Our goal is breast health, our focus is patient care.

Our Board-Certified Diagnostic Radiologists are experts in the field of Breast Cancer Screening and Diagnosis. We have extensive experience in imaging evaluation for breast disease, and we use the latest in non-surgical breast biopsy techniques. Most importantly, we focus on each patient's individual needs.

Schedule an Appointment: (317) 806-8265

Breast Ultrasound

Breast ultrasound is a painless test in which sound waves are used to visualize the internal structures of the breast. Images are created by the sound waves, to help identify fluid filled cysts or solid nodules (solid lumps). Ultrasound is not currently felt to be appropriate as a screening exam for breast cancer, so it is not routinely performed for all patients. However, it is a valuable diagnostic test used in evaluating possible breast abnormalities questioned during mammography, breast MRI, physical exam, or breast self exam. Ultrasound is generally used after mammography, and it is only used before or in place of mammography in certain cases, such as very young patients or pregnant women.

Breast ultrasound is performed with the patient lying on an exam table. Gel is applied to the skin to allow transmission of sound waves. We evaluate the specific area of possible abnormality questioned on the mammogram or MRI, or the area of a lump that can be felt by you or your doctor. The results of a breast ultrasound exam will be correlated with your other test results, and explained to you before you leave the office.

Remember that you cannot be sure if a new breast lump is a cyst by the way it feels, so it is important to report any new or persistent breast lump to your doctor.

Calcium

In many ways, calcium is a miracle mineral. Besides maintaining our skeletons, it may help ward off everything from premenstrual syndrome to hypertension, colon cancer and breast cancer. Food remains the best source of calcium, since it provides other nutrients as well. In a cup of non-fortified milk, for example, you get protein, riboflavin, and vitamin D along with about 300 mg of calcium. Unfortunately, Americans have cut back dramatically calcium-rich foods in recent decades. Huge segments of the population still receive far less than the amount needed to maintain strong bones and teeth and to help prevent osteoporosis. Only 10 % of women 50 and younger consume the recommended 1000mg of calcium each day. Less than 1/3 of the U.S. teens consume the 1300 mg they need each day to support normal bone growth. (The body forms nearly half its bone during the teen years.) Aggressive marketing has helped push soft drinks consumption of record levels, while milk consumption has fallen off. A typical teen now drinks twice as much soda as milk.

The new supplements and fortified foods can help fill that gap. They help people get adequate calcium without having to overhaul their diets. Getting the most out of supplemental calcium takes some effort. First, you need to know which type you are taking. The most common form of the mineral, calcium carbonate, is derived from limestone and oyster shells. This form, which is used in Tums and most tablets, works best when taken in doses of 500 mg or less and combined with food and vitamin D and is usually better absorbed. Calcium citrate malate (the stuff used in many fortified juices) doesn’t require food or vitamin D and is usually better absorbed. Whatever the form, calcium taken with a lot of sodium, protein, or caffeine is more likely to be excreted. For every 500 mg of sodium you eat, you loose 10 mg of calcium. Each gram of dietary protein costs the body 1 mg to 1.5 mg of calcium.

It is hard to get too much calcium from food sources, but supplements and designer foods can easily push people beyond what is needed or even safe. At doses of 2,500 mg or more, calcium poses several potential hazards. Besides causing constipation and stomach upset, it may block the absorption of other critical minerals, especially zinc and iron. Extreme doses can also harden the kidneys and contribute to the formation of kidney stones. And preliminary research suggests that men with high calcium intake are slightly more vulnerable to prostate cancer.

To steer clear of deficiency and excess, read the labels and keep track of what you are eating in the course of the day.

The recommended daily calcium intake in milligrams is:

• Kids age 4-8: 800 mg
• Kids age 9-18: 1300 mg
• Adults age 19-50: 1000 mg
• Adults older than 50: 1200 mg
• Maximum safe daily amount: 2500 mg

Caution: consult with your doctor before taking supplements if you have kidney conditions, are prone to kidney stones, or have a hyperparathyroidism.

What is Osteoporosis?

Osteoporosis is the loss of bone that can occur as you get older. As the bones get thinner, they become weaker. There is a much greater risk they will break if you fall or have an otherwise minor injury. Medical complications of these injuries can result in longer stays at the hospital, disability, and even death.

Osteoporosis is most common in white and Asian women, especially slender women.

How does is occur?

Osteoporosis occurs as women get older. Sex hormones help keep bones strong. The hormone estrogen helps women’s bones stay strong. For example, it helps deposit calcium in the bones. While men continue to produce testosterone, their sex hormone, as they get older, women produce much less estrogen after menopause. Surgical removal of the ovaries and intense exercise (such as marathon running) can also reduce estrogen levels. The lower levels of estrogen cause a weakening of the bones.

Osteoporosis can also occur as a result of hormone disorders or prolonged bed rest during serious illness. It may appear with osteomalacia, a condition in which the bones soften and weaken from lack of Vitamin D.

Other possible causes include an imbalance in the body’s natural acidity or a loss of phosphate. Too much aluminum hydroxide, a chemical used to treat ulcers, in the body can also be a cause.

Women who smoke or are physically inactive are at a greater risk of developing osteoporosis. Too little calcium in the diet or a family history of osteoporosis are other risk factors.

What are the symptoms?

You may have no clear symptoms until a bone breaks. This why screening for osteoporosis is critically important.

Osteoporosis and DEXA Scanning

Osteoporosis is a disease in which bone density decreases, making bones brittle and prone to fracture. Approximately 50% of women over age 50 have this disease and are at risk of an osteoporosis-related fracture. Osteoporosis has been called the "silent thief" because there are no early warning signs and few outward indications of the disease until a fracture occurs, typically at the hip, spine, or wrist. A women's risk of hip fracture alone is equal to the combined risk of developing breast, uterine, and ovarian cancer. The consequences of this disease can be devastating. Each year osteoporosis is accountable for more than 1.3 million fractures.

