MOBILE ON-SITE MAMMOGRAPHY (MOM)

THESE APPOINTMENTS ARE TO BE SCHEDULED, RESCHEDULED AND CANCELED BY THE MOM DEPARTMENT.  

PLEASE TRANSFER THESE CALLS TO MOBILE MAMMO QUEUE USING QUICK CONNECTS OR DIRECT DIAL 480-967-3767 

(Refer to the Training Refresher Materials section under the Tools drop down)

Auth requirements:

Tricare: All US, MG, require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum:(In Nevada ONLY: Out of network for all US except ABI, Arterial, Venous mapping and Prostate 

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

AHCCCS does not cover screening mammograms if patient is under the age of 40 years old.  If a mammography is requested for family history and the patient is younger than 40 years old, a diagnostic mammography is the recommendation by the insurance.

Mammo+ & Mammo+Heart

Replacing PBCD

Available for Medicaid Patients

New SimonMed Employee Screening Benefit

VA Mammogram Orders:

VA orders have a Standardized Episode of Care (SEOC) which covers any additional imaging needed for mammograms.  If this order is linked in a patients screening mammo and we need them to come back for additional views, we can use this same order, or if based on patients screening and guidelines we need to change the exam, we are allowed to do so using the same order.   Below is an example of a VA order referring to the SEOC. 

STAT GUIDELINES

STATS we do try to accommodate same day next day, if it requires auth we schedule out 4 hours or next AM so auth has time to attempt to obtain.

We check the location most convenient to the pt but if we see no openings we offer surrounding sites that may have openings, if surrounding do not have openings as well we are ok to double book following the below guidelines.

*Agents do not have rights to double book so if this occurs they are reaching out to their leads to do the double booking at which time the leads can check thru to make sure it’s an ok spot to add.

If they double book  they should be notifying the patient they are being worked in and may have a wait and notate this was communicated.

A call must be placed to the site only if the following circumstances apply:

·         Clinic/modality is closing within the hour. Example you get call at 3:15pm and that modality closes at 4pm.

·         We are already double-booked and you are needing to add another exam. Example we have two 4pm and you need to add a 3rd (Triple Booking).

·         Only overbook non contrast spots.  Please ensure contrast coverage is available if you are booking a contrast exam.

·         If you are scheduling a specialty exam, there may be limits on certain exams such as: Arthrograms, Fluoro, Diagnostic Mammo’s, Nuc Med, Etc. You must call the site for approval.

·         If you are scheduling an exam that requires authorization please make sure you inform the patient that if authorization is not received by the time of the exam, their appointment   may be postponed. Allow 4 business hours’ time for auth to be obtained.

·         Same day Saturday appointments that require auth must already have auth on file or the patient will not be able to be seen. If exam requires authorization and it has not already been obtained please schedule for Monday to allow time to obtain STAT auth.  

If you are “postponing scheduling” until the next business day please send recap form to the Dr office to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

If you are “postponing scheduling” on a Friday until Monday please send recap form to the Dr office as well as call to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

Watch for scheduling Blocks - hover over block in find slots to see description 

mammography

KEY FACTORS FOR SCHEDULING  MAMMOGRAMS

• SCREENING MAMMOGRAMS CAN BE SCHEDULED AS LONG AS PATIENT HAS NO NEW SYMPTOMS AND LAST MAMMOGRAM WAS NORMAL

  • IF PATIENT HAD AN ABNORMAL MAMMO MORE THAN 18 MONTHS AGO, PT CAN

RESUME WITH A SCREENING MAMMO

• SCREENING MAMMOGRAMS  ARE DONE YEARLY AND CAN BE SCHEDULED  WITHIN THE SAME MONTH OF THE PREVIOUS YEAR.

