For the latest COVID-19 information, visit vcuhealth.org/covid-19 or Children's Hospital of Richmond at VCU for pediatrics. For vaccine details, visit vcuhealth.org/covidvaccine.
Need help
Locations
We offer annual screening mammograms for women without symptoms and diagnostic evaluations for women and men with symptoms of both benign breast conditions and breast cancers.
We offer screening mammograms as part of our patients’ routine annual evaluations, to spot breast cancer in early stages in women with no symptoms.
We understand that there are many controversies around screening mammograms. However, there is an overwhelming amount of scientific evidence that screening mammograms save the most lives when done yearly starting at the age of 40. Early detection significantly decreases the number of deaths from breast cancer by allowing for less aggressive and more effective treatment options.
At VCU Health, we recommend annual screening mammography for women 40 or older. Women with a family history of breast cancer may need to start annual screening mammography earlier, especially women who have two or more immediate family members who have had breast cancer, particularly if they have been diagnosed before menopause or have had cancer in both breasts.
Women with breast-related problems or symptoms should instead request a diagnostic mammogram, to avoid delays in addressing your concerns.
Low-dose radiation is used to capture images of each breast, using compression to keep the breasts from moving, while limiting radiation and spreading the breast tissue, in an effort to enhance the accuracy of the images. Compression can make the difference between finding and missing cancer.
Excellent customer service and very accommodating, even when the patient was running late. Very friendly and placed patient at ease.
–VCU Breast Imaging patient
You know the importance of having regular breast screenings. But let’s face it – no one looks forward to having a mammogram. We’re pleased to offer you this free guide – Making Your Mammo Experience Better. It contains half a dozen helpful suggestions to prepare you for your mammogram and make your screening experience as pleasant and comfortable as possible.
We interpret screening mammograms under optimal conditions, minimizing the likelihood of disruptions and distraction. We focus on looking for potential abnormalities, such as tiny deposits of calcium or masses, and comparing the current films to your prior studies.
Approximately 5 percent of our patients are called back for additional studies following a screening mammogram. Most patients who are called back do not have breast cancer; in some women, breast tissue superimposes, simulating the presence of a lump on the initial images. When additional views are taken by applying a small (spot) compression paddle over the area of concern, the tissue may be characterized as normal.
Alternatively, in some women, ultrasound can be used to characterize a lump as a fluid-filled cyst.
When you return for the additional studies, one of our breast imaging radiologists will oversee your diagnostic evaluation and discuss results and recommendations with you before you leave our facility.
Although mammography is an excellent screening tool that can help identify most breast cancers, it is not a perfect test. In some women with breast cancer, mammograms may appear normal. It is for this reason that you should notify your doctor, or us, if you notice a change in your breast or if you feel a lump or an area of thickening in either breast.
A diagnostic mammogram is a special mammogram to work up symptoms of benign breast conditions or breast cancers. It is recommended for women who are experiencing symptoms that may be related to breast cancer or benign breast conditions. Breast Ultrasound and Breast MRI are also available as complementary procedures for patients with symptoms and those with a higher lifetime risk of breast cancer.
We recommend a diagnostic mammography if you experience any of these symptoms:
A diagnostic mammogram may also be recommended for women who have had a possible abnormality detected during a screening mammogram. Also, for women who’ve had a lumpectomy for breast cancer since their last mammogram.
Although breast cancer is rare in men, it usually presents itself in the form of a lump, in which case a diagnostic mammogram is needed.
Along with the standard top-to-bottom and side-to-side breast images, additional images may be created using a small (spot) compression paddle, sometimes in combination with a magnification technique.
Based on the results of the diagnostic evaluation, the breast imaging radiologist will discuss findings, options and recommendations; answer your questions; and provide your results in writing before you leave our facility. If needed, an ultrasound will be done at the same visit. If a biopsy or fine needle aspiration is needed, you may be able to have it done immediately or schedule it for a later date.
If a breast biopsy is required, we typically offer results within 24 hours.
The technologist made a potentially stressful exam into an enjoyable visit. She was gentle, professional and sweet, just a gem! She kept me engaged so that my mind was not on the mechanical, which she swiftly navigated so that the exam only seemed like moments out of my day.
– VCU Breast Imaging patient
Depending on the results of the diagnostic mammogram, the radiologist monitoring your study may conduct additional studies, which could include:
A breast ultrasound is a study of your breast done using ultrasound waves. Ultrasound is considered a complement to mammography — not a replacement.
For women age 30 or older experiencing signs or symptoms possibly related to breast cancer, our starting point is typically a mammogram. However, a breast ultrasound could be needed, to evaluate findings in the physical examination or the mammogram.
