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Breast Cancer Risk

What are the risk factors for breast cancer?
  • The number one risk factor is simply being a woman; second is age—the risk is higher the older you are.
  • Family history of breast cancer, especially premenopausal breast cancer or breast cancer in a first degree relative like your mother, sister, or daughter; family history of ovarian cancer.
  • Dense breast tissue, which occurs in 40 to 50% of women, is also a significant risk factor for both development of breast cancer, and cancer missed by mammography. For these women we recommend Whole Breast Ultrasound and digital breast tomosynthesis.
  • First pregnancy and childbirth after age 30.
  • Never having a full-term pregnancy.
  • Early puberty and/or late menopause.
  • Obesity.
  • Previous breast cancer, ovarian cancer, or breast biopsy showing atypia or other high risk tissue.
  • Long-term use of post-menopausal hormone therapy.
  • Smoking.
  • Alcohol consumption.

Tomosynthesis /3D Mammography

What is Tomosynthesis ?
Digital Breast Tomosynthesis, also known as 3D mammography, is the newest advance in breast imaging and replaces 2D digital mammography. It is accomplished similar to a traditional mammogram with the exception that the x-ray tube moves during the exposure, acquiring multiple “snap-shots” from different angles. The result is a stack of thin images, spaced just 1 mm apart, that are reviewed with and compared to standard 2D images.
Why is Tomosynthesis better than standard mammography?
The ability to see breast tissue in thin “slices” dramatically improves clarity and detail. Multiple studies have demonstrated improved cancer detection and decreased false positives. A common reason for additional imaging after screening mammography is the confusion created by overlapping tissue. 3D mammography eliminates the overlap; thereby decreasing the need for additional imaging and biopsy. Tomosynthesis was approved by the Food and Drug Administration in 2011 and we are proud to be the first site, from Los Angeles to San Francisco, performing this breakthrough technology.
What are the data?
Multiple large trials, both in the USA and internationally, have demonstrated increased cancer detection by ~ 40% and decreased need for additional imaging by 20 – 40%. Our own experience, since offering this technology in Santa Barbara since December 2012, has mirrored the published data.
Is there additional radiation with Tomosynthesis?
No. Santa Barbara Women’s Imaging has software that allows us to reduce the x-ray exposure for tomosynthesis so that it is now the same as a standard 2D mammogram; the dose is well below nationally regulated standards. Additional radiation is also avoided by the reduced number of patients we recall for follow-up / call back imaging.
I have dense breast tissue is Tomosynthesis the right exam for me?
Tomosynthesis is especially useful for women with dense breast tissue but has been shown to benefit women of all ages and all tissue densities. Women with dense breast tissue will additionally benefit from Automated Whole Breast Ultrasound (ABUS).
Can I have standard mammography at Santa Barbara Women's Center?
Because we believe this to be the state-of-the-art in breast imaging, all patients seen at SBWIC have tomosynthesis examinations. The benefits of increased sensitivity and decreased false positives extend to women of all ages and breast densities.
Will my insurance cover the costs of Tomosynthesis exam?

Tomosynthesis received a billing code in early 2016 and is currently covered by Medicare and an increasing number of private insurance carriers. Currently, there is a small co-pay for the 3D portion which will be reimbursed to you if your insurance pays for the exam. You will be given an estimate of charges at the time your appointment is confirmed. If you are unable to pay the co-pay, are uninsured or out-of-network, our office will work with you so that no woman is denied an exam.


Do I need a mammography every year after the age of 40?

Our physicians  agree with the American Cancer Society, the American College of Radiology, and the American College of Obstetricians and Gynecologists that women in good health should receive an annual mammogram starting at age 40. The American Cancer Society in recommends annual mammograms after age 40 every 1 to 2 years. Breast cancer is completely curable when found in its early stages; two years between mammograms can be long enough to allow a tumor to progress from a small, removable lump to large malignancy that has already spread beyond the breast.

Every woman is unique and should consult with her primary care provider regarding how often a mammogram should be performed.

How often do I need mammography?

Women over age 40 should be screened annually. Women with a family history of premenopausal breast cancer may need to start screening sooner.

What if I have implants?

Mammography is safe for women with implants, and is used both to detect breast cancer and to check the integrity of the implants. A set of images is made to include the entire breast and implant, and a second set of images is made for the breast tissue. It is not possible to image all of the breast tissue with mammography in many women with breast implants, and Whole Breast Ultrasound is sometimes recommended in addition to mammography for these women.


