Advanced Diagnostic Breast Center in Richmond, Virginia
Henrico Doctors’ Hospital is proud to house the Advanced Diagnostic Breast Center, which has been recognized by the American College of Radiology as a Breast Imaging Center of Excellence. Our facility reads over 13,000 mammograms each year and our breast care team focuses on making women’s health a top priority.
To schedule your mammogram, call us at (804) 327-8702.
Why is screening for breast cancer important?
Breast cancer will affect one in eight women in their lifetime, and the two most common risk factors are being a woman and getting older. At Henrico Doctors’ Hospital in Richmond, we offer screening and diagnostic mammograms and imaging services to detect breast cancer in its earliest stages.
The common recommendation is for women 40 years old and older to receive an annual screening mammogram unless otherwise advised by their primary care physician. Women who have a family history of breast cancer or have certain risk factors for the disease may be advised to start receiving mammograms at an earlier age. We offer both 2D and 3D digital mammography, which means we can offer care for women who may have no concerns or symptoms as well as to women who are experiencing problems like a lump or unusual nipple discharge or pain.
Mammography and breast imaging services
3D mammography is advanced technology that allows doctors to examine breast tissue one layer at a time. If your radiologist finds an abnormality during your screening mammogram, you will be called back for a diagnostic mammogram, ultrasound or MRI to determine the diagnosis. Our screening mammograms use low X-ray energy, so your exposure is well below the Food and Drug Administration (FDA) guidelines.
If there is concern about the results of your imaging tests, a biopsy may be recommended for a more precise diagnosis. If the radiologist recommends diagnostic imaging, your primary care provider will need to order the tests.
Breast ultrasound is a painless, noninvasive imaging test that does not involve the use of radiation. Radiologists use this imaging procedure to further evaluate abnormalities that show up during a mammogram. If you are 30 years old or younger, your doctor may recommend a breast ultrasound before a mammogram to evaluate a breast lump that can be felt through the skin.
Breast magnetic resonance imaging (MRI) involves powerful magnet technology (without radiation) and uses 3D techniques to look deeper into the breast to find abnormalities that might not be visible through other types of examinations. Breast MRI can be used to screen women who are at a high risk for developing breast cancer, to evaluate the extent of a patient’s cancer following diagnosis or to further evaluate abnormalities found on a mammogram.
Breast MRI is not a replacement for a mammogram, which is still the gold standard for breast health screenings, but is the best method for determining whether silicone breast implants have ruptured.
Breast density evaluations
Breast tissue is made up of a mixture of tissue types: fibrous, glandular and fatty tissue. Fibrous and glandular tissue appears white on a mammogram while fatty tissue appear black. Your breasts are considered to be dense if you have a lot of fibrous or glandular tissue but not much fatty tissue. Density may increase with age, but there is little, if any, change in most women.
Your radiologist can identify if you have dense breast tissue. It is important to know if you have dense breast tissue as it can make it more difficult for physicians to spot cancer on mammograms. If you have dense breasts, please talk to your doctor. Together, you can decide whether additional screening exams are the best option for you.
High-Risk Breast Clinic
Henrico Doctors' Hospital, affiliate of Sarah Cannon Cancer Institute, is proud to offer women access to our High-Risk Breast Clinic. The High-Risk Breast Clinic is a resource for women identified as having an increased chance of developing breast cancer. Our clinic offers high-risk women access to supplemental screening services to detect and treat breast cancer in its earliest stages. Other comprehensive components of our breast clinic include genetic counseling, smoking cessation, nutrition counseling and pharmaceutical risk reduction.
What makes a woman high risk for getting breast cancer?
The average woman has a 12 percent (one in eight) chance to develop breast cancer in her lifetime. When a woman’s risk is 20 percent or greater due to the factors below, she is considered high risk:
- Family history
- Breast density
- Atypical breast tissue
- Hormonal variations
Keep in mind that risk is age and breast density dependent, meaning it can fluctuate over a patient’s lifetime.
Many people know about the BRCA1 and BRCA2 gene mutations, which place some women at very high risk for developing breast cancer. These mutations are only present in a very small portion of women who are high risk. Many high-risk women do not have these or other known gene mutations.
How is breast-cancer risk calculated?
- During the initial visit to the High-Risk Breast Clinic, each patient will fill out a history form in the waiting room. The information from the form is reviewed and imported into the electronic medical record by the mammogram technologist.
- The medical record has built-in risk models, which can calculate a lifetime risk score for each patient (assuming she hasn't had a previous breast cancer).
- There are multiple risk models; however, the most widely used one is called the Tyrer-Cuzick risk model.
- When a woman has a Tyrer-Cuzick lifetime risk at 20 percent or greater, she is considered high risk and would benefit from a referral to the High-Risk Breast Clinic.
What if I am considered high risk for breast cancer?
