Breast Health

Breast cancer is one of the most common cancers in women, but it's also one of the most treatable. ARA Health provides comprehensive breast services, from 3D and contrast-enhanced screening mammography and screening breast ultrasound to needle biopsy and more. We also offer a Breast Cancer Risk Assessment clinic, arming our patients with a personalized breast care plan for optimal breast health.


About Breast Health

ARA Health offers the most comprehensive and personalized breast health experience for women in western North Carolina. Our imaging centers are recognized as "Breast Imaging Centers of Excellence" by the American College of Radiology and are backed by state-of-the-art technology and ARA Health's subspecialized breast imaging radiologists. Our doctors' extra years of training allows them to catch subtle changes in the breast tissue that other radiologists with less training may miss. Rest assured that our physicians are experts in their field, providing prompt and accurate diagnoses and support along the way.

As part of our breast screening program, we provide breast density and breast cancer risk assessments, which allows us to create personalized screening strategies for our patients. While many women start their annual screening mammography routine at age 40 with a 3D screening mammogram, others may have known risk factors requiring them to start sooner or use a combination of imaging tools for screening. For some patients, physicians will request contrast enhanced mammography, breast ultrasound, breast MRI, or even a needle biopsy when more information is needed. Learn more about breast cancer and ARA Health's comprehensive program in the FAQs below.

Breast Cancer Risk Assessment Clinic

All women should have a risk assessment by age 30. While all women are at risk for breast cancer, some carry greater risk than others. To help each patient understand her own personal risk, we offer appointments at our Breast Cancer Risk Assessment Clinic. A thorough discussion with our breast imaging clinical specialist covers personal and family health history, breast density education, eligibility for genetic testing, and any questions the patient may have. Before leaving, each patient receives a personalized breast cancer screening plan that can be reevaluated and adjusted year after year to account for breast health changes and other individualized factors. Learning more about breast cancer risk can be the first step in catching it at its earliest, most treatable stage.

3D Mammography

This simple exam uses low-dose X-rays to produce multiple images of the breast, allowing our expert breast imagers to view the breast in layers. A sequence of images is taken of each breast from different angles, providing a more detailed and precise evaluation of the breast tissue than traditional 2D mammography. With 3D mammography, the images are clearer and the accuracy is greater, offering improved cancer detection, particularly with more aggressive and invasive cancers.

Contrast-Enhanced Mammography

Contrast-Enhanced mammography (CEM) combines a mammogram with iodinated intravenous (IV) contrast and is used for patients at a higher risk for breast cancer or those who have recently been diagnosed with breast cancer. In newly diagnosed patients, this imaging tool can be used to assess the extent of the cancer and/or the cancer's response to neoadjuvant chemotherapy prior to a patient's surgery. It also can be used as an alternative to screening breast MRI.

Diagnostic Mammography

Diagnostic mammograms require a physician referral. These studies often are ordered for patients who are experiencing a new breast symptom, like a lump, nipple discharge, or changes in the breast skin, or to further evaluate a patient's breast health if a screening mammogram is inconclusive or reveals an area of concern. The experience for the patient is very similar to that of a screening mammogram.

Automated Whole Breast Ultrasound (ABUS)

Automated whole breast ultrasound (ABUS) is a secondary screening tool designed for women with dense breasts. It uses high-frequency soundwaves to create 3D images of the entire breast, able to provide visualization despite dense tissue. ABUS does not replace mammography; rather, it provides additional information.

Breast Ultrasound

Breast ultrasound is used to further evaluate an area of concern alongside mammography. This imaging tool uses soundwaves to create 3D images of the breast. Since it does not use radiation, it may be ordered for pregnant women experiencing breast cancer symptoms.

Breast MRI

Breast MRI is used as a safeguard for women with increased lifetime breast cancer risk and for staging purposes in certain women diagnosed with breast cancer. Breast MRI uses powerful magnets and radio waves combined with IV contrast fluid to produce detailed, cross-sectional images of the breast tissue from all angles.

Needle Biopsy of the Breast

Needle biopsy of the breast is a minimally invasive procedure. Using image-guidance, our subspecialized radiologists extract a small sample of breast tissue to be evaluated by pathology. Needle biopsy of the breast is the standard and preferred means of diagnosing — and ruling out — breast cancer.

You have questions. We have answers.

Below is a list of some of the questions we get asked most frequently from our patients. If you have additional questions, feel free to reach out to our ARA Cares Coordinator at (828) 436-5500.

Breast Cancer Facts
  • 75-85% of women diagnosed with breast cancer have no family history.
  • One in eight women will be impacted by breast cancer in her lifetime.
  • When caught early, the five-year survival rate of breast cancer is 99%.
  • Breast cancers found in women under age 50 are often more aggressive, making screening mammography an important health tool for women in their 40s.
  • The cancer incidence rate increases with age, making annual mammography even more important to women ages 50+.
  • Men can also get breast cancer, although it is much less common than it is for women.
What increases my risk for breast cancer?
The two biggest risk factors for developing breast cancer are being female and getting older. Other factors that increase a person's risk for breast cancer include:
  • being overweight or obese
  • having a sedentary lifestyle
  • drinking more than one alcoholic drink a day
  • exposure to high-dose radiation, particularly before age 30 (e.g. radiation therapy)
  • family history of breast cancer
  • inherited genetic mutations
  • using hormone therapy after menopause
What decreases my risk of breast cancer?
Several factors can decrease a person's risk of breast cancer, including:
  • maintaining a healthy weight
  • exercising regularly, on average 3-4 hours a week
  • one or more full-term pregnancies
  • first full-term pregnancy before age 25
  • breastfeeding for more than 15 months (total months across all children)
  • menopause before age 50
Screening Mammography Facts
  • Mammograms show changes in the breast up to 2 years before a patient or physician can feel them.
  • Annual screening mammography finds cancer in an earlier stage, providing a more favorable outcome and allowing for more affordable treatment options.
  • Screening mammography has helped reduce the mortality rate in the U.S. by nearly 30% since 1990.
  • The amount of radiation received during a mammogram is about what you'd be exposed to during cross-country flight.
  • 3D mammography (tomosynthesis) has reduced call-back rates in women with dense breast tissue by 35%.
When should I begin scheduling breast health services?
Experts agree that beginning screening at age 40 saves the most lives; however, understanding your personal risk for developing breast cancer can empower you to make informed decisions about your own breast health.

