern. Doctors call it mastalgia. Most women have breast pain at one time or another, often more in one breast than the other. Sometimes the pain is only in one breast or in only one area of one breast. It is important to talk to your doctor about your concerns.

Your healthcare professional can help you determine the cause of your breast pain and whether you require treatment.

Here are some frequent questions from our patients at Elizabeth Wende Breast Care about breast pain:

Why do I often feel discomfort around my menstrual cycle, and will it eventually go away?

Most women feel some breast discomfort during their menstrual cycle. Hormonal fluctuations are making your breasts painful and are the number 1 reason for breast pain. It is normal to have breast tenderness that comes and goes around the time of your period. This is because the hormones (estrogen and progesterone) stimulate the glandular breast tissue. This may cause a small fluid accumulation in the tissue and can cause the breast tissue to be lumpier and more uncomfortable or even painful. Irregular periods are commonly associated with breast pain and swelling.

Breast pain can happen at various times in your life including puberty, around your monthly cycle, pregnancy, perimenopause, and menopause. Even some hormone medications can cause breast pain.

What questions will my doctor ask me about the pain?

  • What does the pain feel like?
  • How long have you had this pain?
  • How bad is the pain and what does it feel like (is it sharp, fullness of breasts, tenderness, etc.)?
  • Does it come and go?
  • Do you notice the pain as a pattern related to your period or menopause?
  • How much caffeine do you drink daily?
  • Are you under stress?
  • Could it be related to trauma (chest or muscle injury, seat belt injury)?
  • Do you have any redness, swelling, or visible changes to your breast or nipple?

I’m pregnant and my breasts hurt, why is that?

If you become pregnant, your breasts may remain painful usually during the first trimester as hormone production ramps up. Breast tenderness is one of the earliest signs of pregnancy for many women.

I am breastfeeding and it is causing breast tenderness. Why?

Breastfeeding can sometimes be the source of breast pain. Some of the things you can experience while nursing include:

  • Painful nipples from an improper latch (the way a baby latches on to suck)
  • Discomfort from a blocked milk duct
  • The tingling sensation during letdown (when the milk starts to flow to the baby)
  • Nipple soreness due to being bitten or having dry, cracked skin or an infection

If you have pain while breastfeeding, it is best to talk to your doctor or a lactation consultant. They can help you troubleshoot the problem while maintaining your milk supply.

Breastfeeding women are most likely to get breast infections (mastitis), but infections occasionally may occur in all women. If you have a breast infection, you may have a fever and symptoms in one breast, including redness and swelling. A breast infection will need to be evaluated by a doctor and treated right away (usually with antibiotics).

My breast pain does not have anything to do with my period—what could be causing it and how would I know if it is normal?

There are lots and lots of reasons for breast pain besides hormones (although it is the most common cause). Pain may come from the breast, or it could come from muscles or joints close to the breast and felt in the breast. It usually but not always involves just one breast. A poor-fitting bra, trauma to the chest wall (getting hit in the chest), arthritis, a side effect of certain medications, and psychiatric drugs sometimes cause breast pain.

What feels like breast pain may actually be coming from your chest wall. Muscle strain, a pulled muscle, inflammation around the ribs, or a bone fracture could be a reason for the pain. Women may suffer from arthritis or costochondritis (inflammation between the rib and breastbone), and this may appear to be breast-related pain.

When should I consult my primary care physician or OBGYN?

It is important to talk to your doctor about your concerns! A lump, breast pain that is new or different, or other breast changes should always be discussed with your doctor. Depending on your symptoms, your medical provider may suggest additional tests, such as a mammogram, breast biopsy, or other ways to determine the cause of the pain.

Talk to your doctor if you are worried if the pain does not improve or you notice any of these signs:

  • Your doctor will want to know more about the pain for further evaluation
  • You have a lump (painful or not)
  • You have redness, swelling, or drainage from the area (signs of infection)
  • You have nipple discharge
  • Your breast pan is not clearly associated with your menstrual cycle or lasts more than two weeks
  • Your breast pain is just in one spot and does not involve the whole breast
  • Your breast pain keeps getting worse
  • The pain is affecting your life and limiting what you can do
  • Any new breast symptoms
  • Pain that might be related to implants
  • Bruise that doesn’t go away

What will my doctor do?

Your doctor may order a mammogram. A breast radiologist will look at your imaging and determine if you need any additional pictures or breast ultrasound. If you are younger than 40, lactating, or pregnant, your doctor may order an ultrasound of your breast instead of a mammogram. The breast radiologist may decide to perform a mammogram as well to evaluate your area of pain.

