Breast Cancer Screening & Diagnosis

At Siteman Cancer Center, we have a long history of offering the best imaging services to screen for and diagnose breast cancer. Our doctors also invented and now regularly use a powerful AI-tool that reviews your mammograms over time to help predict your risk of developing breast cancer.

Our Joanne Knight Breast Health Center was one of the first facilities in the country to be designated by the American College of Radiology as a Breast Imaging Center of Excellence. In one coordinated, multidisciplinary program, we have a full array of services that includes screenings, diagnostic imaging, biopsies, and rapid access to oncologists, radiologists, and breast surgeons at Siteman Cancer Center.

We are a fully 3D digital breast health center. 3D mammography has been shown in studies to reduce call back rates by as much as 40%. Digital imaging also means that we can rapidly check that all the images we take are clear and capture the breast from multiple angles.

The Siteman Mammogram: Precise and Personalized

Where you receive your mammogram matters. Siteman brings excellence to every screening and diagnostic mammogram. The expertise and technology behind every Siteman mammogram set a standard other centers cannot match.

Siteman imaging specialists capture every image using all-digital 3D tomosynthesis, a technology that delivers exceptional clarity and precision, every time.

Every image is interpreted by WashU Medicine radiologists, specialists with hundreds of combined years of subspecialty training in breast cancer who are skilled at identifying signs of disease at its earliest, most treatable stage.

Siteman has the technological expertise and capability to personalize your mammogram. Your imaging is guided by your specific needs and risk factors, including dense breast tissue, implants, or piercings. For those with elevated risk, we use contrast-enhanced mammography and go beyond the annual mammogram, offering additional imaging, genetic counseling, and consultation with Amy Cyr, MD, who leads our high-risk breast clinic.

Imaging Services

• All 3D digital mammography (tomosynthesis) 
• Diagnostic mammograms 
• Breast ultrasound 
• Breast Magnetic Resonance Imaging (MRI) 
• Contrast-Enhanced Mammography 

Biopsies and Diagnostic Procedures

• Image-guided core needle biopsy 
• Fine needle aspiration 
• Cyst aspiration 
• Ductography 

The Team of Breast Screening Specialists at Siteman

All members of our team are experts in breast screenings and care. Many are national and internationally recognized leaders in the field, pioneering new technologies and shaping guidelines for breast imaging. All our radiology technologists at Siteman also have advanced specialty certification in breast mammography and have undergone rigorous training in breast anatomy and physiology, positioning and compression, and imaging patients with breast implants.

With our expertise, you can be assured that you will get clear, accurate screenings with us.

Breast Screening Mammogram

Mammograms, which are low-dose X-rays of your breasts, are recommended as a preventive measure against breast cancer. Mammograms can oftentimes find cancer at its earliest stages, when it is most treatable, even when you do not notice any symptoms.

When to Start Screening Mammograms

At age 25, talk with your doctor about a breast cancer risk assessment. There are several online you can take yourself, but you will need an expert to guide you. Your doctor will review your medical and family history and suggest when you should start annual screenings.

If you are at average risk:

• Between ages 25-40: Clinical breast exams should be done every one to three years. 
• Age 40: Start annual screening mammograms and continue clinical breast exams.
• Age 55+: You may be able to transition scheduling a mammogram to every two years if you have been healthy and your doctor recommends it.

Know your own breasts. Regardless of your age or when you had your last mammogram, talk with your doctor if you notice any unusual symptoms or if a family member has developed breast cancer.

Guidelines for High-Risk Individuals

Annual screenings should begin earlier if, based on your own medical and family history, you are considered at high risk.

You are at high risk if there is:

• A family history (mother, sister, daughter) of breast cancer, ovarian cancer, or male breast cancer 
• Several relatives on the same side of the family who have had breast cancer 
• A gene mutation that increases your risk for developing cancer 
• A personal history of radiation treatments to the chest before age 30 
• Dense breast tissue that increases cancer risk and may make it difficult to see small tumors 

If you have a family history of breast cancer, our physicians recommend that you begin yearly mammograms and clinical breast exams 10 years before the age your youngest relative developed breast cancer.

The High- Risk Breast Cancer Clinic at Siteman cares for patients who may have elevated risks for breast cancer. The clinic coordinates genetic testing and counseling when a patient has a family history of cancer or an inherited breast cancer gene. Amy Cyr, MD, leads the clinic and closely follows patients over time with additional screenings and interventions, like risk-reducing therapies.

Talk with your doctor about receiving genetic counseling if you have a strong family history or a known inherited breast cancer gene.

