Indicators and Treatment for Breast Disease Unit 9. Bonnie A. Barnes, BA, R.T., (R)(M)(CT)(f) Xuan Ho, Ph.D., R.T. (R)

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1 Indicators and Treatment for Breast Disease Unit 9 Bonnie A. Barnes, BA, R.T., (R)(M)(CT)(f) Xuan Ho, Ph.D., R.T. (R)

2 Indicators and Treatment for Breast Disease Clinical Breast Changes Risk Factors Associated with Breast Cancer Early Detection of Breast Cancer Manual Breast Examination Treatment Options for Breast Cancer

3 Clinical Breast Changes Lumps Thickening Swelling Dimpling Skin irritation Retraction Pain Discharge

4 Clinical Breast Changes Lumps can occur through out the entire breast and axilla. Their size and shape can vary. They can be mobile. They can also be very painful to the touch.

5 Clinical Breast Changes Thickening of breast tissue can also be located through out the entire breast and axilla. the most common area of thickening is in the upper outer quadrant of the breast.

6 Clinical Breast Changes Swelling of the breast occurs through out the entire breast, or at the areola. this can be due to hormonal changes, or infection.

7 Clinical Breast Changes Dimpling of the breast can occur through out the breast. it can be a sign of a cancer, that has gone undetected for a lengthy period of time. this is also called an orange peel look to the breast. it can also be a sign of infection.

8 Clinical Breast Changes Skin irritation can be the cause of an allergy, dry skin, or infection. the skin may look red and have a rash. it may also look scaly, flaky, and even have blisters. it is not advisable to do a mammogram on a patient with open sores.

9 Clinical Breast Changes Pain a common symptom in women. It can be located through out the entire breast. It is important to treat breast pain as a symptom for a diagnostic exam, if the symptom has been there continuously. If the symptom occurs during the premenstrual phase of a woman s cycle of menses, document the symptom, but no further work up should be necessary. The radiologist needs to be made aware of this symptom.

10 Factors that increase risk Lifestyle Family History Personal History

11 Clinical Breast Changes Discharge from the areola can be of different colors. If clear or milky color, this is not alarming, and can occur after breast feeding. If green or brown, it is usually a sign of infection. If bloody, it can be a sign of breast cancer. If unilateral, this is not a normal occurrence. In any case, the radiologist needs to be made aware of this symptom.

12 Risk Factors Associated with Breast Cancer Sex Age Family History Menses Exposure to hormones Parity Education Diet

13 Risk Factors Associated with Breast Cancer Sex is a determining factor in breast cancer. Women are more likely to get breast cancer than men. According to the American Cancer Society, one in eight women will get breast cancer. It is about 100 times more likely in women than in men, American Cancer Society.

14 Risk Factors Associated with Breast Cancer Age is a risk factor for breast cancer. The older women get, the greater the chances of getting breast cancer. Older women sometimes take hormone replacement therapy drugs. These hormones have been linked to breast cancer. There have been cases of women in their 20 s and 30 s, who have been diagnosed, but this is very rare.

15 Risk Factors Associated with Breast Cancer Family history of breast cancer is also a known risk factor. In the past, only the maternal side of the family has been looked at. Now, the maternal and paternal sides are being studied. Not all breast cancers are considered hereditary.

16 Risk Factors Associated with Breast Cancer Menses is also a known risk factor for breast cancer. If a women start menarche early, and end menopause late in life, this is a considerable risk factor for breast cancer.

17 Risk Factors Associated with Breast Cancer Exposure to hormones, especially estrogen, is a known risk factor for breast cancer. Birth control pills and hormone replacement therapy drugs are known hormones women take. Of these drugs, the estrogen-based ones, are the ones considered with high risk factors.

18 Risk Factors Associated with Breast Cancer Parity is a known risk factor. If a woman does not have a child before the age of 30, she is at increased risk for breast cancer. If a woman does not have any children at any age, she is at increased risk. Multiple births decreases this risk.

19 Risk Factors Associated with Breast Cancer Women of higher levels of education are at decreased risk from dying from breast cancer. They are educated in their health, and are more apt to get a mammogram, and see their physicians regularly. Detection of breast cancer early on, is imperative.

20 Risk Factors Associated with Breast Cancer Diet is also important in decreasing the risk for breast cancer. A woman who consumes vegetables, fruits, and protein, is feeding her body the nutrients it needs to keep the immune system strong. A woman who drinks alcohol, does drugs, and has an unhealthy diet, is more apt to be diagnosed with breast cancer.

21 Early Detection of Breast Cancer According to the ACS, a woman should have her baseline mammogram between the ages of 35 to 40. A woman from the age of 40 on up, should have a screening mammogram every year.

22 Early Detection of Breast Cancer Clinical examinations of the breast should be performed every three years, in women from ages 20 to 40 years old. Women older than 40 years old, should have clinical examinations every year.

23 Self Breast Examination Age Frequency Technique Methods

24 Self Breast Examination Age Manual breast examination should begin at puberty, and continue on through out the patient s life.

25 Self Breast Examination Frequency Manual breast examination should be performed monthly, approximately 7 to 10 days after the last menstrual period. If the patient has gone through menopause, or a hysterectomy, manual breast examination should be performed the first day of each month.

26 Manual Breast Examination Technique The finger pads of the hand should be used in a rotating fashion. Superficial and deep pressure should be applied. The axillae and clavicular areas need to be examined, as well as the breast areas.

