Breast Diagnostics

85-90% of breast cancers are due to genetic abnormalities. Screening tests, such as yearly mammograms, are given routinely to people who appear to be healthy and are not suspected of having breast cancer. Their purpose is to find breast cancer early, before any symptoms can develop and when the cancer is usually easier to treat.

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Dr. Kämpf, Prof. Dr. Ketelsen, Dr. Trübenbach and their team of highly qualified physicians regularly participate in the external quality assurance for curative mammography of the “Kassenärztliche Vereinigung” in order to offer you the highest quality.

Diagnostic Mammography.

Diagnostic mammography is an x-ray of the breast. Mammograms are acquired because of abnormal results from screening or after new clinical signs of a breast mass/ lump alerted by the patient or her doctor for further investigation.

Such clinical signs may include:

  • A mass/ lump in the breast
  • Changes in size or shape of the breast
  • Breast pain
  • Thickening of skin on the breast
  • Nipple discharge

A diagnostic mammogram can help determine the cause of these changes and to evaluate the presence of breast cancer.

Breast Ultrasound.

The ultrasound uses inaudible, high-frequency sound waves to produce pictures of what is inside of the body, and it does not utilize ionized radiation. It is safe and painless. Breast ultrasound imaging is used to evaluate and further diagnose areas of concern involving the breast; for example, a newly detected breast mass/ lump. It is a useful adjunct to mammography, helping to determine if a lump or mass is a harmless fluid-filled cyst or a solid abnormality which may require further investigation. However, it cannot be used as a replacement for a mammogram since (micro)calcifications (often the earliest sign of a breast cancer), do not usually show up well on ultrasound. While there are some research projects currently being conducted to evaluate the ultrasound as a secondary screening test for masses in certain situations, this is not currently recommended. Therefore, at the moment Mammogram images are still mandatory to evaluate the entire breast.

Breast MRI.

Breast Magnetic Resonance Imaging (MRI) uses a magnetic field to produce detailed images of all the structures within the breast. It is used in certain cases as a supplemental tool to mammography and/or ultrasound. Breast MRI does not use ionizing radiation (i.e, x-rays), and when used carefully in conjunction with screening and diagnostic mammography, it can provide valuable information for the detection and characterization of breast disease.
MRI is beneficial especially for patients at high risk for breast cancer due to genetic predisposition or family history of breast cancer. Furthermore it can help diagnosing breast implant rupture, staging and planning treatment of breast cancer. MRI also plays an important role in post-therapeutic follow-up.

MRI screening guidelines for women in the following groups:

  • have a known BRCA1 or BRCA2 gene mutation
  • have a first-degree relative (mother, father, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
  • have a lifetime risk of breast cancer of 20% or greater, according to risk assessment tools that are based on a family history that includes both her mother’s and father’s side
  • had radiation therapy to the chest when they were between the ages of 10 and 30 years
  • have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)

Women at moderately increased risk (15% to 20% lifetime risk) may also have MRI screening in conjunction to their yearly mammogram (There are several risk assessment tools are available to help doctors estimate a woman’s individual risk). These patient groups include:

  • have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based on family history
  • have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)

(Yearly) MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Note: Breast MRI should be performed between the 5th and 12th day of the menstrual cycle (having regular menstrual periods) for best results.

Breast implant evaluation.

MRI is suitable to evaluate silicone breast implants for leaks or ruptures. It is performed in a similar fashion to breast cancer MRI, however, no intravenous contrast is needed for implant evaluation. Various techniques can be used to identify accurately where silicone is located and whether or not the implant has collapsed. This can help patients and their surgeons plan appropriate therapy and help decide whether or not an implant should be replaced.

Coverage by the health insurance companies:

Private health insurance companies usually reimburse the costs of the exam. For patients with social health insurance (“gesetzliche Krankenversicherung”), breast MRI is only covered in a few exceptional cases (e.g. in special situations of tumor follow-up or with known genetic mutations). Breast MRI not advisable and not reimbursed in the context of early detection.

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