Ultrasound is used as the starting point among women who are pregnant or lactating, as well as for women under the age of 30 who have a lump. Ultrasound is useful in evaluating the axilla, or armpit, for potentially abnormal lymph nodes, particularly in patients with breast cancer. Breast ultrasound is also used to guide the radiologist during biopsies and fine needle aspirations.
Breast ultrasound studies are done by a breast imaging radiologist, trained specifically in screening for breast cancer. During a breast ultrasound study, you will lay on your back or slightly turned to one side with your arm placed comfortably under your head. Gel is applied to your breast so there are no air pockets between your skin and the transducer (the instrument used to obtain the pictures). The transducer is moved back and forth over your breast, generating images and, if an abnormality is found, images are taken for your medical record.
A physical examination of your breast is also done by the radiologist at the time of the ultrasound. Combining the ultrasound with physical findings is the equivalent of being able “to see” with our fingertips.
If the ultrasound results are normal, nothing more is usually done. However, if a breast cancer is suspected on the ultrasound, a full diagnostic mammogram is done. Ultrasound is used to characterize lumps detected on a mammogram or physical examination as:
Lumps identified as cysts (fluid-filled) do not require any intervention or follow-up, unless you are having symptoms or atypical features are seen on ultrasound, in which case aspiration can be done.
If the lump is determined to be non-cancerous, no follow-up may be needed. With solid, non-fluid-filled lumps, if the likelihood of malignancy is determined to be less than 2 percent based on clinical and imaging features, a six-month follow-up is usually recommended. A biopsy is suggested for those that are characterized as indeterminate or likely cancerous.
A breast MRI is a study that uses a magnetic field to generate images of your breast before and after a contrast injection. A breast MRI is a supplement to mammograms, not a replacement, because it could miss some cancers that could be detected with a mammogram.
An MRI and mammogram are recommended beginning at age 30 for women considered high-risk. Those with moderately increased risk of breast cancer should talk with their doctors about the benefits and limitations of adding MRI to their yearly mammogram.
Women at high risk include those who:
Women at moderately increased risk include those who:
Several risk-assessment tools, including BRCAPRO, the Claus model and the Tyrer-Cuzick model, are used to estimate a woman’s breast cancer risk. Based on different combinations of risk factors, these tools approximate estimates of breast cancer risk. Depending on the tool used, different risk estimates may be calculated for the same woman.
During the MRI, you will be asked to lie on your stomach while your breasts are positioned in a holder called the “breast coil.” You will be given a call button to press if you need to speak to us during the procedure. Most patients are able to tolerate the study. Thin (1 mm) images of the breasts are done before intravenous contrast is given. One of the nurses will test your liver function and start an IV that will be used to give you intravenous contrast. The contrast used is called gadolinium; it does not contain iodine and is different from the type of contrast used for CAT scans. Allergic reactions are rare. The images are repeated at timed intervals after the contrast is injected.
To prepare for the exam, download the MRI Preparation Checklist [PDF].
An MRI-guided biopsy may be recommended if an abnormality seen on the MRI is not visible on your mammogram or ultrasound; this requires a second MRI at least 24 hours after the first study is done.
A ductogram is used to evaluate nipple discharge that comes out on its own.
We recommend a ductogram when there is nipple discharge that comes on its own (spontaneous), regardless of its appearance. In this case, you may notice dark brown spots on your bra or night clothes, or you may notice fluid coming from your nipple after a hot bath or shower. On physical examination, fluid is obtained easily and consistently from one duct opening.
You should note that milky discharge can be seen for several years following childbirth or after breastfeeding is stopped. This type of discharge may come on its own but it is usually milky white and comes from multiple duct openings on both nipples.
During a ductogram, you are asked to lie on your back while we try to express nipple discharge so that we can identify where on your nipple the discharge is coming from. A tiny blunt-tipped needle is then advanced into the duct with the discharge and a few drops of x-ray dye are injected into this duct. Mammographic images of your breast are done so that we can evaluate the inside of the duct highlighted by the contrast material.
The most common causes of spontaneous nipple discharge include:
If a lesion is identified inside the duct, we may recommend that it be surgically removed.
Nipple discharge that is seen only with expression — when you squeeze or otherwise manipulate the nipple — is not usually related to an underlying problem. It is normal for most women to have some fluid in the milk ducts. We recommend that you not try to express nipple discharge, but that when you do laundry you get in the habit of checking your bra cups and night clothes for spots that may indicate spontaneous discharge.
If you’re experiencing breast cancer-related symptoms, a VCU Breast Imaging radiologist may recommend an imaging-guided procedure for further evaluation and diagnosis.
I feel safe.
– VCU Breast Imaging patient