What kinds of things might the breast radiologist see?

For most of the women who have imaging for breast pain, the mammogram and/or ultrasound are completely normal (75-88%). The radiologist will find a benign cause for the pain, in around 10% of women,

The most common benign cause of pain is a breast cyst. Breasts cysts are sacs of fluid in the breast and many women have them and never know it. They can become painful with changes in your body’s hormones or when they increase in size.

One-to-two percent of women may need further evaluation with a breast biopsy because the radiologist sees something on the images and cannot tell exactly what it is. A breast biopsy is an outpatient procedure where a small piece of tissue is removed from your breast to be evaluated under a microscope.

Very few women with breast pain have breast cancer and some studies show that your chance of having breast cancer is the same whether you have breast pain or not.

Could breast pain mean it is cancer?

Breast pain is rarely a sign of breast cancer. It’s unusual for breast cancer to cause pain, but possible. Inflammatory breast cancer often causes pain but it’s rare, accounting for 1% to 5% of breast cancer cases in the United States. Symptoms of this aggressive disease often come on suddenly and progress rapidly. Inflammatory breast cancer may cause the breast to become red or discolored, swollen or feel heavy, painful, skin on the breast may also thicken or dimple. If you are concerned about inflammatory breast cancer, see your doctor immediately.

Summary

Breast pain (especially dull, aching, itching, or sharp) is common in women and often not a serious concern.

Most women feel some breast discomfort with their menstrual cycle because hormones (estrogen and progesterone) stimulate the glandular breast tissue. This may cause a small fluid accumulation in the tissue and cause the breast tissue to be lumpier, uncomfortable, or even painful. Stress and caffeine can worsen the pain.

Sometimes the pain seems to be within the breast when it’s really coming from a nearby location (shoulder, neck, chest wall). Women may suffer from arthritis or costochondritis (inflammation between the rib and breastbone) and this may appear to be breast-related pain. For these reasons, the mammogram is often normal when breast pain is present.

Sometimes the pain is only in one breast and frequently only one area of the breast.

While breast pain is typically not an early sign of breast cancer, it may be helpful to undergo a thorough evaluation of this symptom. Women who have breast pain may be advised to get a mammogram, ultrasound, or both. In these cases, a doctor may recommend diagnostic mammography, which may involve more images than a routine mammogram. The mammography center may also recommend an ultrasound with your mammogram.

 

EWBC‘s Commitment to Research

Redefining Radiology LogoJust after Thanksgiving every year, Dr. Stamatia Destounis of Elizabeth Wende Breast Care (EWBC) heads out to The Radiological Society of North America (RSNA) Annual Meeting in Chicago, IL. She has been dedicating this week to the meeting for more than 30 years.

The yearly international meeting highlights the latest advances in radiology and displays research from around the world. At the meeting, Dr. Destounis meets with technology companies and gathers information on innovative technologies that will assist in the early detection of breast cancer. This, in turn, aids EWBC in bringing new equipment to the office, and thus the women of our region frequently participate in clinical research trials.

The RSNA meeting gives EWBC a platform to share important research and findings from our center. This year, our own Dr. Destounis will be presenting data findings on breast density and breast cancer risk study in collaboration with our Genetic Counselor, Jessica Salamone. This exciting research will show the effects of adding mammographic breast density into the Tyrer-Cuzick risk model, one of the risk assessment models used to calculate a patient’s lifetime risk of breast cancer.

Elizabeth Wende Breast Care strives to maintain its standing as a Center of Excellence and is always forefront of technological advancements in breast care. EWBC has active clinical trials and an institutional research department. Recent studies have included breast CT (computed tomography), 3D mammography, osteoporosis screening, breast density assessment. Current studies include ultrasound. Elizabeth Wende Breast Care has a long history of commitment to research that provides our patients access to the best technology possible for early detection of breast cancer.

Premenopausal Women More Affected by Adding Density to Risk Mode
Presentation by Stamatia  Destounis, MD, FACR, and Jessica Salamone, CGC
Elizabeth Wende Breast Care, Rochester, NY

 

Risk Assessment Increases Mammography Use in High-Risk Women

A recent article published in JAMA Network Open highlights the positive impact of individual cancer risk assessment on a patient undergoing mammography screening.

Screening mammography saves lives. In fact, in the last 25 years, 40% fewer women have died from breast cancer. However, differences still exist across racial and ethnic groups, with a higher percentage of Black and Hispanic women dying from breast cancer compared to women who are non-Hispanic White.

