Mammograms and Screening Exams

Regularly performed breast exams and mammograms are crucial first steps in the prevention of breast cancer. You are not alone if the thought of a mammogram makes you a little uneasy. To relieve the anxiety, it’s important for you to understand what you can expect your first time and how to interpret potential results.

What is a Breast Self Exam (BSE)?
Women over the age of 20 should examine their own breasts each month. Being aware of what the tissue feels like will help a woman find changes. Not all changes mean cancer, but they should be reported to your healthcare provider for follow up.

What is a Clinical Breast Exam (CBE)?
When a trained healthcare provider examines your breasts, it is called a Clinical Breast Exam. Their experience and knowledge assists them in detecting potential problems. Women over 20 should have a CBE every three years until age 40. At age 40, CBE’s should become a yearly routine.

What is a Screening Mammogram?
A screening mammogram is an x-ray of the breast. Usually two or three views (pictures) are taken of each breast. While mammograms are not perfect, according to the American Cancer Society, they are considered to be the best tool to find cancers of the breast very early.

When should I have a screening mammogram?
All women over 40 should have a yearly mammogram. If there is a strong family history of breast cancer, a mammogram may be ordered at an earlier age.

How do I schedule a mammogram at OSF Saint James?
Check with your healthcare provider to see if you are due for a mammogram. If your healthcare provider recommends a screening mammogram, he or she may offer to schedule the test for you. If you prefer to schedule it, call (815) 842-4931 and the OSF Saint James patient scheduling personnel will assist you. A physician’s order is still required. Hint: It’s best to schedule your mammogram shortly after your period because the tissue is less sensitive.

Will insurance pay for this?
As with all healthcare services, you should check with your insurance provider. Every plan is different. If you don’t have insurance and are worried about the cost, call the Livingston County Health Department at 815-844-7174 for more information regarding financial assistance.

Who reads the mammograms at OSF Saint James?
The radiologists at OSF Saint James read the mammograms. These specially trained physicians are part of the same group that read the mammograms at one of the largest breast cancer centers in Central Illinois. Utilizing the iCAD Second Look software for computer-aided detection of breast abnormalities and disease assures the highest quality in both professional training and computer technology.

Is there anything I need to do to prepare?
Women who have had prior mammograms need to call the facilities that have their films and request that the last 3-5 years of films be sent to OSF Saint James. If all previous mammograms were performed at Saint James, they will be readily available for comparison purposes. On the day of the mammogram, wear a shirt or blouse that allows you to undress from the waist up. Do not use deodorant or powders the day of the test as these can show up as spots on the mammogram.

What will the procedure be like?
The mammogram takes about 20-30 minutes. Your breast will be placed on a special platform and compressed with a clear paddle to flatten it for the x-ray to be taken. This will be the most uncomfortable part of the test. At OSF Saint James we offer special mammography pads for women with very tender or sensitive breasts. After several seconds, the pressure is released. The procedure is repeated until each breast is x-rayed two or three times at different angles. Afterward your breasts may be a little tender, but you should be able to return to normal activity.

When can I expect the results?
An OSF Saint James radiologist will review the images and we will notify you of your results within 5-7 days.

Additional Diagnostic Tests

What if something is abnormal?
If something is found to be abnormal on your mammogram, additional views or an ultrasound may be recommended. Additional testing does not mean that breast cancer has been found, it just means that more images are needed in order to get a more specific view of the breast tissue. Although these tests may cause anxiety, it’s better to be cautious and take every step possible to get a clear view of the breast tissue or abnormality.

What is a diagnostic mammogram?
A diagnostic mammogram is an x-ray of the breast of a woman who has a breast complaint (for example, a breast mass or nipple discharge) or whose screening mammogram showed an abnormality. Mammography pictures will be taken and the view(s) will depend upon the area of specific concern. An ultrasound is sometimes also performed.

What is an ultrasound?
An ultrasound is another diagnostic test that may be used to investigate an abnormality. The ultrasound sends sound waves through your breast and converts them to images on a viewing screen. It is useful to determine if a lump is fluid or solid. It cannot determine calcifications or whether a solid lump is cancerous.