  • MOST INSURANCES WILL NOT COVER THE SCREENING EXAM IF PERFORMED EARLIER THAN THIS

• SCREENING MAMMOGRAMS  DO NOT REQUIRE AN ORDER FOR PT'S AGE 40+ (some of our referring population still require orders to be used for service, you must check the referring provider notes to validate)

  • 39 Y/0 AND YOUNGER NEED AN ORDER

• DIAGNOSTIC MAMMOGRAMS  ARE DONE FOR PT'S EXPERIENCING NEW SYMPTOMS, HAVE HAD AN ABNORMAL MAMMOGRAM, OR RECENT HISTORY OF BREAST CANCER

  • WE NEED PRIORS FOR ALL DIAGNOSTICS THAT ARE A RECALL/FOLLOW UP. PLEASE REQUEST AND SCHEDULE PATIENT OUT 2 WEEKS TO GIVE TIME FOR PRIORS TO ARRIVE.

  • IF PATIENTS HAVE NEW SYMPTOMS AND WE DON'T HAVE PRIORS,THEY CAN STILL BE SEEN. PLEASE STILL REQUEST PRIORS WHEN SCHEDULING APPT.

• ALL DIAGNOSTIC EXAMS NEED AN ORDER. IF YOU ARE SCHEDULING A PATIENT WHO NEEDS A DIAGNOSTIC MAMMO INSTEAD OF A SCREENING YOU MUST CALL THE REFERRING PHYSICIAN FOR A NEW ORDER.

PLEASE SEE BELOW  FOR DETAILED INSTRUCTIONS ON HOW TO SCHEDULE  EXAMS

**Screening Mammograms do not require an order for scanning, however some our our referring population still require orders be used for services. You can validate this information in the referring provider notes in EXA. An example of one of providers is MPHC, they have Provider Alerts in EXA for screening mammograms that patients MUST have an order to list their providers as the referring**

Please check provider alerts

Mammography uses low dose x-rays to allow detailed imaging of breast tissue. Mammograms are used for early detection of breast cancer in women aged 35+ as yearly screening exams. It is also used to evaluate specific breast problems like masses as diagnostic exams. This exam has been proven in multiple scientific studies to save lives by early detection of breast cancer. No other imaging study of the breast can detect cancer as early as mammography.

Terminology:

Screening mammogram: test used yearly to look for signs of breast cancer in women with no current problems. We recommend that screening begin at age 35, but some women with strong family history of breast cancer or high personal risk of breast cancer should have yearly screening beginning earlier. These exams are read after the patient is sent home.

Diagnostic mammogram: test used to evaluate a problem in the breasts. If the patient complains of a mass, persistent pain in a small area of the breast, nipple retraction, discharge or skin changes, a diagnostic mammogram is performed. Diagnostic mammo is also used to follow up abnormal screening exams. Diagnostic mammograms are often paired with breast ultrasound for full evaluation of the patient’s complaint.

3D Tomosynthesis mammogram: It is a special type of mammogram that takes multiple images or slices through each breast. While standard mammography shows all of the breast tissue on one image, the 3D images show thinner slices of the breast, allowing the radiologist to see masses or other problems that may have been hidden by the rest of the breast tissue on standard exams. Most of our mammogram exams at SimonMed are 3D. 3D mammogram does still involve compression of the breast and radiation.

Breast Ultrasound

Ultrasound uses sound waves to make images of breast tissue. In breast imaging, we use ultrasound to look for signs of breast cancer and to diagnose other non-cancerous breast diseases. Ultrasound is used with mammography in most cases. It is also used in women as the first test when they are too young for mammography or can’t otherwise have a mammogram. There is no ionizing radiation in ultrasound exams.

Terminology:

Diagnostic Breast Ultrasound: targeted exam of the breast for women with a breast complaint or abnormal mammogram. The ultrasound tech takes images of the breast using a handheld transducer. The only images obtained are where the tech specifically sees a problem. 

3D Whole Breast Ultrasound: special ultrasound test that uses a larger transducer that is able to record images of the entire breast. This allows the radiologist to look for subtle areas of concern that the tech may not have noticed on handheld ultrasound. This is used for screening exams. For screening, it is used for women with dense breast tissue (half of all women) that may hide abnormalities on mammograms.