Major risk fractures for osteoporosis are: early menopause (prior to age 45), low calcium intake, inactive lifestyle, smoking, Caucasian/Asian ethnicity, family history of fractures in older women, thin or small bones, Corticosteroid use, and excessive alcohol consumption.

Testing for Osteoporosis:

DEXA is a precise, complete measurement of bone density, and is indicated for women with any of the risk factors listed above.

A "DEXA scan" painlessly measures the bone density of the lumbar spine and hips. The exam is performed while the patient lies fully clothed on a flat padded table. A moveable arm passes over common fracture sites such as the hip and lower spine. The radiation exposure is very minimal, less than 1/100 the dosage of a chest X-ray. During the exam a technologist remains in the room at all times.

With a DEXA test, no special preparation is involved, no injection or medications are given, and the entire exam is performed in approximately 15 minutes.

The test will measure your bone mineral density (BMD) or bone mass, and compare that number with a reference population whose age, sex, and racial background are similar to yours. This information will then be provided to your primary care physician to determine if any specific steps need to be taken to protect your bone health. It also assists in predicting the risk of future bone fractures.

Osteoporosis Facts

1. Twenty-four million Americans have osteoporosis.
2. Osteoporosis is responsible for 1.3 million fractures annually, including 300,000 hip fractures, 200,000 wrist fractures and 300,000 fractures at other sites.
3. One-third to one-half of all post-menopausal women are affected by osteoporosis.
4. Premature menopause after removal of the ovaries, excessive exercise or anorexia, may cause osteoporosis in women as early as the mid-thirties.
5. The incidence of osteoporosis is expected to double by the year 2020, as the population ages.
6. Hip fractures are 2-3 times higher in women than men; spinal osteoporosis is 8 times more likely in women than men.
7. Vertebrae affected by osteoporosis may cause loss of height, deforming curvature of the spine and extreme back pain.
8. Selected factors resulting in high risk:
• Early menopause (prior to age 45)
• Low calcium intake
• Inactive lifestyle
• Smoking
• Caucasian/Asian ethnicity
• Corticosteroid usage
• Excessive alcohol consumption
• Family history of osteoporosis
9. Forty percent of women will have at least one spine fracture by age 80.
10. Fifteen percent of white women will have a hip fracture in their lifetime.
11. Fifteen percent of white women 50 years and older will fracture their wrist in their lifetime.
12. The average cost for patients with hip fractures requiring hospitalization is $26,000, excluding physician fees.
13. The annual cost of treating hip fractures is $7 billion, and of treating osteoporosis, $10 billion.

Men with Osteoporosis

Did you know that 2 million American men suffer from osteoporosis?

• An additional 3.1 million men are at risk for developing osteoporosis.
• One in every 8 men over age 50 will have an osteoporosis-related fracture.
• Each year 80,000 men suffer a hip fracture and one-third of these men die within a year.
• Tens of thousands of men also fracture bones in their spine, wrists, or ribs as a result of osteoporosis.

Men at Risk

• Prolonged exposure to certain medications, such as steroids used to treat asthma, arthritis, or other diseases, anticonvulsants, certain cancer treatments, and aluminum-containing antacids.
• Chronic diseases that affect the kidneys, lungs, stomach, and intestines, or alter hormone levels.
• Low levels of the sex hormone testosterone.
• Unhealthy lifestyle habits (smoking, excessive alcohol use, low calcium intake, inadequate physical exercise, etc.).
• Age: The older you are the greater your risk
• Heredity
• Race: Caucasian men appear to be at greatest risk, but all men can develop this disease.

Stereotactic Breast Biopsy

Why do I need a stereotactic biopsy?

Your mammogram has revealed a possible abnormality, or "lesion", in your breast. A possible lesion on your mammogram can be evaluated in one of two ways. Either it is "followed" over a period of time with mammography to see if there is a significant change, or a biopsy is done to remove some or all of the tissue.

Lesions are "followed" if it is felt they are very likely to be benign. Biopsies are done if an area is more worrisome in appearance, or just not specific enough in appearance to wait for follow up. Also, biopsy can be done if a patient is not comfortable with the idea of waiting four to six months for follow up.

It’s good to remember that around 80% of lesions are benign (not cancer).

Biopsy can either be done in outpatient surgery (surgical excisional biopsy), or in our office (needle biopsy). Stereotactic breast biopsy is a type of needle biopsy, which is the least invasive way to obtain a tissue sample for diagnoses. It is accurate, requires less recovery time than a surgical biopsy, and there is not significant scarring to the breast.

How do I prepare for a stereotactic biopsy?

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as 5-7 days before the biopsy. You can take your other medications, and eat your usual breakfast before the biopsy.

How is the stereotactic breast biopsy performed?

The stereotactic needle biopsy procedure will be performed by one of four breast center physicians who specialize in stereotactic core needle biopsy, with assistance from a radiologic (x-ray) technologist, also with a background assisting in this procedure.