27 Manual Breast Examination Methods: There are four methods that can be used for manual breast examination. 1. Spiral method 2. Grid method 3. Pie wedge method. 4. Visual inspection

28 There are two basic steps to conducting a Breast Self Exam (BSE): Visually check the breasts, then touch them.

29 Visual Examination During the first part of the BSE, the visual examination, one is to look for changes in each breast. If the breasts have always been mushy, that's not a concern unless this is a new change.

30 Stand in front of a mirror and look for the above changes in the breasts (from both a frontal and profile view) in 3 different positions: With arms up behind the head With arms down at sides Bending forward

31 The changes to look for include: Size Shape Bumps/lumps NOTE: normal lumpiness, like in the week before and of the menstrual cycle, will appear as very small and separate lumps like the texture of an orange. Contour or symmetry (is there a difference in the level between the nipples? Do both breasts look symmetrical?)

32 Other Changes to Look For Sores or scaly skin Skin discoloration or dimpling Discharge or puckering of the nipple

33 Tactile Examination Begin by looking for the changes while standing up. Some women find it useful to do this part of the BSE in the shower, since soap or bath gel will aid in the ease of feeling the breasts.

34 For the BSE, one needs to pick a pattern to feel the breasts and surrounding areas, which include: the breast itself between the breast and underarm the underarm itself the area above the breast up to the collarbone and across to the shoulder

35 It is important to check surrounding areas because breast cancer may be found in the lymph node tissue around the breast and underarm.

36 Use the pads (where fingerprints are) of the three middle fingers on the right hand pressed together flat to check the left breast, and do the opposite for the right breast.

37 One should press on the breast with varying degrees of pressure: light (move the skin without moving the tissue underneath) medium (midway into the tissue) hard (down to the ribs "on the verge of pain")

38 Patterns Spiral (concentric circles): begin with a large circle around the perimeter of the breast and make smaller and smaller circles as one works her way toward the nipple.

39 Pie shape wedges: divide the breast into sections like pieces of a pie, begin in the nipple area and feel the breast in a small circular motion within one pie shape section, then move on to the next wedge starting in the nipple area again.

40 Up and down: pretend the breast is divided into vertical stripes, begin on one side and feel the breast in a small circular motion up and down in a zig zag pattern.

41 When using any of the 3 patterns, you should always be using a circular rubbing motion (in dimesized circles) without lifting up your fingers.

42 Once one has performed the tactile examination while standing up in front of a mirror, one should do the whole examination again, this time while lying down.

43 Put left arm behind the head and use the right hand to examine the left breast. Put a small pillow or towel under left shoulder could help. Again, use the pads of the 3 fingers of the right hand to check the left breast in the pattern of choice (spiral, pie shape wedges, or up and down). Be sure to always use the same pattern (it's the best way to know if there are changes).

44 And again, do feel the breast using light, medium, and hard pressure. After finished, one must repeat the procedure again for the right breast.

45 Treatment Options for Breast Cancer Surgery Radiation Therapy Chemotherapy Hormone Therapy

46 Treatment Options for Breast Cancer There are many types of surgery for breast cancer, depending on the severity of it. Lumpectomy Partial mastectomy Simple mastectomy Modified radical mastectomy Radical mastectomy Reconstructive Surgery

47 Treatment Options for Breast Lumpectomy Cancer The most common term used in breast surgery. A small portion of malignant breast tissue is removed. This type of removal would be staged 0, I, or II of breast cancer advancement.

48 Treatment Options for Breast Cancer Partial Mastectomy means the same thing as a lumpectomy. The terms are interchangeable. A portion of the breast is removed, that has been diagnosed as cancerous.

49 Treatment Options for Breast Cancer Simple Mastectomy removes the entire breast but does not take out any axillary lymph nodes. Muscles are removed from beneath the breast (pectoralis muscles). This type of removal would be staged 0 or I of breast cancer advancement.

50 Treatment Options for Breast Cancer Modified Radical Mastectomy removes the entire breast and includes a procedure called axillary dissection, in which levels I and II (of the three levels) of the axillary lymph nodes (in the underarm area), are also removed. This type of removal would be stage II of breast cancer advancement.

51 Treatment Options for Breast Cancer Radical Mastectomy includes removal of the entire breast, all underarm lymph nodes, and chest wall muscles under the breast. This type of removal would be staged III (IIIA or IIIB) or IV.

52 Treatment Options for Breast Cancer Reconstructive Surgery surgery is performed to reconstruct the breast, after the breast cancer has been removed. A form of this is called a tram flap surgery, where abdominal tissue is used to reconstruct the breast. This is the most popular of all reconstruction options, especially for women with excess abdominal fat.

53 Treatment Options for Breast Cancer Radiation Therapy Is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. This reduces the risk of reoccurrence. It may be recommended after mastectomy if the tumor is larger that five centimeters, the removed tissue has a positive margin of resection, four or more lymph nodes were involved, and/or the cancer is multi-centered (it occurred in a number of locations within the breast).

54 Treatment Options for Breast Cancer Chemotherapy is a systemic therapy. It affects the whole body going through the bloodstream. The purpose of chemotherapy is to get rid of any cancer cells that may have spread from where the cancer originated to another part of the body. These type of drugs interfere with rapidly dividing cells very well.

55 Treatment Options for Breast Cancer Hormone Therapy is a form of systemic treatment for breast cancer. These drugs are used to block the affects of hormones, such as estrogen and progesterone. Two common types of hormone therapy are called Tamoxifen or Raloxifene. Tamoxifen is the best-known anti-estrogen therapy for fighting and preventing breast cancer. This drug also helps keep the bones strong, and cholesterol down.

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