Breast cancer screening and diagnostic examinations are tailored to each patient’s particular risk factors. They may include digital mammography with tomosynthesis, breast ultrasound and breast MRI, as well as image-guided biopsies under each of these imaging types in a personalized, compassionate, and caring manner.

We offer the following screening services:

• 2-D & 3-D tomosynthesis diagnostic & screening mammograms
• Breast Ultrasound
• Breast MRI
• Breast Biopsies

Mammograms

Screening mammography
Screening mammography is recommended to be done every year beginning at age 40 for early breast cancer detection when a patient has no symptoms and no problems are suspected. If a problem is discovered, a diagnostic mammogram (additional mammographic views of the breast) or ultrasound may be necessary. If the breasts are too dense, a mammogram may not be enough to make an accurate determination, and additional screening is done with ultrasound. A breast MRI or contrast-enhanced mammogram may be ordered for patients at high risk.

Mammograms can be 2D (in which two-dimensional views are performed for each breast) or 3D, also known as Breast Digital Tomosynthesis, in which multiple images are taken in each breast, with the same amount of radiation as a regular 2D mammogram. 3D mammography has proven to have better accuracy for breast cancer detection, especially in women with dense breasts.

At Sylvester Comprehensive Cancer Center, we use Digital Breast Tomosynthesis (3D mammogram) for all our mammograms.

Diagnostic mammography
A diagnostic mammogram is performed when a person has a symptom like nipple discharge, a lump, or localized pain. It may also be used when a patient has had cancer or an abnormal screening mammogram. Diagnostic results are provided at the time of evaluation by a physician to each and every patient to minimize the anxiety and discomfort of unknown results.

Contrast-enhanced mammograms (CEM)
CEM uses the same equipment as a mammogram but includes upgraded software. Intravenous iodine contrast is given before the mammogram to help find cancer in areas in which contrast accumulates. The ideal candidates are women at intermediate risk of developing breast cancer, such as women with a personal or family history of breast cancer, who've had a prior high-risk lesion at biopsy, or even some women with high breast density.

CEM is also an option for women at very high risk who need a breast MRI but have issues like severe claustrophobia, implantable devices that are not compatible with the MRI or have gadolinium allergies. Sylvester is the only NCI-designated cancer center in South Florida offering the new technology of contrast-enhanced mammograms for breast cancer detection.

Breast Ultrasound

High-resolution breast ultrasound is a non-invasive test that may be recommended if you have dense breasts or are at a higher risk of breast cancer, as well as if the mammogram showed an abnormality such as a mass or nodule that needs to be further evaluated. Ultrasound creates images of the breast tissue using sound waves instead of X-rays. These images show the breast tissue in different orientations and can sometimes "see through" dense breast tissue better than a mammogram.

Breast Magnetic Resonance Imaging (MRI)

Many patients will benefit from a breast MRI in addition to a mammogram, especially for increased surveillance in patients with a 20 to 25% or higher lifetime risk for breast cancer. A breast MRI captures multiple images of your breast using magnets, radiofrequency waves, and intravenous contrast called gadolinium. Breast MRI images are combined to create detailed pictures of suspicious areas where contrast accumulates.

A breast MRI, in addition to an annual screening mammogram, is recommended as a supplemental breast cancer screening tool for people:

• with the presence of high-risk breast lesions such as atypia or lobular carcinoma in situ, multiple prior biopsies, and other risk factors
• at high risk of breast cancer
• who have a very strong family history of breast cancer
• who carry a hereditary breast cancer gene mutation
• who had radiation therapy to the chest, such as for lymphoma, prior to the age of 30

For women who have had a mastectomy for cancer and undergone implant reconstruction, a mammogram is not done on that side because the chances of cancer are minimal. If there are symptoms, such as a lump or pain, a breast ultrasound or MRI may be recommended.

A breast MRI may also be performed after you have a biopsy that's positive for cancer and your doctor needs more information about the extent of the disease.

Breast Biopsies

Breast disease may appear in many forms: it may be benign (not cancer) and may or may not need treatment. The breast care experts at Sylvester work together in multidisciplinary teams to analyze the makeup of your particular growth and determine the best course of action to give you the best health outcome.