After arriving at the office, you will undress from the waist up and change into a hospital gown, and you will be escorted to the biopsy room. The technologist will ask you to lie face down on the special procedure table, making sure you are as comfortable as possible. Your breast will be positioned though a special round opening in the table. The table will then be raised so the physician and technologists can work from below. The first part of the procedure will seem much like your mammogram, except that you are lying down instead of standing up. Your breast will be compressed with a compression paddle just as it was during your mammogram. An x-ray will be taken to ensure that the area of breast containing the lesion is correctly centered. With the help of a computer connected to the mammography machine, the exact position of the biopsy is determined. Next, the physician will numb the entire biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast, at the numbed area. A set of x-rays will then been taken to ensure proper needle placement. Once placement is confirmed, the physician will acquire tissue samples. When the physician has retrieved all the samples, a tiny (1/8") metal clip will be left in place to permanently mark the biopsy site. You will not be able to see or feel this clip, but it is extremely helpful in confirming accurate biopsy and in assessing your mammograms in the future. Placing this clip is an absolute requirement of this procedure. The compression paddle will be released from your breast and the technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding, and reduce any possible bruising. Next, a regular mammogram will be obtained, which will serve as a useful baseline for future mammography. Afterwards, a dressing will be applied which you will wear home. You will not need any stitches. You will go home with printed post-procedure care instructions.

Will it hurt?

The entire area is anesthetized to make the procedure as comfortable as possible. Each patient’s experience is slightly different, but patients occasionally report that they feel pressure or a slight discomfort in the biopsied area, as the procedure is being done. We talk to you throughout the entire procedure to keep you informed and make sure you are comfortable.

Will I be able to resume my normal activities right away?

After the technologist has applied a dressing to the biopsy site, you may get dressed. Most women feel fine after the procedure and return to their normal routine right away. However, we recommend that strenuous exercise or activity be avoided for at least 24 hours. You may drive after the procedure.

When can I expect the results of my biopsy?

The Breast Center physician performing the biopsy will send the tissue samples to the lab, where a doctor (pathologist), will look at the samples under a microscope. The pathologist will make a diagnosis and fax a report to our office in two to three business days. We will contact you to discuss your results as soon as we receive them.

Is the stereotactic procedure accurate?

The stereotactic needle breast biopsy method is highly accurate in helping us diagnose various breast abnormalities. Hundreds of thousands of stereotactic procedures have been performed in the United States, and numerous research studies have confirmed the high degree of accuracy and reliability of this procedure.

What are the risks associated with this procedure?

There is a risk of bleeding or bruising, and a very small risk of infection. There is an extremely small risk of obtaining non-diagnostic samples, requiring re-biopsy. If you have implants, there is a small risk of rupture/puncture of the implant.

What if I have more questions?

It is important that you have all of your questions about the stereotactic biopsy procedure and results answered. Please do not hesitate to call us with any question that you have before or after your biopsy.

Ultrasound Guided Breast Biopsy

Why do I need a needle biopsy?

Your mammogram has revealed a possible abnormality, also called a "lesion", in your breast. A questioned lesion on your mammogram can be evaluated in one of two ways. Either it is "followed" over a period of time with mammography and/or ultrasound to see if there is a significant change, or a biopsy is done to remove samples of the tissue.

Lesions are "followed" if it is felt they are extremely likely to be benign. Biopsies are done if an area is more worrisome in appearance, or just not specific enough in appearance to wait for follow up. Also, biopsy can be done if a patient is not comfortable with the idea of waiting four to six months for follow up.

It’s good to remember that around 80% of lesions are benign.

Biopsy can either be done in our office (needle biopsy), or in outpatient surgery (surgical excisional biopsy). Ultrasound guided needle biopsy is a type of needle biopsy, which is the least invasive way to obtain a tissue sample for diagnoses. It is accurate, requires less recovery time than a surgical biopsy, and there is not significant scarring to the breast.

How do I prepare for an ultrasound guided breast needle biopsy?

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as 5-7 days before the biopsy.

You can take your other medications, and eat your usual meals before the biopsy.

How is the ultrasound guided breast needle biopsy performed?

The needle biopsy procedure will be performed by a breast center physician, with assistance from a radiologic (x-ray) technologist.

After arriving at the office, you will undress from the waist up and change into a hospital gown, and you will be escorted to the ultrasound room. The technologist will ask you to lie down on the ultrasound table, making sure you are as comfortable as possible. An ultrasound will be performed to re-locate the area in question, and that general area of your skin will be cleansed with surgical soap. Next, the physician will numb the entire biopsy area by injecting a local anesthetic called Lidocaine into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast at the numbed area, while confirming position of the needle with ultrasound. Once placement is confirmed, the physician will acquire several tissue samples. Then pressure is applied to the biopsy site to prevent bleeding, and an ice pack is applied to reduce any possible bruising. You will not need any stitches. You will go home with printed post-procedure care instructions.

Will it hurt?

The entire area is anesthetized to make the procedure as comfortable as possible. Each patient’s experience is slightly different, but most patients occasionally report that they feel pressure or a slight discomfort in the biopsied area, as the procedure is being done. We talk to you throughout the entire procedure to keep you informed and make sure you are comfortable.

Will I be able to resume my normal activities right away?

After the technologist has applied a band aid to the biopsy site, you may get dressed. Most women feel fine after the procedure and return to their normal routine right away. However, we recommend that in order to reduce bruising and promote healing, strenuous exercise or activity be avoided for at least 24 hours. You may drive after the procedure.

When can I expect the results of my biopsy?

The Breast Center physician performing the biopsy will send the tissue samples to the lab, where a doctor (pathologist), will look at the samples under a microscope. The pathologist will make a diagnosis and fax a report to our office in two to three business days. We will contact you to discuss your results as soon as we receive them.

Is the procedure accurate?

The ultrasound guided needle breast biopsy method is highly accurate in helping us diagnose various breast abnormalities. Hundreds of thousands of these procedures have been performed in the United States, and numerous research studies have confirmed the accuracy and reliability of this procedure.

What if I have more questions?