Who can get a mammogram?

Screening mammogram-

1. Any woman 35 or older with no current or new breast problems qualifies for screening mammograms as long as she has not had a mammogram in the last 12 months.

2. Patients 34 and under can be screening if they meet the following criteria. They MUST have an order and one of the following... first degree relative w/ breast cancer age 40 and younger, IBIS score 20% or higher, known positive BRCA 1or 2 gene mutation, first degree relative tested positive for BRCA gene mutation, or going for mammoplasty surgery. 

3. Pregnant and breastfeeding women ARE recommended to continue having yearly mammograms according to the above recommendations. This is a recent change to recommendations. Breast cancers are found in these women and delaying care because they are pregnant or breastfeeding can lead to more advanced, harder to treat cancers when they are finally diagnosed. The risk from radiation to the baby is very low in pregnant women because the x-rays used are not strong enough to penetrate through the abdominal wall and uterus. There is NO risk to the baby in breastfeeding women who get mammograms.

4. Women with previously evaluated breast masses, pain involving large areas of the breasts, milky nipple discharge, and prior history of breast cancer can all be scheduled for screening. If they have new problems or their most recent mammogram was abnormal, they must have a diagnostic mammogram.

5. Transgender women (male to female trans) who have been on hormone therapy for at least 5+ years or are 50+ years old on hormones

6. Transgender men (female to male trans) who have not had top surgery are still recommended to have yearly mammography under the usual age guidelines above.

7. Screening mammograms are scheduled for 15 minutes. If the patient has breast implants it needs to be scheduled for 30 minutes under the appropriate drop down. It is very important  for you to schedule this correctly so the techs are given the correct amount of time to perform the exam.

• SCREENING MAMMO, BIL W/3D TOMOSYNTHESIS (1380)

• SCREENING MAMMO, BIL W/ IMPLANTS & 3D TOMOSYNTHESIS (1384)

Diagnostic mammogram-

1. Women age 30 and up who have a new breast problem

• New breast mass

• Focal breast pain (can pinpoint the area of pain) If the patient has all over pain or pain related to their menstrual cycle, proceed with screening mammogram if no other issues.

• Skin changes- dimpling, redness, wounds, masses

• Bloody or clear nipple discharge

• Axillary (armpit) mass, pain, drainage

• Recent breast cancer treatment

2. Women with abnormal screening mammograms- check the prior report to see what was recommended in the bottom of the report. Some patients may not need mammograms.

3. Women who are being followed for a problem on prior diagnostic mammogram/ultrasound. Check the old reports for the radiologist’s recommendations for follow up.

4. Women 30 and older who have no complaints but their provider requests diagnostic imaging.

5. Men age 25 and older who have a breast complaint (not in men with only a problem in the axilla. Men with axillary complaints can be scheduled for Ultrasound of the Axilla at any location providing ultrasound.)

• Diagnostic mammo, BIL W/3D Tomosynthesis (1381)

• Diagnostic mammo, BIL, W/ Implants and 3D Tomosynthesis (1385)

• Diagnostic mammo, Uni W/ 3D Tomosynthesis (1383)

Mammogram Screening Questions

 When was your last mammogram? Where was it performed? Was it normal?

1. 1. If performed at SMI, look at the report. The impression portion of the report, will say if the exam was normal or if they need to return for more imaging. Patients whose last exam was not normal cannot have a screening mammogram.

• If abnormal mammo was done more than 18 months ago, patient can resume with screening mammo.

1. 2. If not performed at SMI

• Request all images and reports from mammograms, breast ultrasound or breast MRI performed at another site and document in notes. If the patient is coming to follow up a finding on any other type of exam (CT, PET/CT, non-breast MRI) request that exam as well.

