Breast Cancer Screening and Diagnosis

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Fred Hutch Cancer Center does more than treat breast cancer. We also focus on finding this disease early, when it is easier to treat.  

Screening tests are done on a regular schedule for people with no breast cancer symptoms. For most people, a mammogram is the best screening test for breast cancer. These tests identify signs that might otherwise go unnoticed.  

Diagnostic breast imaging is done for people who do have signs or symptoms to determine what the cause is.

At Fred Hutch, we offer both screening and diagnostic services, including procedures such as breast biopsies.

Schedule a Mammogram 

Call 206.606.7800 to request a screening mammogram.

Fred Hutch or UW Medicine MyChart account users may schedule mammograms online through MyChart.

As of January 1, 2024, Washington state law (RCW 48.43.076) requires many health plans to cover certain breast imaging exams (including follow-up imaging after an abnormal screening mammogram, diagnostic mammograms and breast MRIs/ultrasounds for patients at high risk for breast cancer) with no patient cost-sharing. Contact your employer’s benefits administrator or health insurance carrier to understand your specific coverage.

Why Breast Cancer Screening Matters

Regular screenings for breast cancer are important because the earlier we detect the disease, the better. People with smaller, early-stage breast cancer have more treatment options and a better chance for a full recovery and a long, healthy life.  

Fred Hutch breast health experts provide screening tests and can help you decide what is right for you. This depends on your age, health, risk level and other factors. The screenings we recommend — 3D mammogram and sometimes breast MRI (magnetic resonance imaging) — are based on the best scientific evidence. 

You may choose to have an appointment to receive your imaging results the same day while you wait. Most patients receive their results the same day or the following day after leaving the clinic. 

Breast Imaging Expertise at Fred Hutch 

  • The technologists and radiologists who perform and interpret your screenings specialize in breast imaging.  
  • Our radiologists are certified by the American Board of Radiology. They have extra training in breast imaging and exceed national standards.  
  • Fred Hutch is recognized as a Breast Imaging Center of Excellence by the American College of Radiology.  
  • We do research to improve early detection of breast cancer with imaging and lead important clinical trials to improve screening. 

Where to Get a Mammogram

Fred Hutch Sloan Clinic

Our Clinic Locations

Patients can schedule mammograms at multiple Fred Hutch and UW Medicine locations:

Call 206.606.7800 to request an appointment at the Sloan Clinic or 206.668.1749 to request an appointment at all other locations.

Patients with a Fred Hutch or UW Medicine MyChart account can schedule a mammogram through MyChart.

mammogram van

Mammogram Van

Fred Hutch's Mammogram Van makes getting a mammogram even easier. Our state-of-the-art van travels to neighborhood locations all over the greater Seattle area, making it fast and convenient to get the preventative care you need.

Call 206.606.7800 to request an appointment at the Fred Hutch Mammogram Van or use your Fred Hutch MyChart account. 

View the Mammogram Van Location and Schedule

About Breast Cancer Screening

Mammograms

Read about screening mammograms in other languages:

Screening Mammograms handout, Arabic
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Screening Mammograms handout, Spanish
Screening Mammograms handout, Swahili
Screening Mammograms handout, Vietnamese

Mammograms — the most common and most studied breast cancer screenings — save lives by finding cancers early, before symptoms appear. A mammogram uses X-rays to take images of your breast. With these images, a radiologist can see abnormal areas that may be too small for you or your health care provider to feel.

At Fred Hutch, we use the most advanced technology for mammograms. It is called 3D mammography or digital breast tomosynthesis. We offer 3D mammography as our standard screening for all patients. It gives your radiologist a detailed, layer-by-layer picture of your breast.

Mammograms are the foundation of breast cancer screening. They detect cancer in the large majority of people who have the disease but do not have any symptoms. We also use mammograms to help diagnose breast cancer in people with signs or symptoms and to check the results of breast cancer treatment.

Fred Hutch physicians recommend women 40 or older have a screening mammogram every year if they are at average risk for breast cancer. This matches guidelines from the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers, including Fred Hutch.

This recommendation is not right for everyone. If you are at higher-than-average risk, you may need screenings earlier and more often. Some people may choose to start screening later or to be screened less often.

Organizations like the American Cancer Society and the United States Preventive Services Task Force have different recommendations on the age to start screening and how often to have screenings (every year or every two years).

Here is what is important: Have screenings regularly on a schedule that matches your risk and preferences. Your health care provider or a Fred Hutch expert can assess and explain your risk. We can help you decide on the screening schedule that is right for you.

3D mammography is a way to take many pictures of your breast at once so physicians can see your breast tissue in detail. This improves the odds of finding true cancers early. It also leads to fewer false alarms (suspecting cancer in tissue that is healthy).

Getting a 3D mammogram is much like getting a 2D (conventional) mammogram. A specially trained technologist positions your breast on a platform. They compress your breast under a paddle. Then an X-ray arm sweeps over your breast, taking multiple images. 

