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Schedule Your Mammogram

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Avera offers mammograms at many of our locations throughout the region.

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Imaging and Prevention

3D Mammography

The Avera suite of breast care services includes 3D technology to provide clearer views from multiple angles. This new technology is enhanced by our fourth-dimension of care, which encompasses a team approach to working with you.

3D mammography, also known as DBT, Digital Breast Tomosynthesis, is often combined with a digital mammogram to provide enhanced, digital detail of the breast. Whereas a 2D mammogram takes images from two angles, a 3D mammogram provides images from many different angles by moving over the breast in an arc.

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Digital Mammography

Clearer, state-of-the-art images of the breast mean better diagnosis and better treatment. According to the National Cancer Institute, as a screening measure, digital mammography detects 15 - 28% more breast cancer in women with dense breast tissue or who are younger than age 50.

Digital mammography provides enhanced visual detail of any breast type including augmented breasts. It also reduces the procedure time by as much as 50%, when compared to conventional mammography and eliminates the use of nipple markers which cause some discomfort post procedure.

Compression is still used and important for detailed quality and to minimize the x-ray dose.

Mammography CAD, (Computer-Aided Detection)

Many Avera mammography locations utilize Computer-Aided Detection technology in conjunction with mammography. This technology acts like a second set of eyes. It analyzes mammography images to help identify areas of concern making it easier for physicians to detect cancer at its earliest stages.

Breast Biopsy and Ultrasound

Breast Biopsy

A breast biopsy involves removing tissue of concern from within the breast. This tissue is checked under a microscope to determine a diagnosis. Often this procedure involves a special needle which can sample small pieces of tissue under local anesthesia. Occasionally, a surgical biopsy is needed to make a diagnosis.

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Breast Ultrasound

Breast ultrasound imaging, also called sonography, is often used as a diagnostic tool in addition to mammography. In certain cases, this technology helps characterize the nature of a questionable area seen on a mammogram. Ultrasound uses high-frequency sound waves to produce pictures of the inside of the breast. You will lie on your back with your arm raised above your head on the exam table. A warm gel is applied on the skin and a small transducer moves across the gel, at the area of interest, with slight pressure. No radiation is involved with this exam. Pictures are often reviewed by the Radiologist at the time of the appointment.

When an ultrasound examination cannot characterize the nature of a breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures.

Ultrasound Guided Biopsy and Stereotactic Guided Biopsy

Ultrasound and Stereotactic guidance are both techniques used to assist physicians in obtaining tissue samples from the breast by using either a core or vacuum-assisted needle biopsy technique. After the ultrasound or the stereotactic (mammogram) machine locates the area of concern, the physician cleans and numbs the tissue. A small skin nick is made which allows a hollow needle to be placed at the precise area of concern. Several tissue samples are acquired and images are taken to document the exact biopsy location. Often a very small marker (clip) is left to mark the biopsy site for future reference. No stitches are required for these minimally invasive outpatient procedures. Ask your physician which type of biopsy is recommended for you.

Breast MRI (3 Tesla MRI)

Breast MRI may be recommended by your physician, in addition to mammography for certain cases. The American Cancer Society recently published specific guidelines for the use of breast MRI. MRI can locate areas of concern within the breast by creating images using a large, powerful magnet instead of x-rays. The patient lays on their stomach on a table with the breasts through a special cushioned opening. A coil technology circles the breasts and produces the very detailed images. A contrast material is injected in an IV with pictures taken before and after the injection. Like other MRI's, once in the cylinder-shaped MRI machine, you hear the tapping and humming sounds of the MRI unit.

  • Magnetic field strength at 60,000 times greater than the Earth's magnetic pull allows for superior image quality.
  • Diagnostic applications enhanced with bilateral breast imaging and spectroscopy
  • Scan time is reduced by 40 - 50 %

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Breast-Specific Gamma Imaging (BSGI)

Breast-Specific Gamma Imaging (BSGI) is a molecular breast imaging technique that shows the metabolic activity of breast lesions. BSGI can aid in diagnosis when a mammogram is inconclusive; revealing important information that can help your doctor more accurately determine if an area of concern is cancerous or not. An international medical society, the Society of Nuclear Medicine, provides practice guidelines on patient selection criteria, image interpretation, and reporting for BSGI.