Several studies indicate these differences exist due to delayed diagnosis and more advanced breast cancers at the time of diagnosis. This difference is primarily due to skipping or delaying screening mammography.

The article states, “Public health initiatives and advances in cancer research aim to reduce screening mammography disparities among racial and ethnic minority women. Strategies that improve screening mammogram uptake are opportunities to promote equity at a population level. Scalable solutions include breast cancer risk assessment programs to inform patients about their risk and the role of screening mammography in reducing breast cancer mortality.”

Cancer risk assessment is calculated for the vast majority of female patients at Elizabeth Wende Breast Care (EWBC) as part of their annual screening. We collect the data needed for this risk assessment on our detailed health history form. This assists our doctors, and clinical staff in customizing screening recommendations based on the outcome of the risk assessment. These recommendations could include adding supplemental screening ultrasound, or screening breast MRI (Magnetic Resonance Imaging), and identifying patients who may be a candidate for genetic counseling and testing. These recommendations are shared on the patient’s mammogram report and sent to referring providers for review.

Sharing this information helps better engage patients in conversations with their providers about their risk level, the appropriate age to begin screening, and which tests are most appropriate. The results of a cancer risk assessment can be overwhelming and challenging to understand. Having a conversation with a trusted medical professional about these results creates an opportunity to ask questions and learn what actions can be taken.

The recent study found that 52.1% of patients were at average risk and 47.9% at high risk for developing breast cancer. In addition, 60.6% of the patients self-identified as African American, 37.2% as Hispanic, and 2.1% as other racial and ethnic groups. A nonsignificant increase in screening mammography uptake was found, from 38.6% during usual care to 48.7% after risk breast cancer risk assessment. Additional analysis found a significantly higher rate of newly identified high-risk women having screening mammography after learning their risk status (51.1% vs. 36.6%).

This is evidence that cancer risk assessments can change patients’ behavior and increase their likelihood of beginning screening at the appropriate age. We hope that women, especially Black and Hispanic women, will begin having conversations with their medical providers about their individualized cancer risk and use this information to guide them to appropriate screening recommendations. This advancement alone can save lives and decrease the health disparities surrounding a breast cancer diagnosis.

If you have questions about your cancer risk assessment, please contact our high-risk/genetics department at (585) 758-7050.
Are you part of a medical practice seeking to implement cancer risk assessment into your workflow? Our providers routinely provide training for existing medical practices and assist them in implementing a risk assessment program.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784055 

New Study Confirms Importance of Yearly Screening Mammography

Life is busy, and before we know it, we have missed an important health screening. How often do you say to yourself, “I know I’m due, I’ll call and schedule it soon,” and that “soon” becomes an entire year? A lot can happen in a year, including the development of breast cancer. We cannot emphasize enough the importance of yearly screening mammography. It gives your doctors the opportunity to find breast cancer early when it is most curable.

In a recent study published in the Journal of the American College of Radiology (JACR), researchers show the impact annual screening mammography has on saving lives. The authors explain that their prospective study looked at 549, 091 women eligible for screening mammography in nine Swedish counties between 1992 and 2016. The study found women who attended screening mammography at either of their two last invitations before a breast cancer diagnosis had a significantly lower risk of breast cancer mortality compared with those who did not attend screening examinations; the greatest benefit (49% risk reduction) was seen in women who attended both screening appointments.

The findings of this study are consistent with recommendations from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI). Yearly mammograms save the most lives. Skipping just one year can decrease a person’s 10-year survival rate by ½.

The American College of Radiology (ACR) and Society of Breast Imaging (SBI) jointly published updated breast cancer screening guidelines in June 2021 in the JACR. The guidelines state that all women should have a risk assessment by age 30 – especially minority women. It also emphasizes the importance of screening in overlooked or underserved populations, including transgender individuals and black women. The ACR and SBI continue to recommend annual screening beginning at age 40 for women of average breast cancer risk.

It is easier and more convenient than ever to schedule your yearly mammogram. We are proud to offer several locations close to home, faster exam times, and same-day results from two expert radiologists for screening mammograms. So, do not skip this year’s exam! Schedule today.

KEY POINTS

  • Mammography screening has been proven effective in reducing breast cancer deaths in women 40 years and older, with a mortality reduction of 40% possible with regular screening.
  • Annual mammography screening starting at age 40 provides the greatest breast cancer mortality reduction by enabling diagnosis at smaller sizes and earlier stages, better surgical options, and more effective chemotherapy.
  • Delaying screening until age 45 or 50 results in unnecessary loss of life to breast cancer, adversely affecting minority women in particular.
  • Breast cancer screening in women ages 75 years and older have continued benefits in terms of deaths averted, and life-years gained.
  • Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals.
  • There is risk in not screening; treatment advances are important but cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor.