It is important that you have all of your questions answered, both about the needle biopsy procedure and the biopsy results. Please do not hesitate to call us with any question that you have before or after your biopsy.

Cyst Aspiration

Cysts are small pockets of fluid in the breast that may feel like a lump, or may be first noticed on a mammogram. Ultrasound frequently can confirm that such a finding is a cyst, and thus benign. Occasionally it may be necessary to aspirate a cyst to prove that it is benign and not a tumor.

Cyst aspiration is most accurately performed under ultrasound guidance. With the patient lying down, the skin is first cleansed, and local anesthesia may be used, if necessary. While watching the cyst with ultrasound, a small needle is placed through the skin, into the cyst, and as much fluid as possible is removed. This procedure is quick and most patients tolerate it well, with little to no discomfort. If fluid is obtained, it may need to be sent to the lab for analysis. You will usually be released immediately following the procedure. If a specimen is sent to the lab, we will call you with lab results as soon as we receive them; usually in 2-3 working days.

MRI Guided Breast Biopsy

Why do I need an MRI Guided Breast Biopsy?

Your breast MRI has revealed a possible abnormality, or "lesion", in your breast which was not visible on mammography or ultrasound, and cannot be felt. A possible lesion on your MRI can be evaluated in one of two ways. Either it is "followed" over a period of time with MRI to see if there is a significant change, or a biopsy is done to remove some or all of the tissue.

Lesions are "followed" if it is felt they are very likely to be benign. Biopsies are done if an area is more worrisome in appearance, or just not specific enough in appearance to wait for follow up. Also, biopsy can be done if a patient is not comfortable with the idea of waiting four to six months for follow up.

How do I prepare for an MRI Guided Breast Biopsy?

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as 5-7 days before the biopsy.

You can take your other medications, and eat your usual breakfast before the biopsy.

How is the MRI Guided Breast Biopsy performed?

The MRI-guided needle biopsy procedure will be performed by one of four breast center physicians who specialize in needle biopsy, with assistance from a radiologic (x-ray) technologist, also with a background assisting in this procedure.

After arriving at the office, you will change into a hospital gown, and you will be escorted to the MRI room. An IV will be started. The technologist will ask you to lie face down on the MRI table, just as you did for your Breast MRI. Your breast will be compressed with a compression paddle. MRI images will be taken, and after IV contrast is given, the exact position of the biopsy is determined. Next, the physician will numb the entire biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast, at the numbed area. Once placement is confirmed by additional MRI images, the physician will acquire tissue samples through the needle. When the physician has retrieved all the samples, a tiny (1/8�) metallic clip will be left in place to permanently mark the biopsy site. You will not be able to see or feel this clip, but it is extremely helpful in confirming accurate biopsy and in assessing your mammograms in the future. Placing this clip is an absolute requirement of this procedure. The compression paddle will be released from your breast and the technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding, and reduce any possible bruising. Next, a regular mammogram will be obtained, which will serve as a useful baseline for future mammography. Afterwards, a dressing will be applied which you will wear home. You will not need any stitches or sutures. You will go home with printed post-procedure care instructions.

Will it hurt?

The entire area is anesthetized to make the procedure as comfortable as possible. Each patient’s experience is slightly different, but patients occasionally report that they feel pressure or a slight discomfort in the biopsied area, as the procedure is being done. We talk to you throughout the entire procedure to keep you informed and make sure you are comfortable.

Will I be able to resume my normal activities right away?

After the technologist has applied a dressing to the biopsy site, you may get dressed. Most women feel fine after the procedure and return to their normal routine right away. However, we recommend that strenuous exercise or activity be avoided for at least 24 hours. You may drive after the procedure.

When can I expect the results of my biopsy?

The Breast Center physician performing the biopsy will send the tissue samples to the lab, where a doctor (pathologist), will look at the samples under a microscope. The pathologist will make a diagnosis and fax a report to our office, usually in two to three business days. We will contact you to discuss your results, unless your surgeon prefers to do this.

What are the risks associated with this procedure?

There is a risk of bleeding or bruising, and a very small risk of infection. There is small risk of obtaining non-diagnostic samples, requiring re-biopsy. If you have implants, there is a small risk of rupture/puncture of the implant.

What if I have more questions?

It is important that you have all of your questions about the biopsy procedure and results answered. Please do not hesitate to call us with any question that you have before or after your biopsy.

Ductogram (galactogram)

A ductogram is a mammographic procedure performed to help in the evaluation of abnormal nipple discharge. We usually perform a ductogram in conjunction with evaluation of the patient by a surgeon. In ductography, (galactography), the draining duct is identified visually through a magnifying glass, and a tiny catheter is carefully placed into the draining duct at the nipple. After a very small amount of contrast (clear x-ray dye) is instilled, a mammogram is obtained to produce an image of the duct. Blue dye may be added to the clear contrast if the patient is scheduled for surgery the same day. This blue dye temporarily stains the duct, giving the surgeon a visible guide to the draining duct, in addition to the mammogram x-ray image.

If we cannot elicit any discharge on the day of the scheduled exam, the ductogram cannot be performed. However, if the patient is already scheduled for outpatient surgery that day, the surgical procedure can usually still be performed.

Pre-operative Wire Localization (Needle Localization)

Wire localization is a procedure used to guide a surgeon to a suspicious finding in a breast that cannot be felt, but can be seen on mammogram or ultrasound. The abnormality is often a cluster of tiny calcifications or a nodule too small to be felt.

The radiologist uses either the mammogram machine or ultrasound machine to guide placement of a small needle through the skin to the suspicious finding. A mammogram confirms correct position of the needle. A thin wire is placed through the needle, and the needle is then removed, leaving the wire in place.

