Breast Imaging

Ontario Breast Screening Program

The Ontario Breast Screening Program (OBSP) offers mammograms beginning at age 40 for people who are considered to be at an average risk for developing breast cancer.

If you are between the ages of 40 and 49, the OBSP recommends speaking with your physician to decide whether breast cancer screening is right for you.

If you are between age 50 and 74, the OBSP recommends getting screened every two years. 

If you are between age 40 and 74, the screening is covered by OHIP and you do not need a referral from a health-care provider.

If you are over the age of 74, you need a referral from a physician in order to get screened. The screening will be covered by OHIP with a referral.

Learn more about the OBSP and how to get screened.

OBSP High Risk Screening Program 

You can get screened through the OBSP High Risk Screening Program if you are aged 30 to 69, referred by a physician, have a valid Ontario Health Insurance Plan (OHIP) number, have any acute breast symptoms and fall into one of the following risk categories. 

You are in a higher risk category if you have:

• A gene mutation that increases your risk for breast cancer (for example, BRCA1, BRCA2, TP53, PTEN, CDH1)
• A first-degree relative of someone with a gene mutation that increases your risk for breast cancer and have either had genetic counselling or decided not to have genetic testing
• Been assessed by a genetics clinic as having a 25 per cent or higher lifetime risk of breast cancer based on personal and family  
• A history of chest radiation therapy for another cancer or condition (like Hodgkin Lymphoma) before age 30 at least eight years ago

If you are considered high risk, the OBSP recommends getting screened for breast cancer once a year.

Speak with a physician to be referred to this program. The physician will need to submit an OBSP high risk program referral form. 
 

Mammogram

A mammogram is a digital X-ray of breast tissue. It can give physicians information about lumps, calcifications and other abnormalities that may be present in the breast. Mammograms are also used to screen for breast cancer.

During your mammogram you will stand in front of the X-ray machine with your breasts resting on a plate. The technologist will gently but firmly compress your breasts between two plates for a short time during the exam. This might feel uncomfortable, but it is necessary to get clear pictures and keep the radiation dose low.

If you can, it is a good idea to schedule your mammogram about two weeks after your period has ended.

Before the procedure starts, let the technologist know if you:  

• Are pregnant or might be pregnant  
• Have any implanted devices like a pacemaker or port
• Have any shoulder or other mobility issues
• Have any skin conditions

Mammography, which is the process of doing a mammogram, is accredited by the Canadian Association of Radiologists. 

Breast ultrasound

A breast ultrasound uses sound waves to create a picture of the breast. It can show areas of the breast that are hard to see in a regular mammogram, like the areas closest to the chest. This helps physicians get more information about lesions, lumps or masses that were found on a mammogram or felt during an exam.

During your ultrasound, you will lie on your back on the examination table with your arm raised above your head. The technologist will apply a water-based gel on your breast and then press the ultrasound probe firmly against the skin and glide it over the area of interest several times to get a good look. 

Ductogram (galactogram)

This procedure is done when someone has fluid (discharge) coming out of their breast in order to figure out which duct the discharge is coming from.

Before the procedure, we might use a warm towel on your breast to help get the fluid flowing.  

If the radiologist can see where the fluid is coming from, they will put a thin, flexible tube called a blunt-tipped cannula into the duct. Then, they will inject a small amount of contrast dye into the duct through the cannula. You might feel some pressure or fullness when the dye is injected.

After that, the technician will take some mammogram pictures of the ducts.

Once the procedure is done, you can go back to your normal activities.  

Breast biopsy

A breast biopsy is a procedure to remove a small amount of breast tissue for testing. It is done when something suspicious shows up on a mammogram and your physician wants to know more about it.  

Here are some important things to keep in mind:  

• If you are taking blood thinners (anti-coagulants), please talk to your physician before your appointment. Depending on the medication, they might need to check your blood’s clotting ability beforehand. A recent international normalized ratio (INR) test may be needed and should be provided by the referring physician in advance of your scheduled appointment.
• Let your physician know if you have any concerns or known allergies to local anesthetic before your biopsy.
• Please arrange to have a support person accompany you home after the biopsy. A post procedure care sheet with instructions on how to take care of yourself after the biopsy will be given to you afterwards.

There are different methods used for doing biopsies, including the following.

Stereotactic core biopsy

A stereotactic core biopsy is used to obtain breast tissue when small calcium deposits are seen on a mammogram.

During the procedure, you will either sit or lie on your side with your breast compressed between two flat plates. The radiologist will make you as comfortable as possible since it is very important that you stay still during the procedure.

The radiologist will numb the area to be biopsied with a local anesthetic. Several tissue samples will be taken and then x-rayed to see if they contain calcifications. A mammogram will also be done during the procedure.

At the end, the radiologist may place a clip in the biopsy site for future reference if necessary.

Ultrasound-guided core biopsy

In an ultrasound-guided core biopsy, a physician inserts a needle in an area in the breast through a small cut in the skin to obtain tissue samples.

You will first get some numbing medicine on the area (local anesthetic), and then the physician will take the samples.  

Core biopsy is performed using a device that makes a loud clicking noise or using a vacuum assisted device.

You may feel some discomfort or pressure during the biopsy.

At the end, the radiologist may place a clip in the biopsy site for future reference if necessary.

Fine needle aspiration biopsy

A fine needle aspiration biopsy uses ultrasound and a thin needle to collect fluid or cells from the breast or lymph node. The sample is analyzed under a microscope to give a more accurate diagnosis.

You will be asked to lie on your back on the examination table, as you would for a regular breast ultrasound. The radiologist will find the spot of interest and numb it with a local anesthetic. Once the areas is numb, the radiologist will use a fine needle to collect cell samples.

Digital breast tomosynthesis (DBT)

Digital breast tomosynthesis (DBT) is a high-tech version of a mammogram. Instead of just one picture, it takes multiple images of your breast from different angles to make a 3D image.

DBT can be useful in many cases, especially if you have dense breast tissue that can make it difficult to identify cancer on a standard two-dimensional mammogram.