If you are under age 30, your doctor may recommend an ultrasound before mammography. A younger woman’s breast tissue is often more dense and a mammogram may not be able to show sufficient detail.

You will lie on your back on an exam table. The technologist or radiologist will put gel directly on your breast or on the hand held device to help it glide easier. Ultrasound does not use any radiation. The exam takes approximately 20 – 30 minutes.

Who reads the diagnostic mammograms and ultrasounds at OSF Saint James?
The radiologists at OSF Saint James read these additional diagnostic tests. These specially trained physicians are part of the same group that reads the tests at one of the largest breast cancer centers in Central Illinois. You will receive your results that same day.

What if something is abnormal?
Diagnostic test results may suggest that a biopsy is needed to determine whether or not the abnormality is cancerous. If a biopsy is recommended, it does not mean that cancer is present. A large percentage of breast changes that are biopsied are found to be benign.

Biopsy Procedures

Core Needle Biopsy and Excisional Biopsy
When it comes to biopsies; our process is uniquely personal compared to other larger centers. The decision is made by the physician and patient together and is based upon the unique situation at hand. The radiologist and general surgeon take the time to review your situation and then personally sit down with you to discuss your options.

When considering a biopsy of breast tissue, samples can be obtained by either surgery or a needle. The technique depends upon such things as the nature and location of the lump and the woman’s general health. You and your physician, as partners, will decide the best approach.

What is Needle Localization?
In order for a surgeon to surgically remove suspicious tissue from the breast, he will need a guide to show the exact location of the abnormality. The needle localization procedure precisely pinpoints the abnormality, thereby increasing the surgeon’s ability to remove all of the abnormal tissue while reducing the removal of healthy tissue.

What will the procedure be like?
The radiologist will numb the outer skin and deeper tissue within your breast with a small needle. The injection of the anesthetic may sting for a few seconds. Once the anesthetic takes affect, you usually will not feel any pain during the placement of the needle. Then, under ultrasound guidance or mammographic guidance, a needle will be inserted into your breast by the radiologist to mark the exact position of the abnormality. Once properly located, the needle will be removed, leaving a thin wire as the guide for your surgeon. The procedure takes approximately one hour.

What is a Core Needle Biopsy?
In a Core Needle Biopsy, the radiologist makes a tiny cut in the skin of the breast and inserts a small needle to get tissue samples. Usually, four to six samples are taken through that one cut. Most women report little discomfort following a Core Needle Biopsy. The procedure takes about an hour and patients usually receive their results within 1-3 business days. If the core biopsy shows that cancer cells are present, removal of the area and a possible Sentinel Node Biopsy will follow.

What is an Excisional (Open) Biopsy?
During an Excisional Biopsy, a general surgeon will attempt to completely remove the area of concern, along with a surrounding margin of normal breast tissue, while the patient is under general anesthesia. A picture is taken of the tissue that is removed and compared to the prior image of the breast to ensure the entire affected area is removed. The suspicious tissue is sent to a pathologist who identifies the tissue as cancerous or non-cancerous. Patients usually receive their results within 1-3 business days.

What if something is abnormal?
If the abnormality is cancerous, the cancerous tissue will need to be removed. Traditionally, standard treatment for breast cancer involved removing an extensive amount of tissue under the arm which contained the lymph nodes. However, there is a relatively new technique that offers an alternative. It’s called the Sentinel Node Biopsy. This is an option that is offered at OSF Saint James by specially trained general surgeon, Dr. Trent Proehl.

Sentinel Node Biopsy

With the new ability to biopsy the sentinel nodes for the spread of cancers, specially trained surgeons, like OSF Saint James general surgeon Trent Proehl, are able to prevent women from having extensive surgery.

Traditionally, the lymph nodes under the arm closest to the cancerous breast were removed to examine them for the spread of cancer. However, research shows that only one-third of women with breast cancer will have cancer in the lymph nodes. Their removal causes side effects, like painful swelling in the arm (lymphedema) which often results in infection and interferes with activities of daily living. Sentinel Node Biopsy lowers a woman’s chance of developing lymphedema by as much as half, in comparison with the traditional approach of removing many of the nodes.

