Breast Center: Frequently Asked Questions

What are the symptoms of breast cancer?

  • New lump in the breast or under the arm
  • Changes in consistency of the breast, hardening of the breast
  • Change in size/contour of the breast
  • Skin or nipple retraction
  • Nipple discharge that is unilateral, bloody or clear
  • Inflammatory breast cancer can look like a breast infection with skin redness, warmth and thickening

Remember that many breast cancers have no symptoms, that is why screening is very important.

When should a women begin screening mammography?

All major medical groups that are involved with women's health recommend that a woman begin annual screening at age 40. If a woman is at higher risk, alternate screening protocols can be initiated for that patient.

There is no way of completely preventing breast cancer at this point, so your best defense is early detection, which significantly improves prognosis. That is why screening mammography is so important. Digital mammography can show small lesions sometimes years before the patient might feel a lump in the breast.

More on Mammography

What is 3D mammography and what are its benefits?

3D mammography, or digital breast tomosynthesis, is a breast imaging modality approved by the FDA for clinical use in February 2011. The Breast Health Center at UF Health Jacksonville is the only facility in Northeast Florida to offer this service. This technology has proven to be an extremely useful tool for early detection of breast cancer, and when used in the screening population, can decrease the number of patients who have to come back for additional mammographic views because of something seen on the traditional screening mammogram.

From the patient's perspective, there is no significant change from having a typical mammogram. The machine takes additional cross-sectional images of the breast while in compression, but this only takes a few seconds to complete. The radiologist can then view reconstructed 1mm thin slice images of the breast.

This is incredibly helpful for detecting early breast cancer, especially in those patients with dense breast tissue. When we report mammograms, we are required to comment on breast tissue density, and this is assigned using four categories from almost entirely fat density to extremely dense. Dense glandular tissue can easily obscure the margins of a cancer, because the mass and the surrounding normal tissue can have a similar density. In addition, patients with extremely dense breast tissue are at increased risk of developing breast cancer.

More on Digital Breast Tomosynthesis

What is the difference between a screening mammogram and a diagnostic mammogram?

The main difference is that a screening mammogram is only meant for women who have no symptoms related to the breasts. If there are any symptoms detected by the patient or suspicious findings by the referring physician, then the patient must be scheduled for a diagnostic study. This means that the radiologist will do whatever imaging is necessary to fully evaluate the symptom. This might include special mammographic views, tomosynthesis, ultrasound or MRI. This might also involve breast surgical consultation. Remember that if you feel a lump in your breast, a negative mammogram does not necessarily exclude the possibility of an underlying malignancy and further workup may be warranted.

Answered by:

Martha C. Wasserman, M.D.

Martha C. Wasserman, M.D.

UF Assistant Professor of Radiology; Chief, Division of Women's Imaging

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Who should go through genetic counseling and testing for breast cancer?

The National Comprehensive Cancer Network guidelines recommend genetic testing for people who are diagnosed with breast cancer at an early age, 50 years of age or younger. It also recommends genetic testing for the following:

  • Women with triple-negative breast cancer before age 60
  • Women with breast cancer and a family history of breast cancer in a close blood relative before age 50
  • Women with breast cancer and a family history of ovarian cancer in a close blood relative
  • Individuals with breast cancer and also a personal history of other cancers
  • Women with ovarian cancer at any age
  • Men with breast cancer
  • People who don’t have cancer but have a strong family history of breast and/or ovarian cancer at a young age, or family history of multiple other cancers
  • Family members with a known cancer susceptibility gene should all undergo counseling and possible testing
  • High-risk populations such as women of Ashkenazi Jewish descent with family or a personal history of breast and ovarian cancer should be tested regardless of age

Will my insurance premiums go up based on the results of genetic testing?

Federal law (GINA: Genetic Information Nondiscrimination Act) prohibits discrimination based on results of genetic testing. This means that insurance companies cannot raise your premiums, or drop clients based on genetic testing results. These results cannot be considered a pre-existing condition and employers or schools cannot discriminate against a person based on genetic testing results.