2D mammography takes one image of your breast from above and one from the side. 3D mammography takes many images from different angles. It uses high-powered computing to convert the images into a stack of layers, or “slices.” Each layer is only 1 millimeter thick. 

With these layers, your radiologist can see breast cancers more clearly and provide a more confident assessment. 3D mammography might reduce your need for follow-up tests of tissue that is normal but could seem abnormal on a 2D image.

For most patients, the benefits of getting a mammogram outweigh the risks. But, like all tests, mammograms are not completely risk-free.

Most breast cancers can be seen on mammograms, but some cannot. If you have breast concerns, talk with your physician or breast health specialist. This is important even if you just had a mammogram that did not show any problems.

A mammogram can also result in a false alarm, showing a possible problem that turns out not to be cancer after you have more tests, like a special diagnostic mammogram, breast ultrasound, or a biopsy procedure. 

At Fred Hutch and UW Medical Center, false alarms happen for fewer than 10 in 100 patients. This is better than the average rate for health care facilities in the United States.

Mammograms should not be painful. If you feel any pain, let your technologist know so they can reposition your breast. 

Mammograms require the use of a small amount of radiation. This level of radiation is very safe. It is smaller than the amount you would get in your daily life over two months. 

When you have a mammogram, you may learn you have dense breasts. Breast density refers to the amount of normal, non-fatty tissue seen in a mammogram. There are four levels, from almost all fatty tissue to extremely dense tissue with very little fat. If your breasts are in the two higher levels, they are considered “dense”.  

Keep in mind that there is no “normal” amount of breast density. About half of patients who get a screening mammogram have dense breasts, and half do not.
There are two main reasons that breast density matters:

  • Cancer can be harder to see in mammograms of people who have dense breasts. 
  • Density has been linked to a higher risk of getting breast cancer. (But density alone has only a small impact on breast cancer risk.)

If you have dense breasts, Fred Hutch breast health specialists will talk with you about your breast density and what it means for you. 

Breast MRI 

Breast MRI with contrast is useful for screening, along with a mammogram, if you are at high risk of developing breast cancer. A breast MRI uses strong magnetic fields, rather than X-rays, to create an image of your breast. It can help detect breast cancers that are harder to see on a mammogram. This makes it a powerful tool, in addition to mammography, for some patients. 

Fred Hutch offers screening breast MRI with contrast given through your veins to people who are at high risk. The goal is to help find signs of cancer that mammography and ultrasound can miss. Our physicians also use breast MRI to plan the best treatment for people who are diagnosed with cancer. 

MRI is a powerful tool to detect breast cancer early. But it is not right for everyone. This is because an MRI can show areas of concern, which lead to more tests and procedures, about spots that turn out not to be cancer.

Like the National Comprehensive Cancer Network, we recommend you have an annual screening breast MRI, along with a mammogram, if any of these is true: 

  • You have a lifetime risk for breast cancer of at least 20 to 25%. (Physicians have tools to calculate your risk.) 
  • You had radiation therapy to your chest between the ages of 10 and 30. 
  • You have a genetic predisposition to (meaning, a family history of) breast cancer. 

Fred Hutch radiologists and breast health providers are experts at knowing which patients can benefit the most from breast MRIs and at getting high-quality breast MRI images.

If you are not sure of your breast cancer risk and wonder if you need breast MRI, ask your health care provider or an expert at the Fred Hutch Breast Health Program or UW Breast Health Program.

Other Breast Imaging  

Fred Hutch experts constantly review the latest scientific evidence about which screenings work best. We want to be certain the benefits outweigh the risks for any breast imaging we recommend for you. Mammography and MRI are the most proven ways to detect breast cancers with imaging. 

You may hear about other imaging tests being used or studied for screening. Examples include thermography or molecular breast imaging (such as scintimammography). None of these other tests has been proven to save lives. This is why physicians at Fred Hutch do not routinely recommend them as screenings for most patients. 

Breast Exams 

Physical exams, done either by a health care provider or on your own, are another tool to help find breast changes that might signal cancer.

A clinical breast exam is a physical exam of the breast and underarm lymph nodes that is done by a physician, physician assistant or nurse practitioner (such as your primary care provider or OBGYN). This is typically recommended on a yearly basis.

You can help detect breast cancer by being aware of how your breasts normally feel and look. Some breast cancers are self-detected, meaning people feel or see something unusual in their own breast.

There is no one right way to examine your breasts. We encourage you to regularly inspect and feel your breasts so you know what is normal for you and what is new or different. 

You should seek attention from a medical provider if:

  • You feel a new or different lump or thickening in your breast, especially if it lasts more than a month in the same spot.
  • You notice changes in the appearance of your breasts, such as dimpling of the skin, redness of the skin or nipple discharge.

