Finding a lump or noticing a change in your breast can bring a rush of questions. What is it? Which tests will I need? When will I get answers?
Wollongong Diagnostics breast radiologist Dr Alok Gupta understands how difficult that uncertainty can be.
“The worst part, I feel, is the uncertainty,” he said.
Breast imaging helps investigate a concern and guide the next step. Mammography, ultrasound and breast MRI provide different information, and the right combination depends on your circumstances.
Start with your GP
If you notice a new lump, a change in breast shape, skin or nipple changes, or another unusual symptom, make an appointment with your GP.
They will ask about the change, consider your medical and family history, and may examine your breasts. If imaging is needed, they can provide a referral describing the concern.
Routine screening is for people without symptoms. A new breast change needs a diagnostic assessment, even if your most recent screening mammogram was normal.
What mammography and ultrasound can show
Mammography uses X-rays to examine breast tissue. Wollongong Diagnostics offers 3D mammography, also called tomosynthesis, at Kiama and Corrimal.
It takes images from different angles so the radiologist can examine thin layers of tissue. This helps distinguish abnormalities from overlapping breast tissue.
Ultrasound uses sound waves to assess an area more closely. It can help investigate a lump and determine whether a finding is fluid-filled or solid.
Dr Gupta says mammography and ultrasound are commonly used together when investigating breast concerns. Your age, symptoms, history and previous imaging help determine which tests are appropriate.
Why breast MRI may be recommended
Image: Wengert et al. (2019), Current Breast Cancer Reports, Figure 1. Source. CC BY 4.0. Image unchanged.
Sometimes mammography and ultrasound do not provide all the information needed. Breast MRI can add information that helps detect or assess an abnormality.
Contrast-enhanced breast MRI is the most sensitive breast imaging method for detecting cancer. Unlike mammography, its sensitivity is not limited by breast density in the same way.
This is important because dense tissue can conceal cancers on mammograms, including 3D mammograms. MRI may detect cancers that are not visible on mammography or ultrasound.
Depending on your circumstances, breast MRI may be considered:
- As additional screening for women at high risk of breast cancer or with extremely dense breasts.
- To help investigate an unresolved concern when other assessments have not provided a clear answer.
- After a cancer diagnosis, to help assess its size and extent, or look for additional areas of disease.
MRI does not replace every mammogram, ultrasound or biopsy. Each test has a different role, and persistent symptoms still need clinical review.
What to expect from breast MRI
Breast MRI uses a magnetic field and radio waves rather than X-rays. For cancer detection and assessment, it generally involves an injection of contrast into a vein.
You lie face down with your breasts positioned in a dedicated support and need to remain still while images are taken. The team will check your suitability beforehand, including relevant implants or devices and any concerns about contrast.
MRI can also identify findings that turn out to be benign, leading to additional imaging or a biopsy. Your doctor and radiologist can explain the expected benefit and any limitations for you.
When a biopsy or follow up is needed
Imaging cannot always establish exactly what a finding is. A biopsy takes a tissue sample for laboratory examination; a recommendation for one is not itself a cancer diagnosis.
Other findings may need repeat imaging after a set period. Before leaving, ask when and how you will receive results and who will explain the next step.
If a change persists or worsens despite reassuring results, return to your GP. Further assessment may be needed.
Book breast imaging at Wollongong Diagnostics
Wollongong Diagnostics provides breast imaging including 3D mammography, ultrasound and breast MRI, with biopsy services where required.
Noticed a change? Speak to your GP and ask about a referral to Wollongong Diagnostics.
If you have dense breasts or a higher breast cancer risk, ask your GP or specialist whether breast MRI could be appropriate. Contact our team to discuss breast MRI appointments, referral requirements and applicable fees.
Already have a referral? Book your breast imaging appointment with Wollongong Diagnostics.