Answered by:

Laila Samiian, M.D., FACS

Laila Samiian, M.D., FACS

UF Assistant Professor of Surgery; Chief, Section of Breast Surgery

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What should women ask their physician when discussing breast health?

The most important question a woman can ask her physician is “What is my personal risk for breast cancer?” Mammograms aren’t enough. It’s important for physicians to know about other factors, including if a close relative has been diagnosed with breast cancer.

When doctors do not have relevant personal information about a patient’s risk of developing breast cancer, the benefits of early detection and prevention can be lost. Without this knowledge, physicians may not consider referring the patient for appropriate cancer risk assessment and possible DNA genetic testing, screening mammograms and breast MRI at an earlier age. It is the patient’s right to understand his or her own cancer risk and to make choices based on this information.

What kind of conversations should parents have with their children about breast health?

It is important for parents to have conversations about cancer, including breast, ovarian and other forms, with their children. If anyone female or male family member has had disease, tell your adult children need to know as much information about this as possible. If possible, put the information in writing so it can be shared with other family members as needed.

Sharing information about your family’s history of cancer with your children may be awkward or cause you to bring up sad memories, but remember it could have life-saving consequences. Pass it on as a part of your family’s story, just like you do with the humorous or heroic episodes in your family’s past.

We know heredity plays a role in a woman’s risk of breast cancer. For example, women who have a close relative – mother, sister, aunt, or cousin – who develops breast cancer before menopause have an exceptionally high risk for developing cancer themselves. Other factors that increase a woman’s risk of breast cancer include being over the age of 50 or having history of breast biopsy with atypical hyperplasia. This is the kind of information women should be bringing up with their doctor when they get their annual check-up, even if the doctor doesn’t ask.

Why should someone who has been diagnosed with breast cancer seek a second opinion? When should they seek the second opinion?

A second opinion is a suggested and critical first step after a diagnosis. It can be helpful in confirming whether or not the patient has cancer, and if so, exactly what type of cancer. All cancers are not created equally. In my Second Opinion practice, I take many factors into consideration, such as family history, lifestyle, and overall health. A second opinion can give the patient a clear understanding of their individual diagnosis and risk factors, so that they can ask the right questions to get the optimal treatment for their specific type of cancer.

More on Second Opinion Services

Answered by:

Shahla Masood, M.D.

Shahla Masood, M.D.

UF Professor of Pathology and Laboratory Medicine; Chair, Department of Pathology and Laboratory Medicine; Medical Director, UF Health Breast Center–Jacksonville

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How do I know if breast reconstruction is right for me? When is the right time to have it?

Any female who will undergo a mastectomy for breast cancer or has undergone a mastectomy in the past is a candidate for breast reconstruction. Before pursuing breast reconstruction, patients should consider their overall health to determine if they’re healthy enough to undergo surgery and if they have the time, since it can take up to a year to complete breast reconstruction.

Immediate reconstruction refers to starting the process of breast reconstruction at the time of a patient’s mastectomy. The breast surgeon will complete the mastectomy, and the plastic surgeon will then come into the operating room (while the patient is still under anesthesia) and begin the process of breast reconstruction. Delayed reconstruction refers to initiating breast reconstruction at a later time, even months or years after a patient has undergone a mastectomy. Both the decision to undergo breast reconstruction and the timing of breast reconstruction should ultimately be the decision of the patient, made with the guidance of a plastic surgeon who specializes in breast reconstruction.

Most breast surgeons will refer a patient to plastic surgery for consideration of breast reconstruction if mastectomy is being considered. Also, even if a patient has had a mastectomy years ago and has completed cancer treatment, a patient's primary care physician can refer a patient to a plastic surgeon for consideration of delayed breast reconstruction. Meeting with a plastic surgeon can help answer any questions and address any concerns a patient may have and help a patient decide if breast reconstruction is the right option for them.