  • BSGI is a strong diagnostic tool especially for patients who have:
  • Dense breast tissue
  • Indeterminate areas on mammography, ultrasound or MRI
  • Lumps that can be felt, but not seen with mammography or ultrasound
  • Implants and breast augmentation
  • Scarring from previous surgeries
  • High risk factors or previous malignancy
  • Recently identified disease requiring evaluation of disease extent

Read more about Breast-Specific Gamma Imaging (BSGI)

Case Study:
48 year old with a digital mammogram on the left and a BSGI on the right. The BSGI detected multifocal disease in the patient with a negative clinical examination, mammogram and ultrasound. Pathology revealed Ductal Carcinoma in Situ (DCIS) and axillary nodes that were positive for cancer. (Legacy Good Samaritan Hospital, Portland, OR)

Mammo vs. BSGI

Contrast Enhanced Spectral Mammography (CESM)

How CESM works

GE’s SenoBright Contrast Enhanced Spectral Mammography (CESM) uses multiple X-ray energies to create two images: one low energy, standard digital mammography image and another high energy image enhanced by a contrast agent. CESM uses the intravenous contrast agent (much like a CT scan) to compare the two images and highlight areas with abnormal blood flow or lesions. These areas with abnormal blood flow or tissue are easier for physicians to see, diagnose and even predict the tissue’s pattern of growth.

CESM patient benefits

  • Easy mammogram procedure that takes minutes to perform
  • Reduces waiting time and uncertainty of results
  • Offers enhanced clarity to patients with dense breast tissue
  • Less affected by hormone replacement or menstrual cycles, so the exam can be performed at patient’s convenience
  • Can be performed on patients who may not be a candidate for MRI
  • Allows doctors to find growing numbers of small blood vessels, which could be the start of a tumor
  • Helps doctors and surgeons determine the most effective treatment plan, if cancer is detected
  • In the better majority of cases, CESM results can be given to the patient the same day as her exam, reducing her anxiety

Read more about Contrast Enhanced Spectral Mammography (CESM)

Frequently Asked Questions

What is dense breast tissue?

Breasts are made up of different types of tissue including fatty, glandular, and fibrous. Breast density represents the ratio of fatty tissue compared to the more fibroglandular tissue in the breast. Dense breast tissue is not abnormal and is very common, but can make it harder to evaluate the results of your mammogram and may provide a slight increase in risk to breast cancer.

Breast density can only be determined by mammograms. It is not related to breast size or how firm they may feel. Radiologists, who interpret breast imaging tests, use a grading scale for breast density in their reports. Nearly 40 percent of all women have breast tissue that is considered to have more fibroglandular breast tissue (which is the more dense type of tissue) and about 40 percent have breasts that have more fatty tissue. Approximately 10 percent of women have extremely fatty tissue and 10 percent have extremely dense tissue.

For some women, breast tissue can change as a person gets older or as they experience hormonal changes. It is more typical for older women to have more fatty-type tissue, but this is not always the case.

When do I need a mammogram?

Current American Cancer Society guidelines recommend that women should have screening mammography annually starting at age 40.

What are some steps I can take to prevent breast cancer?

  • Make breast screenings routine
  • Watch your weight
  • Keep Moving
  • Think before you drink alcohol
  • Discuss lifestyle choices with your health care provider
  • Learn more >>

What may increase my chances of breast cancer?

Four-Dimensional Breast Care

3D technology is just one way the Avera suite of breast care services offers multidimensional care. The fourth dimension encompasses a team approach to working with you.

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Looking for a Doctor?

Our team of OB/GYN, family medicine and internal medicine doctors are available at a location near you.

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Breast Cancer
Diagnosis Resources

Find Avera Cancer Institute locations, information on the latest treatment methods such as genomic medicine and IORT, and more.

Cancer services and resources

Screening Guidelines

The American Cancer Society recommends the following breast cancer screening guidelines.

- Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health

- Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over

- Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.