Schedule Your Mammogram Today

You can refer yourself directly to our breast health specialists at Siteman Cancer Center for your Siteman mammogram.

Siteman accepts patients who want second opinions, also. Even if your screening or diagnostic mammograms were done elsewhere, call us, and we can transfer your images free of charge direct to our institution to review and discuss next steps.

Our oncology-trained care coordinators — nurses who help with scheduling and navigation — can help you through the process of setting up your Siteman mammogram.

Talk with them directly at 800-600-3606.

Mammograms if You Have Breast Implants or Nipple Piercings

Mammograms are safe and effective even if you have breast implants or nipple piercings. With implants, we can gently image breast tissue with minimal movement. Studies have shown that it takes 50 times the pressure of a mammogram to cause a rupture.

With piercings, you likely will be asked to remove nipple rings to prevent shadows on your X-rays, which can require additional scans. If you cannot remove your piercing, talk to us prior to coming in for a mammogram. There are certain techniques we can use, including the use of a non-metal covering, to enable you to get your mammogram.

Always inform our team if you have piercings or implants prior to and on the day of your screening.    

Breast Cancer Screenings for Men

Males also have breast tissue. While it is uncommon, the American Cancer Society and the National Cancer Institute estimate that 2,800 males develop breast cancer each year in the United States.

Males should know the early symptoms for breast cancer and, if you are at high risk, you should talk with your doctor about regular breast screenings, especially if you have a strong family history of breast and other cancers. You can call to set up a screening at Siteman to establish care with our experts.

Taking a Closer Look: Diagnostic Tests for Breast Cancer 

If your screening mammogram detects something unusual, or if you already have noticed early symptoms, such as a lump in the breast, or itchiness or redness that won’t go away, we recommend more comprehensive testing.

• Diagnostic Mammogram: This is usually scheduled if your initial mammogram indicates something abnormal or if you have already noticed early symptoms. Diagnostic mammograms take images from multiple angles (more than in a screening mammogram) and usually focus on a specific area of concern. Diagnostic mammograms can help doctors determine if a lump is non-cancerous or is something that should be examined further.
• Contrast-Enhanced Mammography (CEM): If you are at high risk or have dense breasts, CEM may be recommended. Most times, dye will be injected into your arm to help highlight any cancerous tissue before you have your diagnostic mammogram. CEM also is used to check the progress and effect of chemotherapy prior to surgery.
• Breast MRI: More sensitive than mammography, breast MRIs are often recommended for high-risk individuals or those with dense breast tissue.
• Breast Ultrasound: Uses sound waves to create images and helps doctors determine whether a mass that was identified in a screening or diagnostic mammogram is solid or a fluid-filled cyst. Breast ultrasound also can be used as a first or extra screening option for those who are pregnant or who have very dense breasts. 

Breast Tissue Biopsy 

If an imaging test finds something suspicious, or if doctors are concerned about a lump that does not go away, you may be asked to undergo a breast biopsy. A biopsy means that doctors will take a small sample of your breast tissue or remove some fluid to examine under a microscope.

A biopsy does not always mean you have cancer. In fact, biopsies can also confirm a lump is benign, or non-cancerous.

Types of Biopsies 

• Image-guided core needle biopsy: This is one of the most common procedures for imaging follow-up. A doctor will use a small, hollow needle to remove tiny pieces of tissue from a suspicious area. During the procedure, imaging is used in real-time to help guide the needle to the exact spot to be tested.
• Fine needle aspiration: As its name suggests, a very thin needle is used to withdraw cells or fluid. It is similar to how a nurse draws a blood sample from your arm. It is less invasive than a core needle biopsy but also collects fewer cells.
• Cyst aspiration: A small needle is used to retrieve fluid from inside a cyst (fluid-filled sac). This procedure can be done to simply remove the fluid from a benign cyst that may be causing pain or discomfort as well as to check for cancer.
• Ductography: If you have unusual nipple discharge, doctors will place a small tube into a duct at the nipple. Contrast dye is then added, and imaging will be done to check for blockages inside the milk ducts or to look for abnormal growths.

Breast Biopsy Clip 

At the time of your biopsy, radiologists may place a small metal clip, called a tissue marker, where the biopsy was done. This clip is so that future imaging tests will be able to accurately note the exact area that was biopsied. The clip is not noticeable, and you can’t feel it. You also can still get MRIs and go through metal detectors without a problem. 

Screenings find areas that need more evaluation. Diagnostic imaging takes a closer look. Biopsies confirm if you have cancer.