• Request prior reports for these exams. These often can be obtained more quickly and allows the patient to be seen sooner

• Notify the patient that it is often quicker for them to get a disc with their images from the prior company to bring to SimonMed. We have no control of how long it takes another company to send us images

• If the patient is coming to follow up an abnormality on a prior exam from another company, we must have prior reports and images to do the exam.

• If the patient is coming for a screening exam, she can be scheduled for her screening without waiting to receive priors. (Priors must still be requested).

• If the patient is following up an abnormal mammogram from another facility, we MUST have their images/reports to perform the exam. The patient should be scheduled in 2-3 weeks to allow priors to be sent to us. The patient can go be scheduled sooner if she is able to get her priors from the other facility to bring to her appointment.

1. 3. Patients need to have a screening bilateral mammogram exactly 12 months from last exam

Do you have an order from your doctor?

2. 1. If yes, what does the order say? Why are they recommending you have a mammogram? They need to read the entire order to you.

   2. If no, screening mammograms can be performed without an order ONLY if the patient is 40+ years, has no new symptoms and identifies her primary care provider to receive the report. (some of our referring population still require orders to be used for service, you must check the referring provider notes to validate)

DIAGNOSTIC IMAGING WILL ALWAYS REQUIRE AN ORDER

Do you currently have a new breast lump, pain or discharge from your nipple? Did your doctor tell you they found a problem in your breast on their exam?

3. 1. If the patient has a new lump, they will need a bilateral diagnostic mammogram and ultrasound if they are 30 years old or older. Patients under 30 should be scheduled for ultrasound only.

   2. If the patient has pain, ask for details

• Diffuse pain (involves large areas of one or both breasts), pain comes and goes or is associated with menstrual cycle, no specific area to pinpoint. These patients can have a screening mammogram if ordered/requested.

• Focal pain (specific area patient is able to pinpoint), persistent or new pain. The patient should have diagnostic imaging but follow age requirements for mammography.

3. 3. If the patient has nipple discharge, ask for color

• Red/bloody or clear discharge will need diagnostic mammo/ultrasound for patients 30+ and ultrasound for younger patients.

• White, brown, green discharge can have a screening but can have diagnostic if ordered as a diagnostic by their provider.

Have you been diagnosed with breast cancer in the past two years?

• Patients who have completed treatment (ie. surgery, radiation therapy and chemotherapy (if part of therapy) can have screening mammography if that is what is ordered by their provider

• Patients who have not completed their treatment (surgery and radiation) need diagnostic mammography for any imaging. Patients who have completed therapy but their provider still wants diagnostic imaging may also have diagnostic mammogram.

• Patients with prior bilateral mastectomy should be scheduled for 2D ultrasound not mammography.  

  • If the patient has had a unilateral mastectomy, they should be scheduled for a Screening Unilateral Mammo.

Do you have breast implants?

• If yes, make sure to choose the exam that includes breast implants. 

Are you breastfeeding?

• If yes, the patient needs to express milk prior to the appointment.

Do you have dense breast tissue on prior mammogram exam?

• Please check the previous report. If the patient had C (Heterogeneously dense) or D (Extremely dense) density under “Breast Composition” those patients are recommended to have 3D whole breast ultrasound at the time of their screening mammogram.

• If the patients reports that she was told she had dense breast tissue on outside mammogram, try to get an order to schedule a 3D whole breast ultrasound if they are C or D density at the time of screening. It is helpful to have all of this done at one time.

• When scheduling a patient for a mammogram that has not had their prior mammograms done with us we must obtain prior films.

1. Patients who had abnormal findings on outside films that want to follow up at SimonMed MUST have their prior images and report available to have their diagnostic mammogram performed. If we do not have the prior exam, the appointment will be rescheduled.

2. Patients who are scheduled for screening exams, may have their appointment before we receive their priors. However, those priors should be requested at the time of scheduling.

3. Sometimes the patient will have their outside films or they may request the exams themselves. Please inform the patient that they must bring these exams to us at the time of their appointment.