A final set of mammograms is obtained with the wire in place. These films accompany you to the surgical suite. The surgeon removes the wire and abnormality in the operating room.

Breast Pain and Fibrocystic Changes of the Breast

Most women experience breast pain at some point in their lives.

Breast pain may be related to:

1. Hormone effect on fibrocystic breast tissue, the most common cause of pain
2. Injury
3. Infection
4. Breast cancer (though this is very rarely associated with breast pain)

The term "fibrocystic disease" has historically been used to describe breast pain in women, with or without generalized lumpiness. But this is NOT a disease, and represents the type of pain that may occur when normal breast tissue responds to hormonal changes. We now like to use the term "fibrocystic change" to describe this common symptom in women. It may occur during the menstrual cycle, pregnancy, perimenopause and when starting or changing birth control pills or hormone therapy.

When patients with fibrocystic change undergo ultrasound of the breasts, cysts can often be seen. Cysts are sacks of fluid which seem to cause tenderness, either as they fill with the fluid, or sometimes as the cysts spontaneously empty of fluid. Patients may have either tiny "micro-cysts" and/or larger cysts that occasionally can be felt on physical exam or breast self exam. Pain may or may not be associated with cysts. When present, the breast pain tends to be chronic, but intermittent, often cyclical, and may be generalized or focal.

Most pain will subside with time. If you experience persistent, non-cyclic pain, you should consult your physician. The following treatments may be helpful in reducing breast pain. We have no medical research to confirm the effectiveness of these treatments, but they seem to work for some women, and you may want to try them out for yourself.

1. Wear a sport or support bra
2. Take an over-the-counter pain medicine
3. Decrease your daily salt intake
4. Reduce or avoid caffeine, found in coffee, many soft drinks, and chocolate. This will not have an immediate effect and it may take 6-8 weeks to notice a change.

Remember:
Any time a lump is felt, you should have it checked,
whether there is pain or not.

Breast Cancer

Breast cancer affects one in eight women during their lives. Breast cancer is the second leading cause of cancer deaths in U.S. women; it is second only to lung cancer. Risk factors include age (risk increases as you get older), beginning periods before age 12 or going through menopause after age 55, being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having any children, having your first child after age 35, having dense breasts, and personal history or family history of breast cancer, ovarian cancer, or one of the two genes that are associated with risk: BRCA1 and BRCA2. But women without any known risks can develop breast cancer. Physical exam, self breast exam and mammography are important for all women, and can help find breast cancer when it is small and most treatable.

Signs and Symptoms of Breast Cancer:

It is important to be aware of the signs and symptoms of breast cancer because if the disease is discovered early, you have a better chance for a cure.

Most breast lumps aren't cancerous, but the most common sign of breast cancer is a lump or thickening in the breast.

Warning signs of breast cancer:

• A lump or thickening in the breast or the underarm
• A spontaneous clear or bloody discharge from your nipple
• Retraction or indentation of your nipple; change in nipple shape
• A rash on the nipple or areola
• A change in the size or shape of your breast
• Any flattening or indentation of the skin over your breast
• Redness or pitting of the skin over your breast, like the skin of an orange; it may appear swollen, irritated or inflamed
• Pain: although breast pain is usually associated with benign breast problems rather than breast cancer, it can be associated with either condition

If you find a lump or other change in your breast - even if a recent mammogram was normal - see your doctor for evaluation. If you haven't yet gone through menopause, you may want to wait through one menstrual cycle before seeing your doctor. If the change hasn't gone away after a month, have it evaluated promptly.

Breast Cysts

Simple pockets of fluid in the breast are referred to as breast cysts. Many normal women develop breast cysts at some point during their life. They can occur at any time from puberty well into post-menopausal years. You may have only one or several, in one or both breasts.

Most cysts cannot be felt. Some cysts are first discovered on mammography. However, some are large enough to be felt, and they may change size rapidly. Cysts can become very tender; usually the soreness fluctuates, and often improves on its own. Cysts are almost always benign processes, but a new lump questioned on mammogram, physical exam, or breast self exam should be evaluated with "additional views" mammography and then ultrasound. Those tests can determine if it can be diagnosed as a benign "simple cyst". Sometimes, mammography and ultrasound cannot absolutely confirm the diagnosis of "simple cyst", and the cyst may need to be aspirated in the office for further evaluation.

Remember that you cannot be sure if a new breast lump is a cyst by the way it feels, so it is important to report any new or persistent breast lump to your doctor.

Breast Discharge

Discharge from the nipple can be alarming, but many women do have some discharge that can be expressed (squeezed) from the nipple. A 1987 study at a Boston hospital actually found 83% of women had discharge that could be expressed. These included women who were old, young, mothers, non-mothers, previously pregnant and never pregnant.

Luckily, most discharge from the breast is nothing to be alarmed about. In general, discharges that occur in both breasts at the same time are due to hormonal cause. If a woman is not breast feeding, milky discharge is known as galactorrhea. This occurs because something is increasing the prolactin levels in the body. This can be related to the pituitary gland in the brain, or other hormonal problems. Also, certain medications can increase prolactin levels in the body, including birth control pills, certain antihypertensive or blood pressure medication, or major tranquilizers.

Concern is raised about a nipple discharge when it occurs spontaneously (without squeezing), persists, comes from a single duct, involves only one breast, and looks bloody or clear colored. If you notice any of these changes, you should call your doctor because these findings are sometimes a sign of cancer.