What is Automated Whole Breast Ultrasound?
  • Ultrasound has been used for over twenty years to investigate the cause of breast lumps or to evaluate findings first discovered by mammography. Since many cancers are not apparent on mammograms but can be seen with ultrasound, several companies are now developing equipment designed to perform ultrasound screening of the entire breast. Since February, 2005 we have used AWBU, which collects thousands of ultrasound images of the breast and formats them for radiologist review.
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What is the cost of Whole Breast Ultrasound?

Automated whole breast ultrasound is currently a covered service by Medicare and some commercial insurance carriers. The out of pocket cost depends on your current insurance plan, deductible, co-insurance and/or co-payment. You will be given an estimate of charges at the time your appointment is confirmed. If you are uninsured or out-of-network, the cash price is $320. Our office will work with you so that no woman is denied an exam.


What are Biopsy options available ?
  • PRE-BIOPSY: For all biopsy procedures it is preferable to be off aspirin and other “blood thinner” medications and supplements for 5 to 7 days beforehand. This includes aspirin, Excedrin, Advil, Plavix, Naprosyn, Motrin, extra doses of Vitamin E, Ginko, Fish Oil and many herbal products. Consult your physician before changing your routine. 
  • FINE NEEDLE ASPIRATION BIOPSY: Using local anesthesia a very thin needle is used to extract cells, the material is mounted on slides or preserved in special fluid, and the samples sent to a laboratory for review by a pathologist. Also called cytology, this technique can be done on lumps by manual technique or image-guided. This test is about 75 – 80 % reliable.
  • CORE NEEDLE BIOPSY: Using local anesthesia and ultrasound or MRI guidance, a large bore needle is used to remove small shavings of tissue, which are sent to the laboratory in fluid for a pathologist to examine. A small skin nick (about 1/8th inch) is made in the skin and bruising is common. This technique is 98% reliable.
  • VACUUM ASSISTED CORE NEEDLE BIOPSY: Using local anesthesia and either ultrasound or mammographic guidance a large bore needle is used to remove shavings of tissue. About a 1/4th inch skin incision is needed and almost everyone will experience some bruising. This technique is 99%-100% reliable and can be used to completely remove many masses, even up to an inch in size. 
  • PRE-OPERATIVE WIRE LOCALIZATION: Using local anesthesia a thin wire or wires are placed through the skin and in or around the lesion to be removed surgically. Also called wire-guided surgery this technique is used for non-palpable lesions, like microcalcifications or lumps that are too deep or too small to be felt or seen during surgery, but need complete removal.

Bone Density Testing

What is DXA?

Dual Energy X-ray Absorbitometry is a test for bone mineral density. To perform the scan the patient lays on her back on an open examination table while the detector moves above her. The whole procedure takes only a few minutes, and is the most accurate way to assess bone density.

What are the risk factors for low bone density ?
  • The most important risk factor is being a woman, and the second is age. Low bone density is more common after menopause and the risk is higher the older you are. Any low estrogen state, such as surgical removal of the ovaries or anorexia with loss of menstrual cycles, can cause low bone density. Other risk factors include long-term use of several specific medications, such as thyroid hormone, steroids like prednisone, and others; nutritional disorders; Crohn’s Disease; petite stature; previous chemotherapy for cancer; and bed-rest or sedentary life style.
  • How often should I have a DEXA study? Many doctors suggest having a first DEXA before menopause, so that there is time to take action before menopause if your bone density is low. If your bone density is normal, it generally does not need to be repeated until after menopause. If your bone density is low your doctor may ask for another scan in a year or two to assess the effect of intervention. For post-menopausal women with normal bone density the test should be repeated as advised by your doctor based on your specific risk.
  • Osteoporosis may affect up to half of women during their lifetimes, and the prevalence of pathologic fractures is expected to climb as life expectancy increases worldwide.
  • Only one third of patients who experience a fracture related to osteoporosis fully recover their physical function, so early detection and treatment before fractures occur is key.
If my bone density is low what can I do to correct it?
  • First be sure you have eliminated all the possible causes of calcium loss, like carbonated beverages, alcohol, caffeine and smoking. Next make sure your diet contains ample calcium, probably at least 2000 mg. The most bio-available calcium is in dairy products like fluid milk, yogurt, cheese, ice cream, etc. Vitamin C promotes calcium absorption, so calcium fortified orange juice is a good choice. Vitamin D is important for healthy bones, and your doctor can order a blood test to determine if yours is adequate. Many calcium supplements are not well-absorbed, but can be added if needed. Weight-bearing exercise is essential to both maintaining and increasing bone density. Yoga and Pilates can be helpful in building core strength and improving bone density. Your doctor may also prescribe medication to correct your low bone density, but these work best when there is ample dietary calcium and exercise to stimulate bone growth.
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