4. We are able to request outside films for patients. You must enter a request through the Medical Records Ticketing System on the Simonmed portal under the Medical Records tab and Medical Records will obtain the films.

5. It is very important to have prior exams on file prior to the mammogram. We must have them for comparison. Not having previous films at the time of the exam will delay accurate results and may result in the patient having to return for additional imaging

6.  If the patient currently has new symptoms and has an order for a screening mammogram you MUST contact the doctor's office and obtain a new order for a diagnostic mammogram. Do not schedule a diagnostic exam without a correct order.

Diagnostic Mammography and Ultrasound Tips

• We MUST have an order from the provider to schedule diagnostic mammogram or ultrasound

• Diagnostic mammograms are ordered when a patient is experiencing symptoms such as localized pain, lumps including axillary lumps, skin changes including redness or dimpling, nipple retraction or discharge.

• Can be scheduled in patients to follow-up an abnormal screening mammogram (recall).

• Can be scheduled for patients that have a history of breast cancer or recent biopsy (please see biopsy report for recommendations.)

• Diagnostic imaging can be performed more than once a year and may be ordered as mammogram only, ultrasound only or both, as well as unilateral (one breast) or bilateral (both breasts). Patients (35+) who have not had a bilateral mammogram (screening or diagnostic) within the past 12 months need to be scheduled for bilateral diagnostic mammogram (even if the other side has no problems.) 

• A breast ultrasound should always be scheduled to follow a diagnostic mammogram unless the prior report requests mammogram only. Please ask a tech or women's care coordinator if you have questions.

• Remember the following guidelines when scheduling diagnostic mammograms:

  • Under the age of 30: Complete breast ultrasound on the side of complaint.

  • If prior exams were abnormal: Schedule what is recommended in the report

  • 30 and over:

No mammogram within past 12 months: Bilateral diagnostic mammogram followed by bilateral breast ultrasound (this will be changed to fit the needs of the patient as determined by the radiologist).

Prior mammogram 6 months or more old: Unilateral diagnostic mammogram followed by unilateral breast ultrasound.

Prior mammogram less than 6 months old: Unilateral breast ultrasound

Most recent prior mammogram was abnormal: Schedule what is recommended in the report.

• Diagnostic mammograms are scheduled for 30 minutes followed by a 30 minute breast ultrasound.

• Diagnostic imaging can also be performed on men (Follow the age guidelines)

• Males 29 and younger:  Limited breast ultrasound on the side of complaint

• Males 30 and over: Bilateral diagnostic mammogram and bilateral breast ultrasound (Males do not get yearly screening mammograms)

• Males with only an order for Ultrasound of the axilla or only have a complaint in the axilla do not need a mammogram. They may be scheduled at any location that performs ultrasound.

• Women with an axillary complaint or order for Ultrasound of the Axilla MUST be scheduled based on the diagnostic rules above. They should not be scheduled for just an Ultrasound of the Axilla.

Recalls

• A recall is performed when a patient has had a screening mammogram and something suspicious or unclear was found by the radiologist. Approximately 10% of screening mammograms are abnormal and require the patient to return for additional mammographic images of the breast or a breast ultrasound.

• An abnormal screening exam DOES NOT MEAN that the patient has cancer. The majority of cases end up being from non-cancerous causes

• 80% of callback cases result in benign findings on additional imaging. This is why priors are so important. The prior may show that the finding has not changed over time and follow up is not needed. These women will be told to return in 6 months to document the finding hasn’t changed or told to return to yearly screening mammogram.

• Something that may look abnormal on one woman's mammogram may be normal tissue to another patient’s exam. Breast tissue appearance is unique to them. Use the analogy of your thumb print. No two are the same.

• If the patient is recommended for 3D whole breast ultrasound, the patient should be scheduled for Bilateral 3D Diagnostic Whole Breast Ultrasound at the time of their diagnostic exam.