Full article: Duffy Tabar et al. Radiology 2021

 

Dr. Destounis in national spotlight as a co-author of updated screening guidelines just released

Updated breast cancer screening guidelines from the ACR and SBI highlight the importance of annual screening for all women
HIGHLIGHTS include
  • Starting screening at 40 for all women
  • The benefit of a risk assessment by 30
  • Addressing underserved and overlooked populations including transgender people and minority women’

See the full article on Spectrum News 1

 



The American College of Radiology (ACR) and Society of Breast Imaging (SBI) jointly published updated breast cancer screening guidelines in June 2021 in the Journal of the American College of Radiology (JACR). The updated guidelines have a few main points. The guidelines state that all women should have a risk assessment by age 30 – especially minority women. It also emphasizes the importance of screening in overlooked or underserved populations, including transgender individuals and Black women. The ACR and SBI continue to recommend annual screening beginning at age 40 for women of average risk.

The new guidelines point out that certain factors such as sex assigned at birth, hormone use, and surgical histories place transgender individuals at increased risk for breast cancer, and describe that “due to hormone use, biological males transitioning to female are at increased risk for breast cancer compared to other males.” Further, biological females transitioning to a male who does not undergo mastectomy remain at their previous risk for breast cancer – this is important to note as many transgender individuals are less likely to undergo routine checkups and screening. This is true, too, for many minority women, “said Dr. Emily Conant, one of the authors of the guidelines. Minority women are 72% more likely to be diagnosed with breast cancer before age 50, 58% are more likely to be diagnosed with the advanced-stage disease before 50, and 12% more likely to die from the disease, compared with white women.” Therefore, it is vital that all women undergo a risk assessment by age 30 and start screening at age 40 – delaying screening until 50 will result in unnecessary loss of life to breast cancer, particularly in minority women.

Stamatia V. Destounis, M.D., FACR

Since the 1980s, when annual screening mammography became widespread, it has been proven to decrease breast cancer mortality by 40%. To maximize the benefits of screening mammography, annual screening should be followed without an upper age limit. Dr. Stamatia Destounis, one of our very own Elizabeth Wende Breast Care (EWBC) physicians, and author of the new guidelines, and the Chief of the ACR Breast Imaging Commission said, “new evidence continues to support annual screening starting at age 40, with closer attention given to minority women in underserved populations…. mounting data and more inclusive screening recommendations should remove any thought that regular screening is controversial.”

Reference: Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung J, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021, article in press.

Read the full article

 

Why going to the same breast center every year is important in mammography screening

It is important to develop a lifelong relationship with your breast imaging specialists dedicated to the early detection of breast cancer.

Most women of average risk will begin having annual screening mammograms at the age of 40. Current guidelines from the Society of Breast Imaging and the American College of Radiology state that patients should continue having annual screening mammograms as long as they are in good health, which for many could be well into their late 70-80s. This potentially means patients could have a 40-year relationship with EWBC! Every year for 40 years! But, WHY?

What is so important about coming to EWBC compared to going to another facility that also does mammograms?  Aren’t all mammograms and radiologists the same? From the first time you call our office to schedule an appointment and step into one of our seven locations, you can tell why EWBC is different. Our professional and supportive staff is led by a team of highly trained breast imaging radiologists who double read every screening mammogram. All EWBC technologists are specifically focused on mammography, and our sonographers are specialized in breast ultrasound.

Our goal is to provide the type of care for our patients that we would expect our loved ones to receive. We take time to explain every step along the way and make sure you are as comfortable as possible. If you have an unexpected problem or concern, we can typically see you within 24-48 hours. Most importantly, we’ve invested in the latest technology to provide you with quick and accurate results. Our doctors go the extra mile to answer questions, review results and provide support. Whenever patients have a biopsy, they leave the office with the doctor’s cell phone number and are encouraged to call if needed.  If you have a diagnosis that requires surgery or treatment, we are always available to answer questions.

We adhere to the recommended screening intervals set forth by the Society of Breast Imaging and the American College of Radiology. Their guidance allows us to remain focused on our patients and provide the most appropriate care for each patient. Our experience of opening the first dedicated breast clinic in the nation sets us apart.

Call one of our many offices located throughout the Rochester, NY area at (585) 442-2190 to request an appointment today!

 

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