BREAST HEALTH AND BREAST CANCER SCREENING. Sarawak General Hospital

Transcription

1 BREAST HEALTH AND BREAST CANCER SCREENING Dr Lee Phaik Im Dr Lee Phaik Im Sarawak General Hospital

2 BREAST HEALTH

3 BREAST HEALTH FACTS Being breast aware is an art Develop a positive attitude Give our breasts some attention as well, besides our face No one will know your breasts as intimately as you would, because we live with our breasts daily Breasts are organs in plain sight of you, therefore the best chance to detect a growth earlier.

4 WHAT CAN YOU DO? 1: monthly self breast examination ( SBE) beginning g at age of 18 2: annual physical exam from your doctor after age of 40 3: consider regular screening mammograms from the age of 40 onwards 4: ask your doctor how to determine your personal risk for breast cancer 5: if you suspect any abnormalities, see your doctor immediately.be responsible for your own breast health!

5 MEN TOO! Know your own breasts. It is the first step towards being breast aware. Everyone s breasts are different in texture, shape and size Self breast exam ( SBE) is one way of knowing your breasts SBE should be done ONCE a month.

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7 BREAST CANCER SCREENING

8 Breast cancer screening refers to testing the breast in asymptomatic women (with no symptoms) for the purpose of detecting unsuspected breast cancer at a stage where early intervention can affect outcome.

9 Breast cancer takes years to develop. Early in the disease, most breast cancer cause no symptoms. When breast cancer is detected at a localized stage (has not spread to lymph node), the 5-year survival rate is 98% If cancer has spread to regional LN, rate drop to 83% If cancer has spread to distant organs (liver, lung, bone, brain), rate is only 26%

10 Screening mammogram Is an x-ray exam of the breast in a woman who has no symptoms. The goal is to find cancer when it is too small to be felt by a woman or her doctor. Finding such small cancer by a screening mammogram greatly improves a woman s chance for successful treatment.

11 What is Mammography? A mammogram is a special X-ray image of the breast. Two X-rays are taken for each breast. The X-rays are usually done by a trained woman radiographer. The mammograms are then reported by a radiologist. Radiologists are doctors who have special training in diagnosing diseases by looking at images of the inside of the body produced using x-rays, sound waves, magnetic fields, or other methods.

12 How Do I Prepare for a Mammogra 1. It is a simple procedure and there is no need to fast. Wear a 2- piece outfit, either pants with blouse or skirt with blouse. This is not absolutely essential but helps so that you only need to remove your upper clothing. 2. You should not apply any talcum powder, perfume or deodorant to your upper body, and armpit areas. These may cast white spots on the mammogram, which may affect the interpretation of the mammogram by the radiologist.

13 3. If you have breast pain, you may wish to schedule your mammography afteryourperiod is over. Thisisnormally the phase of the menstrual cycle where the breasts are less tender. 4. If you have previous mammograms, pleasebring them along with you so that a comparison can be made between them. This helps the radiologist reading your films, especially in the detection of subtle abnormal details on your mammogram. It helps to improve the accuracy of the report.

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21 When Should I Go For a Mammogram? The present guidelines for screening of asymptomatic ti women (women who do not thave any symptoms related to the breast) are: At age 35-40: baseline mammogram At age 40-49: annual mammograms At age 50 and above: mammograms at one or two year intervals depending on several factors such as hormone replacement therapy, risk profile

22 Can I have a mammogram if I am younger than 35 years old? Symptomatic women, that is women who have signs or symptoms related to the breast like a lump, nipple discharge, mastalgia (breast pain), unexplained decrease or increase in breast size or appearance, will require a mammogram to resolve the particular problem. There is no age limiti when there is a symptom or sign in your breast. The above guidelines are for women without any symptoms or signs of breast problems.

23 Is Mammography Perfect? Mammography may be the key to successful treatment and cure of the disease. However, mammography can fail in detection of some cancers since not all breast cancers produce a recognizable change in the mammogram and this occurs more often when the woman has dense breast tissue. Palpable cancers are not always visible and visible cancers are not always palpable.

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25 What do radiologists i look for on your mammogram?

26 1: calcifications i tiny mineral deposits within the breast tissue, which h look like small white spots on the films. This may or may not be caused by cancer (a): macrocalcifications: coarse calcium deposits, most likely caused by aging gof the breast arteries, old injuries or inflammation. Related to noncancerous condition, do not require a biopsy (b): microcalcifications: tiny specks of calcium, may appear alone or in clusters. More concerning, but still do not always mean that cancer is present. The shape and layout of the microcalcifications helps radiologist judge how likely it is that cancer is present.

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28 Examples of cancerous calcifications magnification (enlarged close up views)

29 2: MASS Mass can be caused by many things, including cysts, noncancerous solid tumours and cancerous tumours. If the mass is not a simple cyst( non-cancerous, fluid-filled sacs), further imaging gtests are required. Your prior mammogram may help show that a mass has not changed for many years, which would be mean that the mass is likely a benign condition and biopsy would not be needed. If the mammogram show something suspicious, tissue must be removed and looked at under the microscope to tell if it is cancer. This can be done with a needle biopsy or an open surgical biopsy.

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31 What happens if there is some abnormality on my mammogram? A palpable p lump or an abnormality detected on screening mammogram may require further examination like breast ultrasound or special mammographic procedures such as stereotactic guided fine needle aspiration cytology (FNAC), core biopsy or wire localization.

32 Breast Ultrasound Also known as sonography high frequency sound waves are used to look inside a part of the body.

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36 Role of ultrasound of the breast in screening Mammography is NOT perfect and picks up on average 85% of the breast cancers. As the density of the breast increases, the cancer pick up rate for mammograms decreases. Women who do not have much fatty tissue in their breasts can benefit from ultrasound screening examinations in addition to routine mammogram. a It has been used as a standard d adjunct to mammography in many centers.

37 Current evidence does not recommend ultrasound alone as a reliable screening tool for breast cancer. It lacks fine detail, cannot detect t most calcium deposits, is largely dependent on the operator (the radiologist i or ultrasound technologist, t also known as the sonographer), and cannot document how much breast tissue has been imaged and also has its share of false pick-ups or missed cancers.

38 Mammography continues to be the most important screening tool for breast cancer and combining the mammography with ultrasound may prove to be an important way to increase sensitivity in women with dense breast tissue.

39 In Malaysia,

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43 What happens if there is some abnormality on my mammogram? A palpable p lump or an abnormality detected on screening mammogram may require further examination like breast ultrasound or special mammographic procedures such as stereotactic t ti guided d fine needle aspiration cytology (FNAC), core biopsy or wire localization.

44 Ultrasound guided biopsy If the mass is too small or too deep within the breast to be felt, ultrasound imaging i can be used so that the doctor can see the needle on a screen as it moves toward and into the mass

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48 Wire localization ation Is a procedure used to guide a surgical/excisional breast tbiopsy of a small mass that t would be hard for the surgeon to locate. It can also be useful with areas that look suspicious on the x-ray ( microcalcifications) but do not have a distinct lump Can be done under ultrasound guidance or mammographic guidance

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51 Ultrasound guided wire localization

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60 Usually for suspicious microcalcifications, not seen on ultrasound.

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