• When scheduling a recall study the best way to know what you should schedule next is to look at the recommendations on the report from the last time the patient was here. The radiologist will always include in their report what the patient should have done next. For example it can say "patient can resume her bilateral screening in one year if clinically stable", or "patient needs to return in 6 months for spot compression views and possible ultrasound". You will usually find this in the impression portion of the report.

Example:

IMPRESSION:

1. No significant interval change in the left breast. No mammographic evidence of malignancy in the left breast.

2. Incomplete evaluation of the right breast with additional coned-down compression views and a rolled 90 degree lateral view recommended for further evaluation. Ultrasound is also recommended, if the density persists.

BIRADS 0-INCOMPLETE

NEED ADDITIONAL IMAGING EVALUATION

•  Regarding patients with abnormal Breast MRI results that recommend Diagnostic Mammogram and/or breast ultrasound, these recall exams need to be scheduled at a location with a Rad on site.  In AZ and NV, it should be scheduled at a site with an on-site rad because the rad can go personally scan and look for subtle findings to biopsy. In Flagstaff, Tucson, Prescott/Prescott Valley, CO and FL they can go anywhere because there may not be a close enough site with a onsite rad.  Review QGenda Rad Schedule on the SimonMed portal page.  If you need help, please reach out to leadership for assistance.  

Ductograms and Galactograms  (NO LONGER PERFORMING AT ANY SIMONMED LOCATION)

Please follow the following guidelines when scheduling these exams.

1. It is done only for actively and current spontaneous nipple discharge that is bloody/red/brown. Cannot be upon expression. Cannot have only happened once.

2. Clear or milky discharge are ok.

3. If there is no discharge at the time of procedure, the exam will be canceled.

4. They are always scheduled as a single study, very rarely will be bilateral.

5. Must have had a Mammogram within the last 3-6 Mos. (More recent would be better).

Dropdown: MG GALACTOGRAM SINGLE STUDY (595)

If you have any questions regarding these please ask a Women's Care Coordinator for assistance.

Breast/Axilla Lymph Node Biopsies:  All breast/axilla lymph node biopsies are to be scheduled by a Women's Care Coordinator (WCC). Please see direct phone number listed below.

Transfer to WCC Queue

SECOND LOOK BREAST ULTRASOUNDS

• • • • SHOULD BE HANDLED BY THE WOMENS CARE COORDINATOR*****     Transfer to WCC Queue

      • BREAST-BILATERAL IN RIS PULL DOWN FOR BILATERAL

      • BREAST-UNILATERAL IN RIS PULL DOWN FOR UNILATERAL MAKE SURE TO CHOOSE LEFT OR RIGHT

      • SCHED FOR 30 MINUTES (2 Blocks)

      • NO PREP

      • THESE ARE RECOMMENDED AFTER A DIAGNOSTIC/ULTRASOUND OR BREAST MRI HAS ALREADY BEEN DONE

      • THESE MUST BE BOOKED AT THE SITE WHERE THE READING RAD WILL BE WHO ORIGINALLY READ THE DIAGNOSTIC/ULTRASOUND OR BREAST MRI 

      • PLEASE MAKE SURE TO CHECK THE SITES BANNERS AND SCHEDULING BLOCKS TO ENSURE THEY ARE AT THE RIGHT TIME AND CORRECT ROOM

      • PLEASE REFER TO THE BANNERS AND SCHEDULE BLOCKS AT THE SITE YOU ARE SCHEDULING FOR AND KEEP IN MIND A RAD HAS TO BE PRESENT SO THESE CANNOT BE DONE TOO EARLY OR TOO LATE.

***IF A PATIENT CALLS STATING THAT THEY HAVE NOT 

RECEIVED A LETTER AFTER COMPLETING THEIR MAMMOGRAM***

• This letter is sent to the patient within 30 days of completing their mammogram, the letter contains the findings of the patient’s mammogram.

