A Team Approach to Breast Care

Montgomery Regional Hospital's breast care physicians and healthcare professionals have joined together to provide comprehensive care in all phases of treatment for breast problems, breast cancer and other cancer diagnoses.

We look at breast health from a woman's point of view and are committed to:

• Diagnosing breast cancer early and accurately
• Responding to a woman's concerns immediately, with compassion and support
• Working together with the patient to determine her best treatment plan
• Taking time to educate the patient
• Caring for the patient as an individual, not as a disease

MRH Clinical Breast Care Team

The MRH Clinical Breast Care Team includes radiologists, women's health physicians, and other members of the Clinical Breast Care Team who work closely to provide a holistic approach to individualized patient care.  A registered nurse with unique training as a breast health specialist is also available to assist patients throughout all phases of the diagnostic/treatment process by answering questions, scheduling appointments, locating resources, and providing personal support in a manner which is comfortable for each individual.

Understanding the Process

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life.  Normally, cells grow and divide to produce more cells only when the body needs them.  Sometimes, however, cells keep dividing when new cells are not needed.  These extra cells form a mass of tissue called a growth or tumor.  Tumors can be benign or malignant.

Benign tumors are not cancer.  They can usually be removed, and in most cases they do not spread to other parts of the body, and are not a threat to life.

Malignant tumors are cancer.  Cells in these tumors are abnormal.  They divide without control or order, and can invade and damage nearby tissues and organs.  Cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system.  That is how cancer spreads (metastasizes) from the original (primary) cancer site to form new tumors in other organs.

Diagnosing Breast Cancer

To help find the cause of any signs or symptoms of breast cancer, a physician or nurse practitioner does a careful physical exam and asks questions about personal and family medical history.  In addition, he/she may do one or more of the following.

Clinical breast exam.  A practitioner can tell a lot about a lump by carefully feeling it and the tissue around it.  (Benign lumps often feel different from cancerous ones.)  He/she can examine the size and texture of the lump and try to determine whether the lump moves easily. Other signs and symptoms that warrant further study include not only a lump but a thickening of the breast tissue, a change in the size or shape of the breast, nipple discharge, dimpling, puckering, or scaling of the skin or nipple or any change from the norm.

Mammography.  A mammogram is the best tool available for finding breast cancer early, before symptoms appear.  Mammograms can often detect a breast lump before it can be felt.  Although mammograms are the best way to find breast abnormalities early, they do have some limitations.  A mammogram may miss some cancers that are present (false negative) or may find things that turn out not to be cancer (false positive).For more detailed information about mammography click here.

Computer-Aided Detection.  MRH uses the ImageChecker system in conjunction with all screening and diagnostic mammography exams.  The first FDA-approved Computer Aided Detection (CAD) system for breast imaging, R2 assists radiologists during their review of mammograms by identifying abnormalities that may be indicative of cancer.

Ultrasound.  Using high frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).

If an area of the breast looks suspicious as a result of any of these diagnostic tests, your doctor may advise you to have a biopsy.

Biopsy

If a biopsy is requested fluid or tissue is removed from the breast to assist your physician in providing a diagnosis.  He/she may refer you to a member of our Clinical Breast Care Team for one of the following:

Fine needle aspiration.  A thin needle is used to remove fluid and/or cells from a breast lump.  If the fluid is clear, it may not need to be checked by a lab.

Core Needle Biopsies

Free Hand Core. Core needle biopsies involve removing small samples of breast tissue using a hollow (core) needle.  One method is a free hand procedure which is used for lumps that can be felt.  The area biopsied is cleaned and injected with a local anesthetic where the needle will be inserted.  Three to six separate samples of tissue are usually taken.  The tissue removed is sent to the lab to be evaluated by the pathologist.

Ultrasound Guided Core.  Ultrasound can be used as an imaging tool to locate the abnormality that cannot be felt.  The radiologist locates the area with ultrasound and guides the biopsy needle to obtain the core samples.

Mammotome Stereotactic Core Biopsy.  Stereotactic biopsy is a core biopsy using specialized equipment to take a series of mammography films to locate the biopsy area on a computer.  The radiologist then calculates where the needle should be inserted. This biopsy procedure is used for areas that are identified in the breast by mammography, such as microcalcifications. The procedure is done as an outpatient in the hospital.  Stereotactic procedures are done with the woman lying on her abdomen on a special table with her breast hanging through a hole in the table. The breast is injected with a local anesthetic and a small surgical slit is cut in the breast to allow the biopsy probe to pass into the breast. (No stitches are required after the procedure).  The biopsy probe is connected to a vacuum line that pulls tissue into the sampling chamber. The physician can rotate the probe without removing it from the breast with each sampling. 8 -12  tissue samples are removed from the breast and sent to the lab for a pathologist to evaluate. A small sterile clip may be placed into the biopsy site to mark the area in case a future biopsy is needed. The procedure takes about 30 minutes to 1 hour. 

Incisional Biopsy.  An Incisional biopsy is the removal of a small piece of the suspicious area under either local anesthesia or general anesthesia. The sample of breast tissue is then sent to the lab to be evaluated by the pathologist.

Excisional Biopsy.  Excisional Biopsy is the removal of an entire lump or suspicious area by a surgeon.  The area surrounding the area, referred to as the margin may be removed at the same time.  The size of the incision varies according to the size of the lump removed and the area is closed with several stitches.

We're Here for You!

If you have any questions or wish to receive more information, call us at 540-553-0849.  For additional resources for breast cancer click here.