What is a Sentinel Node Biopsy?
A Sentinel Lymph Node Biopsy is a surgery that takes out lymph node tissue to look for cancer. Research has proven that the sentinel lymph node is the first node in a group of nodes in the body where cancer cells move to after they have left the original cancer site. In breast cancer, normally the sentinel node is one of the lymph nodes under the arm. If the sentinel node is free of cancer, then others further from the site can be presumed cancer free and be left alone.

How is the procedure performed?
Since the procedure is performed under general anesthesia, you will be given instructions by your surgeon and the anesthesiologist prior to the day of your biopsy. Your radiologist will inject a tracer substance and your surgeon will inject a blue dye into the tumor site. The dye or tracer will move to the first lymph node (sentinel node) that drains close to the cancer site. The dye makes a map pattern of lymphatic fluid, showing where the cancer is likely to spread and which nodes are likely to have cancer cells. The surgeon will use a special instrument to detect the tracer. A small incision will be made to remove the node, which will be sent to the pathologist to be examined for cancer cells. The results come back while you are under general anesthesia. Pathologists from OSF Saint Francis Medical Center, where many Sentinel Node Biopsies are performed, are present during surgery to evaluate your node.

Expert Training of General Surgeon Trent Proehl

Dr. Trent Proehl is board-certified by the American Board of Surgery and has an interest in new minimally invasive surgeries. He was trained by surgeons at one of the largest breast cancer centers in Central Illinois, who were part of a large study testing the accuracy and effectiveness of the sentinel lymph node techniques. He worked beside them learning these techniques and now performs them at OSF Saint James Medical Center.

Dr. Proehl joined OSF Medical Group in 2004 and is on the staff at OSF Saint James - John W. Albrecht Medical Center. He maintains operating privileges at OSF Saint Francis Medical Center in Peoria for patients who may require complex procedures currently not available locally.

Dr. Proehl chose to practice in rural Livingston County because his roots are in rural Central Illinois. Growing up on a farm south of Peoria. He attended the University of Illinois at Urbana-Champaign and received his medical degree from the University of Illinois College of Medicine at Peoria (UICOMP). Dr. Proehl completed general surgery residency training through the University of Illinois College of Medicine at OSF Saint Francis Medical Center in Peoria.

He received the Outstanding Teaching and Service Award for Community Based Faculty by the University of Illinois College of Medicine at Peoria for his work in the development of a rural medical education program and his mentorship of medical students and surgical residents.

Other Breast Procedures Available at OSF Saint James

Nipple discharge and fluid filled cysts are two common breast abnormalities which often require evaluation and treatment. Some of the same techniques and state of the art equipment used in diagnosing cancer related abnormalities are used to perform the ductogram and cyst aspiration. Both of these procedures are available at OSF Saint James Medical Center.

What is a ductogram?
A ductogram is a special type of mammogram used for imaging the breast ducts to aid in diagnosing the cause of abnormal nipple discharge. Nipple discharge can be caused by non-cancerous tumors or cancerous tumors; however, the majority are benign.

The ductogram procedure takes 30 minutes to one hour. The radiologist applies manual pressure to the duct to cause discharge. Once the duct with discharge is determined, a contrast dye is injected so detail can be seen. The contrast helps enhance the image of the duct during mammography, which will help locate the origin of the abnormal discharge.

What is a cyst aspiration?
Cyst aspiration is a procedure that uses a thin needle on a syringe to draw fluid and/or cellular material from a breast cyst. Cysts are the most common cause of breast masses felt by premenopausal women over 40 years old. A cyst aspiration is done when the cyst is painful or complex, to make sure it isn’t solid.

What will the procedure be like?
You will undress from the waist up and lie on your back. Using ultrasound guidance, the radiologist inserts a needle into the lump and the contents will be drawn out. The procedure takes only a few minutes. The skin can be numbed if you would like.

Related Information from the OSF Health Library:

Breast Cancer
Breast Diseases and Conditions
Biopsy
Breast Self-Examination
Glossary of Breast Cancer Terms
Women’s Health Check List