- When a woman is identified as high risk, the breast imaging radiologist reviewing the mammogram (or other breast-imaging study) will insert a high-risk phrase in the report to let the referring provider know her lifetime risk and that she is high risk.
- The patient is notified by a letter that she is high risk, which will explain what that means and what her next steps should be.
- A breast-imaging navigator is notified and will follow up by phone with the patient in two business days to review her high-risk status and what her options are at that time.
- If a woman is high risk, it is recommended that she be seen in the High-Risk Breast Clinic for a more thorough evaluation.
What is supplemental screening for breast cancer?
- Some women may not be high risk (over 20 percent lifetime risk), but they are higher than average (above 15 percent). This is intermediate risk.
- If a woman is intermediate risk (between 15 to 20 percent lifetime risk) and has dense breasts, there are other tests that can be added to an annual mammogram to better detect breast cancer.
- Many women with dense breasts are younger and have a longer life expectancy, which means early detection is key to saving lives.
- Having dense breasts is normal and very common. Almost half of all women screened have dense breasts. Dense breasts are seen most commonly in younger woman and may become less dense with age.
Why should I consider supplemental screening?
- Women with dense breasts can have a two to four times increased risk for developing breast cancer than women without dense breasts.
- Identifying cancer in a woman with dense breasts is much more difficult, even with a 3D mammogram.
Supplemental breast screening options
There are three options for supplemental screening: Abbreviated beast MRI, contrast enhanced mammography and whole breast ultrasound.
Abbreviated breast MRI (ABMRI)
- Patient is given an IV and is positioned in the MRI scanner. MRI contrast dye (gadolinium) is injected while the patient is in the MRI scanner.
- Pros of ABMRI include:
- It's fast: the scan lasts only about five minutes (normal scan is 25 to 30 minutes).
- MRI has a high sensitivity, meaning it can find almost all cancers.
- High cancer detection rate: it finds more cancers than the traditional mammogram (even 3D).
- MRI can see through dense breast tissue.
- No X-rays = no radiation.
- Cons of ABMRI
- MRI scanners are noisy and uncomfortable, not ideal for patients with extreme claustrophobia.
- IV dye is injected.
- Can’t be performed in patients with renal failure.
- Can’t be performed if patient has an allergy to gadolinium.
- May not be covered by insurance.
- Does not take the place of an annual mammogram.
Contrast mammogram (CEM)
- Patient is imaged in breast imaging center. IV is placed. Contrast dye (iodinated) is injected prior to a mammogram. Patient has a mammogram in the same way as previous mammograms.
- Pros of CEM
- CEM has high sensitivity, meaning it can find almost all cancers.
- High cancer detection rate: it finds a lot more cancers than the traditional mammogram (even 3D mammogram).
- It's fast: total imaging time is eight to 10 minutes
- Can see through dense breast tissue (contrast lights up abnormalities such as cancers).
- Can take the place of the annual mammogram.
- Likely covered by insurance (except for small contrast fee of approximately $20 to $25)
- Cons of CEM
- IV contrast is injected.
- Can’t be done in a patient with an allergy.
- Can’t be done in a patient with kidney disease.
- Does require mammogram compression.
- Patient is imaged in the breast imaging center. Ultrasound performed by a breast ultrasound technologist and/or breast imaging radiologist.
- Pros of whole breast ultrasound
- No IV placed and no contrast dye injected.
- No X-rays = no radiation.
- Relatively comfortable imaging position.
- Can see through dense tissue.
- Can be performed on patients who have kidney disease or allergies to contrast dye.
- Covered by most insurance companies.
- Cons of whole breast ultrasound
- Not as fast as ABMRI or CEM (takes about 20 to 30 minutes).
- Not as sensitive as ABMRI or CEM, meaning ultrasound may not be able to find the abnormality.
- Lower cancer detection rate than ABMRI or CEM (similar cancer detection to traditional mammogram).
- Higher false positive rate, meaning it can find things that look like cancer but are not cancer. This can lead to more biopsies.
Overall, breast-imaging radiologists prefer ABMRI and CEM because these tests have a higher cancer detection rate compared to whole-breast ultrasound.
Breast care team
Our team of highly skilled and experienced breast care experts will answer your questions and provide accurate results in a timely manner. Our breast care team is made up of radiologists, mammography technologists, ultrasound technologists and a breast-imaging navigator. Our mammography and ultrasound technologists will work with your radiologist to perform all necessary procedures. If necessary, our breast-imaging navigator will help you in scheduling additional breast-imaging tests -r a breast biopsy.
If you are diagnosed with breast cancer, our breast imaging navigator will connect you with a breast cancer nurse navigator who will work closely with you and your doctors throughout your care. Your breast cancer nurse navigator will help you be aware of your options and make sure your receive the treatment, care, education and support you need.