When nipple discharge is not bloody or clear, but rather appears yellow, green, brown, or black colored, this is less worrisome and breast cancer is considered less likely. Occasionally, the discharged liquid may be smeared on a microscopic slide or other wise tested to evaluate for the presence of abnormal cells or blood that the naked eye cannot detect. If negative, and the discharge is present only when expressed, the patient may be instructed to refrain from expressing the discharge for several weeks. Often, the amount of discharge may decrease, or the discharge will resolve spontaneously without further treatment.

Again, nipple discharge is a relatively common occurrence among women at certain points in their lives and usually is not worrisome unless the discharge is from one breast, from a single duct, spontaneous, and bloody or clear in color. If any of these signs are present, your physician should be contacted for further evaluation.

Male Breast Problems (Gynecomastia)

Most breast diseases occur in women, but a surprising number of men will notice a lump or tenderness in one or both breasts some time in their lives. This usually reflects a condition we refer to as gynecomastia.

Gynecomastia is the condition of development of breast tissue in the male. It is often first noticed in only one breast and is often first noticed because of associated tenderness and firmness behind the nipple.

Gynecomastia may occur anytime, but usually occurs in the newborn, around male puberty, and in men after the age of 50. During puberty the peak time is 13-14 years of age and may persist for up to 1-2 years and then usually disappears. This is a normal event.

In older men, gynecomastia usually appears between 50 and 75, and lasts for variable periods of time. It often is temporary but may last several years. Occasionally it is aggravated by certain prescription medications. Such medications include anabolic steroids, digitalis, some antidepressants, marijuana, Tagamet, and others. Please consult with your physician as to whether any of your medications may be responsible if you develop gynecomastia.

Obesity may mimic gynecomastia on physical examination. In addition, obesity in general may make men more susceptible to breast tissue development (gynecomastia). Mammography can usually identify both of these conditions, and surgery or biopsy is usually not necessary.

In some males where breast enlargement is unusually persistent, is greater than usual, or occurs at unusual ages, additional blood tests may be necessary to look for rare diseases that cause gynecomastia. Testicular failure and decreased testosterone production are in this category.

Breast Cancer in Men

Newly detected lumps in the breast, either behind the nipple or particularly away from the nipple, deserve investigation to exclude cancer. If the mammogram/ultrasound do not reveal typical findings of gynecomastia or they show something else, a biopsy may be necessary.

Breast cancer is rare in men but does occur. Approximately 1% of all breast cancers occur in men. Mammography is usually very helpful in distinguishing between male gynecomastia and male breast cancer.

Fibroadenoma, Breast Lumps

Fibroadenomas are the second most common cause of a benign (non-cancerous) breast mass or lump, with cysts being the most common. They are composed of a combination of fibrous and glandular tissue. The exact cause is unknown, but they are formed by an overgrowth of these two normal types of tissue found in the breast.

Fibroadenomas are most commonly seen in women less than 40 year old, but can be seen at nearly any age. They are sometimes found in teenagers. They are not the result of diet, exercise, or medication, though they may be sensitive to hormones. Because of this sensitivity to hormones, they can enlarge during pregnancy and breast feeding.

Fibroadenomas usually present as a lump you can feel. They may be found incidentally on a mammogram. They are usually moveable and painless, although some discomfort can be present. Many women have only one fibroadenoma, however a significant number of women have several in one or both breasts. Even if you have a history of one or more fibroadenomas, a new lump should be checked out.

If you or your doctor finds a lump in your breast, mammography and/or ultrasound will be used to evaluate it. If it demonstrates benign (non-cancerous) characteristics, it may just be followed to be sure it remains stable. Otherwise, it may need to be biopsied in the office with special needle devices using ultrasound guidance, thus avoiding surgery. It should be removed if it enlarges, or if you are comfortable with needle biopsy or follow-up.

Remember, most changes or lumps you find in your breast will not be breast cancer, but it is important that you have any change evaluated.

Caffeine

Caffeine is the most widely used drug in the world. Coffee, tea, chocolate and many soft drinks contain caffeine, and it is used to flavor some foods. It is in medications for staying awake, dieting and treating colds, allergies, migraines and muscle tension.

WHAT ARE THE HEALTH RISKS OF USING CAFFEINE?

Heart Disease and High Blood Pressure: Caffeine can produce a temporary rise in blood pressure, and people with high blood pressure (hypertension) should consult with their physician before using caffeine. Limited research links heavy coffee drinking with heart attacks. Caffeine can produce heart rhythm problems, and those subject to irregular heartbeats should avoid caffeine.

Cigarettes and Coffee: Because nicotine raises blood pressure, cigarette smoking increases the risk of cardiovascular complications for anyone with high blood pressure. A typical smoker experiences at least eight hours a day of nicotine-elevated blood pressure. Caffeine can worsen this situation. In addition to blood pressure problems, both increase stomach acid production. Coffee and smoking are a frequent, but unhealthy, combination.

Pregnancy: Caffeine enters the bloodstream and passes through the placental barrier to the fetus. Pregnant women should check with their doctor before taking any drug, including nonprescription medications, many of which contain caffeine. No significant link between birth defects and caffeine has yet been found, but the safest course is to limit caffeine during pregnancy. Caffeine is in the breast milk of mothers who ingest caffeine. No study confirms its harm, but it may affect a breast fed infants behavior, possibly leading to sleep disruptions and irritability.

Anxiety Disorders and Insomnia: Caffeine acts upon the brain and may affect coordination, sleep patterns and behavior. Delayed sleep, frequent might-time awakenings, poor sleep quality or tension-nervousness cycles may result from excess caffeine intake.

Dehydration: Caffeine has a diuretic effect. It increases urination, causing you to lose more fluid than usual. Therefore, caffeinated drinks should not be used for re-hydration after exercise, and they should not be counted as part of your "8 glasses a day" of water.