Biopsies are usually image-guided procedures using stereotactic mammography, ultrasound, or MRI guidance and can be performed in the office using local anesthesia to numb the site of the biopsy. During the procedure, a small sample of the suspicious breast tissue is removed (biopsied) and tested.

Biopsies can be performed in several ways, depending on the circumstances:

• Image-guided core needle biopsy: The radiologist uses a hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area, guided by ultrasound or mammographic imaging. Typically, three to 12 samples are obtained during the procedure with a tiny vacuum or spring-cutting device. Sometimes, a biopsy may be performed under MRI guidance if the suspicious area can only be seen on breast MRI.
• Cyst aspiration: Your imaging exam may reveal fluid-filled sacs or cysts within your breast. The good news is that these are usually not cancer. If the cysts are painful, your surgeon or radiologist can insert a needle and drain them.
• Surgical biopsy: Sometimes, an incision or a small cut is required. During this procedure, the surgeon will remove a sample of the breast tissue for diagnosis. Sometimes, the whole abnormal area will need to be removed, and sometimes, just a portion of the abnormal area will be removed. This depends on how large the abnormal area is. These types of biopsies are performed by the surgeon in the operating room.
  At Sylvester, all our radiologists specialize in breast imaging and, are dedicated to the diagnosis of breast disease and participate in a multidisciplinary team that treats patients with breast cancer and high-risk breast lesions. This greatly increases the accuracy and ability to spot abnormalities. They also have more experience in performing biopsies and localization procedures.

After a cancer diagnosis is made, several tests can be performed on the biopsy sample to determine the exact type and treatment options:

• Estrogen and progesterone receptor test: This test measures the amount of estrogen and progesterone (hormone) receptors in your cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer may grow more quickly. Test results show whether treatment to block estrogen and progesterone is needed.
• Human epidermal growth factor type 2 (HER2/neu) receptor test: This test measures how many HER2/neu breast cancer cells are present in the specimen sample. If there is more HER2/neu protein than normal, the cancer is more aggressive and may grow or spread more quickly and a special chemotherapy is indicated.
• Oncotype DX and MammaPrint: These tests help predict whether stage I or stage II breast cancer that is estrogen receptor positive and HER 2neu negative are at increased or decreased risk. If the risk of the cancer spreading is high, your oncologist may recommend chemotherapy to lower the risk of the cancer spreading later, in addition to an estrogen-blocking agent. If it is low, you won’t need chemotherapy; just an estrogen blocking agent.

What are High-Risk Breast Lesions?
High-risk breast lesions increase the risk of developing breast cancer in the future. They are identified as pathology after a biopsy of the breast is performed.

High-risk breast lesions include atypical ductal hyperplasia, flat epithelial atypia, complex sclerosing lesions/radial scar, atypical lobular hyperplasia, and lobular carcinoma in situ. Some of these high-risk breast lesions will require surgical excision to evaluate a larger area of breast tissue and confirm that breast cancer is not present. In patients with high-risk breast lesions, the doctor may recommend additional breast cancer screening with breast MRI. In addition, medications that block estrogen activity or reduce estrogen production may reduce the risk of developing breast cancer.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Breast Imaging Center of Excellence designation by the American College of Radiology. You benefit from the expertise of our board-certified, fellowship-trained radiologists who are experienced in a variety of breast cancer detection approaches. We provide services in four convenient locations, the Gail S. Posner Pavilion for Breast Cancer Care at the Braman Family Breast Cancer Institute, Lennar Foundation Medical Center, Sylvester Plantation, and Sylvester Deerfield Beach.

Breast Imaging Center of Excellence designation by the American College of Radiology. The Breast Imaging Centers of the University of Miami, Sylvester Comprehensive Cancer Center, and Miller School of Medicine have two facilities that consist of a group of board-certified and fellowship-trained breast-dedicated radiologists with experience and training in all imaging modalities for the evaluation and detection of breast pathology.

The only cancer center in South Florida offering the new technology of contrast-enhanced mammograms in breast cancer detection. It uses the same equipment as a mammogram with upgraded software and intravenous iodine contrast to enhance the images.

State-of-the-Art Lennar Foundation Medical Center Women’s Imaging Center in Coral Gables. Every woman receives personalized care with a one-stage visit for every screening and diagnostic mammogram. Ultrasound and even biopsies can be done at the same visit.