1. You are to send an email to Nancy Castillo with the patient's name, date of birth, best contact number, and MRN. In the email you are to include a short message stating that the patient has not received their letter after completing their mammo and is requesting that it be sent out.

2. Give the patient the Women's Care Coordinator contact number and let them know that a Women's Care Coordinator will contact them within one business day.

ge pristina dueta mammogram

These mammogram machines allow a patient and tech to control the compressions with a button.

 For locations that offer this exam please visit the site search on the portal here.

BREAST CARE BREAST DENSITY AND TC SCORE SCHEDULING

If a patients mammogram results show that the patient would benefit from a Whole Breast US Screening (for Breast Density) or an MRI Breast (for eligible TC Score calculations) SimonMed will be faxing the referring providers office to get permission to perform those exams.

If the provider agrees they will sign the fax we sent and send back. Once these are sent back the labeling team will create pre orders in EXA for the exam.

Below are screenshots of what those orders look like. Agents should be able to confidently communicate to patients why the exam is being requested based on prior report and the description on the order faxed back.

This process does not replace the Breast Care Breast Density and TC Score workflow in place, this is in addition to the attached.

3d whole breast screening ultrasound (previously abvs)

3d whole breast screening ultrasound (previously abvs)

Room: Ultrasound Room Procedure Dropdown: 3D Whole Breast 

8008 = Bilateral

8009 = Unilateral Left

8010 = Unilateral Right

Duration: 30 minutes

Prep instructions: No prep.

Guidelines regarding scheduling this exam are:

• Exam may be subject to the deductible (unlike screening mammogram.)

• Order does NOT have to say “3D Whole Breast”.  Some verbiage you might see for 3D Whole Breast US is: 3D Whole Breast US, Breast US, 3D ABVS, Complete Breast US.  SimonMed order forms for mammogram that say “with additional views/US if indicated” can be scheduled for supplemental screening with 3D US if this is what is being recommended. 

• If the patient is symptomatic (new focal pain, lump, etc) they are no longer eligible for screening 3D Ultrasound. See Diagnostic Mammogram and Ultrasound Tips section. 

• The best way to schedule these exams is on the same day as the screening mammogram. 

• 3D ABVS is ideal and recommended for women with dense breast tissue as additional screening to look for cancers that may be hidden on mammogram. 

• Patients who are not dense may also have 3D ABVS if ordered. 

• 3D ABVS is a screening option for women who refuse or cannot have mammograms. Mammography is the gold standard for screening, and patients should be encouraged to have a yearly mammogram as it shows early signs of breast cancer that cannot be seen on ultrasound. 

• If a patient had a mastectomy, 3D ABVS should not be performed on the side of mastectomy. 2D whole breast ultrasound should be performed on the mastectomy side. 2D or 3D ultrasound can be performed on the side that did not undergo mastectomy.

What does breast density mean and why should we care?

The breasts are a mixture of breast tissue and fat. On mammography, breast tissue is white and fat is gray. We need enough fat mixed with the white tissue to see masses because cancer on mammography is also white. Patients with dense breast tissue have more of this white breast tissue and less of the gray fat so masses can hide on the mammogram.

Patients who have dense breasts also have a higher risk of developing breast cancer than women with fatty breasts. This is likely due to having more cells in the breast that can turn into breast cancer.

Because of the risk of missing a mass on mammogram and the overall increased risk of developing breast cancer, women with dense tissue are recommended to have additional screening each year with ultrasound. We recommend that this be performed at the time of the patient’s screening mammogram as she is more likely to get her ultrasound if she doesn’t have to come back for another visit.

Schedulers play an important role in making sure patients get the imaging they need to keep them safe. Looking at prior reports to see if they have dense tissue and asking patients if they have ever been told they have dense tissue is important so that the 3D Whole Breast Ultrasound can be requested. The patients are appreciative to have peace of mind about what is hiding in their breasts without having to come to SimonMed multiple times.