Osteoporosis: Some studies indicate that caffeine interferes with the kidney’s ability to absorb calcium and increases its excretion: this might put heavy caffeine consumers at greater risk for bone loss.

Breast Pain: Some women report a decrease in breast pain when they reduce their caffeine intake. While this has not been confirmed by research, it is certainly reasonable to try. However, if you note a new or persistent lump in your breast, don't assume it is "fibrocystic": it should be reported to your doctor.

About Mammography

A mammogram is a special type x-ray image of the breast. In order to achieve the best possible image at the lowest possible radiation dose, images are obtained with mild compression of the breast tissue to achieve a more uniform thickness for imaging. The actual compression only lasts long enough for the x-ray exposure, which is just several seconds, before compression is automatically released. This may be uncomfortable for a very short time, but is extremely important to diagnose, and will not permanently harm your breast in any way. Your registered technologist is highly trained and will work closely with you, monitoring for any discomfort and tailoring the examination to your needs. You will be acting together as a team to obtain the best quality exam we can offer.

Types of Mammograms: Baseline, Screening, and Diagnostic

You may have heard of several different "types" of mammograms such as baseline, screening, and diagnostic. Your baseline mammogram is your first mammogram, which will serve as a basis for future comparison to detect subtle changes. Screening mammograms are routine examinations performed to detect breast disease in women having no symptoms of a lump, discharge, pain, or other clinical findings. In this standard screening examination, two images of each breast are taken, one from the top (called a cranio-caudal view) and one from the side (called a mediolateral oblique view). This allows the images to display as much breast tissue possible in only two views. Diagnostic mammograms are studies performed when the patient does have a symptom, and often requires extra tailored images to fully evaluate the clinical problem.

Situations in Which You Will Need a Diagnostic Mammogram May Include:

• You feel an abnormality on breast self-examination.
• Your doctor felt an abnormality when he/she examined you.
• You have a new area of focal persistent breast tenderness or pain.
• You have one-sided nipple discharge that is clear, bloody or red-tinged.
• You had a previous finding on mammography that needs short-term follow up mammography to verify that it has remained stable.
• You have had a recent biopsy and your surgeon wants follow up images.

Age Recommendation for Screening Mammography:

• Baseline screening mammogram between age 35-39.
• All women over 40 should have annual mammography examinations.

Age Recommendations for Higher Risk Patients:

• Baseline screening mammogram when you are 10 years younger than the age at which your mother or sister was diagnosed with pre-menopausal breast cancer.
• Annual mammograms thereafter.
• Contact us about any other recommendations that might apply to your individual high risk status.

Scheduling Your Appointment

Scheduling an appointment at one of our breast centers is easy. You or your referring physician may call to speak to one of our schedulers. She will help you find a day and time that fits best with your schedule. Be prepared to give her some background information, such as your name, type of exam needed (screening, or diagnostic mammogram), date of birth, referring physician name, location of previous mammogram films and insurance information.

It is extremely important that we have your previous mammograms for comparison at the time of your appointment. This significantly increases the sensitivity of your current examination, because we can look for even subtle changes. It also can reduce the amount of additional evaluation necessary because old films can confirm stability of your present breast pattern.

Please check with your insurance company about your benefits or limitations of coverage. We will file your insurance claim at the time of your visit.

To Schedule an Appointment: - Call: 317.806.8265 About Your Visit

What happens during my visit?

1. You will report to the receptionist to complete the necessary insurance information and paperwork.
2. You will be escorted to a private changing area, given a comfortable gown, and asked to undress from the waist up. You will also be asked to remove any deodorant before your examination, because it can create an artifact on your mammogram. Spray deodorant is provided for you to reapply after your exam is complete.
3. You will be assisted by a specially trained mammography technologist who will explain each procedure and answer your questions.

Your Mammogram Results

When you are seen at one of the Breast Diagnostic Centers, you will be seen by one of the mammography technologists. If you are having a breast problem, you may also be seen by the radiologist. Once your test is completed, one of the radiologists will interpret your test and dictate a report for your referring physician. Typically, your test is reviewed and reported the same day that your test is completed, or within 24 hours of your test. This report will be sent to your primary care and/or referring physician within 1-2 working days.

Your radiology test is frequently one part of an overall diagnostic or treatment plan being directed by your physician. We report your results to him/her so that they may share them with you in the context of your entire work-up. We encourage you to contact your physician to obtain the results of your radiology testing.

You will receive a summary of your results by mail if you did not receive them at the time of your visit. In the event that there is a need to contact you following your mammogram, one of our personnel will call you, or leave a message asking you to call our office.

What if I am called back after my screening mammogram?

If there is a question of an abnormality on your screening mammogram, this may require additional imaging to fully evaluate the findings. Nationwide, approximately 1 in 10 women who have a screening mammogram will need an additional mammogram view, and possibly, breast ultrasound. Often, the possible abnormality can be from superimposed or overlapping normal glandular tissue caused by a non-uniform pattern in the normal breast tissue. The questioned abnormality often resolves when the breast is positioned in a slightly different way. If any area remains abnormal on additional mammography work-up, a breast ultrasound may be necessary as another means of evaluation. Ultimately, any suspicious or new finding may need either short-term follow up imaging to verify its stability, or occasionally a biopsy to find out the type of tissue present. Again, most of these findings are due to benign causes, but only a thorough work-up can exclude a serious lesion.

Although mammography is still the most sensitive test for identifying early breast cancer, it does not identify all breast cancers. As many as 10-15 percent of breast cancers cannot be seen with mammograms. All cancers affect the normal breast tissues, however some of these changes do not show up on mammograms. This problem is somewhat greater in younger women when the breast contains more fibrous and glandular tissue. However, mammography is still very useful.

