At Siteman Cancer Center, we have a long history of offering the best imaging services to screen for and diagnose breast cancer. WashU Medicine physicians at Siteman are experts in screening and diagnostic mammography and are pioneering how AI can be leveraged for breast health in the future.
Our Joanne Knight Breast Health Center at the Werths building and the Center for Advanced Medicine 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
- Cyst aspiration
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.
Pioneers in Breast Cancer Risk Prediction
WashU Medicine researchers Graham A. Colditz, MD, DrPH, and Shu (Joy) Jiang, PhD, developed a powerful AI-software tool, Prognosia Breast, that received Breakthrough Device designation by the Food & Drug Administration in 2025. This designation means it is not FDA approved but has been moved quickly into testing to evaluate its accuracy when analyzing mammograms to predict a person five-year risk of developing breast cancer.
Debbie L. Bennett, MD, the Ronald and Hanna Evens Endowed Professor of Women’s Health at Barnes-Jewish Hospital and chief of breast imaging for WashU Medicine Mallinckrodt, serves on the National Comprehensive Cancer Network Breast Cancer Screening and Diagnosis Panel, and is a leader in helping shape guidelines for breast cancer screenings within the American College of Radiology.
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.
Early Signs That May Signal Breast Cancer
The first step of lifelong breast health is being self-aware about your own breasts. If you know how your breasts feel and look throughout your life, you can more quickly notice any changes that should be discussed with your doctor, no matter your age.
Things to keep a look out for:
- Lump or “knots” in your breast or armpit
- Changes in the size or shape of your breast
- Dimpling or puckering on your breast
- Unusual changes in your nipple(s), such as a discharge or if the nipple has turned inward
- Unexplained and persistent breast pain or redness
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 may need to begin earlier if, based on your own medical and family history, you are considered at high risk.
You might be considered at higher 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
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.
Breast Density and Mammography
Every mammogram mentions the density of a woman’s breast. It’s a newer, federal guideline. If you’ve noticed this addition on your mammogram, it’s good information to have for your breast health.
Dense breast tissue is common; isn’t an immediate reason to be concerned; and because it can be associated with a higher risk of breast cancer, it can benefit from the knowledge and expertise of WashU radiologists at Siteman.
Our patients who have dense breasts get specialized care that matches their needs. Sometimes they benefit from additional imaging and more frequent monitoring. The WashU Medicine experts who lead this care develop a plan specific to them and their level of lifetime risk.
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 directly 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.
- 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.
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.
Nurses at Siteman answer every call and every form. Speak with them directly 8:00 am to 4:30 pm CT Monday- Friday for guidance on appointments, second opinions, and referrals.