If you or your provider have concerns about a breast lump or other breast abnormality, request an appointment for a consultation and examination with a breast specialist. Call the Breast Health Program at Fred Hutch at 206.606.6487 or at UW Medical Center – Northwest at 206.668.6746.

About Breast Cancer Diagnosis 

Every person with breast cancer is different, and every tumor is different. The more we can learn about your specific tumor, the better we can customize your treatment plan to you. 

At Fred Hutch, we do extensive testing to diagnose and stage your disease precisely and accurately. Identifying features of your disease is important. It helps your physicians choose the treatments that will work best. 

Getting a breast cancer diagnosis usually starts in one of two ways. One is that your screening mammogram shows something that isn’t normal. The other is that you notice signs or symptoms and decide to see a physician. Then, you will often have an exam, imaging tests and a biopsy. 

We offer a full range of imaging tests and biopsy methods to get the details we need to know your diagnosis, stage your disease and plan your care. 

Our researchers are studying additional ways to detect and diagnose breast cancer, such as through blood tests that pick up tumor DNA circulating in the bloodstream (ctDNA). This approach, sometimes called a liquid biopsy, has been a focus of medical oncologist Heather Parsons, MD, MPH, program head of the Fred Hutch Breast Oncology Program. 

The exciting thing about ctDNA tests for breast cancer, Dr. Parsons explained, is that “it offers this opportunity to be able to take a sample of the cancer by just taking a small sample of blood. That sample can be used for everything from trying to understand whether a person has cancer, all the way to understanding what kinds of treatments might address their cancer.” Read more about her research on ctDNA. 

Diagnosis Process at Fred Hutch

Many of our breast cancer patients are first diagnosed right here at Fred Hutch. Our breast health experts look at your signs and symptoms, and they do screenings, imaging tests and biopsies. Fred Hutch breast imaging specialists study your imaging tests and give the results. 

Our pathologists test your tissue samples to get details about your specific cancer. Together, these details create a complex picture that will help guide decisions about your treatment. For example, some medicines may work well against some types of breast cancers but not others. 

If You Were Diagnosed Elsewhere

We have many patients with breast cancer who come to Fred Hutch after they have been diagnosed somewhere else. Our breast imaging specialists look at your mammograms and any other scans. Our pathologists look at the pathology slides and the report from your biopsy. We may also run more tests on your tissue samples. We do this in order to be sure about your diagnosis and to plan treatment that matches your needs. 

Imaging Tests for Breast Cancer 

Fred Hutch technologists and radiologists specialize in breast imaging only. They will do your imaging tests and give the results. To help find and diagnose breast cancer, we use mammography, ultrasound and breast MRI. 

Your team uses the same types of imaging to figure out the stage of your disease. For staging, you may also need more imaging, like a chest X-ray, CT (computed tomography) scan, PET (positron emission tomography) scan or bone scan. 

Mammogram

Fred Hutch physicians use 3D mammography to check breast problems or symptoms. We also use it to follow up if a screening showed something abnormal. Typically, we take more views of one or both breasts to get more details. 

Our radiologists specialize in mammography. Studies show that specialists like ours can read the images more accurately than physicians with less experience.

Ultrasound

If your mammogram shows anything that isn’t normal, it might help to get an additional special diagnostic mammogram or a breast ultrasound.

An ultrasound uses sound waves to better understand if there is an abnormality in your breast tissue. Sound waves bounce off solids and fluids differently. So an ultrasound can often help us tell if a lump is a solid mass or a benign cyst (a sac of fluid that is not cancer).

Breast MRI

An MRI using contrast injected into a vein can help us detect breast cancers that may be harder to see on a mammogram. This makes MRI an important test for some people. We use it to diagnose and plan treatment.

Fred Hutch radiologists are experts at knowing if this test will help you. We have the training and knowledge to get high-quality breast MRI images. 

Biopsies for Breast Cancer 

To know for sure if you have breast cancer, you will need a biopsy, which is a procedure to take out a small sample of tissue. Biopsies show if there are cancer cells in a small tissue sample. 

In most cases, Fred Hutch breast radiologists take a sample of tissue using a small needle (core biopsy) under precise image guidance. This can mean using ultrasound, mammography (stereotactic biopsy) and MRI imaging. If core biopsies do not give your care team clear results, you might need a surgical biopsy. 

After diagnosis of breast cancer, most people will need surgery to take out their breast tumor. We may do more tests on the tumor as well as nearby lymph nodes to see if cancer has spread there (sentinel lymph node biopsy). 

Fred Hutch pathologists will study and test your tissue samples to learn about your specific disease. This matters so your care team can choose the treatments that will work best for you. 

Schedule a Mammogram

Fred Hutch performs screening and diagnostic mammograms. At the clinic, you can choose to have an appointment where we give you your imaging results the same day.

You may also choose to have a mammogram at a location near your home. This is done in our mammogram van.

Schedule on MyChart