Therefore, breast self-examination is important. A lump, particularly a new lump or fullness, can be significant even if both your mammogram and breast ultrasound have not revealed an explanation. In this case, surgical evaluation may still be necessary to determine the reason for the new lump.

Breast MRI

Breast MRI, or magnetic resonance imaging, uses a magnetic field to provide three-dimensional images of the breasts. It has been used for years without intravenous contrast (IV "dye") to evaluate implants for possible leaks. It is now being used with IV contrast as a screening tool for breast cancer. Because MRI screening for breast cancer is still relatively new, there is debate over appropriate indications, but the suggested list of indications continues to expand. In April 2007, the American Cancer Society recommended that women at "especially high risk" receive both yearly mammograms and MRI screening, which together increase the odds of finding breast cancer in its earliest form, when treatment has the greatest chance of success.

The ACS definition of women with especially high risk
of developing breast cancer includes:

• Women who have a BRCA1 or BRCA2 mutation, or a first-degree relative with a BRCA1 or BRCA2 mutation. Mutation of BRCA1 or BRCA2 can reflect an increase an individual's risk of breast cancer up to 85 percent.
• Women with a 20 to 25 percent or greater lifetime risk of breast cancer. Your risk can be calculated by your doctor, using one of several accepted risk assessment tools, which includes assessment of first degree relatives with breast cancer
• Women who received radiation to the chest between the ages of ten and 30 for the treatment of childhood cancers such as Hodgkin's disease.

Also, a 2007 study in the New England Journal of Medicine suggests that MRI should also be performed for women who have newly diagnosed cancer in one breast. This may affect therapy plans and ultimately reduce treatment time.

Unfortunately, these guidelines do not cover all categories of women at high risk, and insurance carriers vary in their coverage of Breast MRI. At present, Breast MRI remains generally accepted as a screening tool only, and therefore we do not commonly perform Breast MRI as part of an initial diagnostic evaluation of a clinical (physical exam) or mammographic finding.

Breast MRI is performed with the patient lying on her stomach. Your breasts will be positioned through special round openings in the table. If the MRI is being performed to evaluate for possible implant rupture, no IV is needed. If the MRI is being done to evaluate for breast cancer, an IV is started before the exam.

MRI Guided Breast Biopsy

"Why do I need an MRI Guided Breast Biopsy?"

Your breast MRI has revealed a possible abnormality, or "lesion", in your breast which was not visible on mammography or ultrasound, and cannot be felt. A possible lesion on your MRI can be evaluated in one of two ways. Either it is "followed" over a period of time with MRI to see if there is a significant change, or a biopsy is done to remove some or all of the tissue.

Lesions are "followed" if it is felt they are very likely to be benign. Biopsies are done if an area is more worrisome in appearance, or just not specific enough in appearance to wait for follow up. Also, biopsy can be done if a patient is not comfortable with the idea of waiting four to six months for follow up.

"How do I prepare for an MRI Guided Breast Biopsy?"

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as 5-7 days before the biopsy.

You can take your other medications, and eat your usual breakfast before the biopsy.

"How is the MRI Guided Breast Biopsy performed?"

The MRI-guided needle biopsy procedure will be performed by one of four breast center physicians who specialize in needle biopsy, with assistance from a radiologic (x-ray) technologist, also with a background assisting in this procedure.

After arriving at the office, you will change into a hospital gown, and you will be escorted to the MRI room. An IV will be started. The technologist will ask you to lie face down on the MRI table, just as you did for your Breast MRI. Your breast will be compressed with a compression paddle. MRI images will be taken, and after IV contrast is given, the exact position of the biopsy is determined. Next, the physician will numb the entire biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast, at the numbed area. Once placement is confirmed by additional MRI images, the physician will acquire tissue samples through the needle. When the physician has retrieved all the samples, a tiny (1/8") metallic clip will be left in place to permanently mark the biopsy site. You will not be able to see or feel this clip, but it is extremely helpful in confirming accurate biopsy and in assessing your mammograms in the future. Placing this clip is an absolute requirement of this procedure. The compression paddle will be released from your breast and the technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding, and reduce any possible bruising. Next, a regular mammogram will be obtained, which will serve as a useful baseline for future mammography. Afterwards, a dressing will be applied which you will wear home. You will not need any stitches or sutures. You will go home with printed post-procedure care instructions.

"Will it hurt?"

The entire area is anesthetized to make the procedure as comfortable as possible. Each patient’s experience is slightly different, but patients occasionally report that they feel pressure or a slight discomfort in the biopsied area, as the procedure is being done. We talk to you throughout the entire procedure to keep you informed and make sure you are comfortable.

"Will I be able to resume my normal activities right away?"

After the technologist has applied a dressing to the biopsy site, you may get dressed. Most women feel fine after the procedure and return to their normal routine right away. However, we recommend that strenuous exercise or activity be avoided for at least 24 hours. You may drive after the procedure.

"When can I expect the results of my biopsy?"

The Breast Center physician performing the biopsy will send the tissue samples to the lab, where a doctor (pathologist), will look at the samples under a microscope. The pathologist will make a diagnosis and fax a report to our office, usually in two to three business days. We will contact you to discuss your results, unless your surgeon prefers to do this.

"What are the risks associated with this procedure?"

There is a risk of bleeding or bruising, and a very small risk of infection. There is small risk of obtaining non-diagnostic samples, requiring re-biopsy. If you have implants, there is a small risk of rupture/puncture of the implant.

"What if I have more questions?"

It is important that you have all of your questions about the biopsy procedure and results answered. Please do not hesitate to call us with any question that you have before or after your biopsy.