ARA Health's subspecialized breast radiologists, along with the American College of Radiology and Society of Breast Imaging, recommend:

Age 30
  • All women should undergo a breast cancer risk assessment (especially Black women and those of Ashkenazi Jewish decent).
Age 40
  • All women should have a 3D screening mammogram and plan to repeat them every 12 months (not just every calendar year).
What is the difference between a screening and diagnostic mammogram?
Screening mammograms are used for women who have no symptoms of breast disease. They do not require a physician referral and are usually covered by insurance at 100%. Diagnostic mammograms do require a physician referral, and costs are applied to a patient's insurance deductible. Diagnostic mammograms are used for specific reasons:
  1. If radiologists have concerns about a particular area on a screening mammogram, a diagnostic mammogram can be ordered to further evaluate.
  2. If a patient has a new breast concern, like a lump, nipple discharge, or changes in the breast skin, referring physicians will order a diagnostic mammogram.
  3. If a patient has previously been diagnosed with breast cancer, she may receive diagnostic mammograms for several years post-treatment.
What is breast density?
Density measures the amount of fatty, glandular, and fibrous tissue in the breast. Dense breasts have more glandular and fibrous tissue than fat, and the only way to determine this is through a mammogram. Radiologists determine density based on a scale approved by the American College of Radiology. Women with high density (level C or D) are considered to have an increased risk for breast cancer, because dense breast tissue can obscure the presence of lumps and other abnormalities.

Approximately 40% of women over age 40 have dense breast tissue. Dense tissue makes breast cancer more difficult to detect on a mammogram and is also a risk factor for developing breast cancer. Women who have been identified as having category C or D density on a mammogram may sit down with our clinical specialist at our Breast Cancer Risk Assessment Clinic to discuss in detail what this means and how to best address it with a supplemental screening plan.
How do I prepare for a mammogram?
It is helpful to wear a two-piece outfit so that just your top may be removed. Please do not wear lotion or deodorant, as these products may damage our equipment.
What should I expect during a mammogram?
In most cases, the entire exam takes just 20 to 30 minutes. A female technologist will explain the procedure before it starts. You will undress from the waist up, putting on a gown that opens in the front. During the exam, the technologist will position each breast in the scanner. Your breasts will be compressed, or flattened, which may be uncomfortable, but not painful. Compression is essential to producing clear images of the breast's tissue at a lower X-ray dose, and each compression lasts less than a minute.
What should I expect during a contrast-enhanced mammogram?
Similar to a screening mammogram, the breast will be compressed; however, before the imaging study begins, an IV will be inserted to allow for the injection of the contrast agent. Once the contrast is injected, it is normal to feel warm all over and experience a metallic taste and the urge to urinate. The mammogram will begin a couple of minutes after the injection. Two images will be taken for both breasts – one similar to a regular mammogram; the other using higher energy X-rays to highlight the contrast agent in the breast tissue. The images are combined to allow the radiologist to better visualize potential cancers.
How do I prepare for a breast ultrasound, and what should I expect?
It is helpful to wear a two-piece outfit so that just your top may be removed. Please do not wear lotion or deodorant, as these products may interfere with the images.

The sonographer will apply a water-based gel to the area that will be scanned. The gel allows the transducer (wand) to move easily back and forth, thus generating clear images. The gel also prevents air pockets that could block sound waves being used for the scan. External ultrasound scans are painless and noninvasive.
How do I prepare for a breast MRI, and what should I expect?
A breast MRI is safe and painless for most people. Please talk to your doctor at the time of scheduling if you are concerned about anxiety or claustrophobia, as a sedative may be prescribed to reduce stress or anxiety.

Please advise your doctor and MRI technologist if you have any metal in your body (pacemakers, shrapnel, implants, surgical plates or screws, etc.) or if you have tattoos. Please leave all jewelry at home.

If you are receiving IV contrast, you may be asked not to eat or drink anything for 8 hours before the test.

At your appointment, you will be given a gown to wear during the procedure, as well as ear plugs or ear muffs to reduce the noise level and protect your hearing during the breast MRI (the scan can be a bit loud). If IV contrast is being used, an IV will be inserted to allow for injection of the contrast agent. When the exam begins, you will lie on your stomach on a narrow table that slides into a large cylinder (tube) with a strong magnetic field. When the contrast is injected, it is normal to feel warm all over and experience a metallic taste and the urge to urinate. The exam is painless and generally takes less than an hour to complete, but please allow for 30 to 60 minutes of waiting time before the test.