Early Detection Of Breast Cancer

A Formidable Challenge

CANCER

FEAR AND APPREHENSION

Introduction• Breast cancer is currently the most frequent

cancer in women.

• There are more than one million cases occurring world wide annually.

• Over 200,000 new cases in USA and about 42,000 in the UK per annum

• One in every six women is expected to develop breast cancer in USA.

Introduction

• There is no national-based data on incidence of breast cancer in Pakistan however limited studies have shown an alarmingly high incidence—in fact highest in Asian countries.

• The ASR was reported to be as high as 51.7 per 100,000 per year in a report by American society of Human Genetics 2002.

IntroductionEven though there is paucity of nation wide data the various institutional and

localized data are quite concerning.

Data of New Breast Cancer Patients

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Total Breast Cases Total Number of cases

Data of patients below 40 yrs.

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patients below 40 yrs.

According to UICC and World Health Report 2005 47% of newly diagnosed breast cancers in Pakistan are already in advanced stage.

Gloomy Outlook?

• During the year 2007 out of 811 new breast cancer patients registered at INMOL

• 320 patients (40% were stage 1 and stage 2)

• 491 patients(60% were stage 3 and stage 4)

WHAT SHOULD BE DONE ?

Prevention?

• No single known cause of breast cancer.

• we cannot talk about prevention.• However certain risk factors are

known which increase the risk of developing breast cancer.

Risk Factors• Increasing age—risk increases.• Early age at menarche.• Late age at menopause.• Nulliparity.• Late age at first live birth—more than

30.• No breast feeding.• Hormone intake.

Risk Factors

• Positive family history and genetic factors especially with history of breast or ovarian cancer in first degree relative such as mother or sister.

• However we should know that only 10% of all breast cancers are familial.

Risk Factors

• Post menopausal obesity.• High intake of saturated fat and high

protein diet.• Lack of vegetables and fruits in the diet.• Lack of exercise with a sedentary lifestyle.• Increased stress levels—lack of secretions

of endorphins.

Many Patients Still Come To Us With Breast Cancer - No

Known Risk Factors Involved.

What can be done?Early Detection---A Challenging Field Of

Endeavour

We can save lives---MANY LIVES

Early Detection

• Self breast examination.

• Clinical examination by physician or surgeon.

• By imaging – MAMMOGRAPHY, BREAST ULTRASOUND, BREAST MRI.

Self Breast Examination

• Should be started at the age of 20• It should be done monthly several days

after periods end when breasts are least likely to be swollen.

• The women should be well aware of the technique of self examination and any change noted in the breast should be further evaluated by a clinician.

Self Breast Examination

• Practice self breast examination so you become aware and familiar with the feel of your breast.

• Do not feel shy or afraid of bringing any complaints to the doctor.

• NOT ALL LUMPS ARE CANCERS.• 8 out of 10 lumps removed by surgery

are benign that is non-cancerous.

Signs and Symptoms

• Any palpable lump—whether painless or painful.

• Any change in appearance of skin—hardening, redness etc.

• Change in shape of breast or nipple.• Any lump in axilla.• Nipple discharge especially if it is

spontaneous,blood stained and unilateral.

Clinical Examination

• Annual clinical examination should be performed by a trained health worker after age 40 and at least after every three years starting at age 20.

• Any signs of disease seen should be further evaluated with imaging.

Mammography

• A special kind of X-Ray of the breasts done by a dedicated machine.

• A non invasive test.• Involves insignificant radiation hazard.• Takes only about half an hour.• ACR recommends screening

mammogram every year starting at age 40.

• Cancers below 1cm can be detected.

Mammography

• Always bring previous mammography films and imaging reports whenever you come for a mammogram.

• Do not wear talcum powder or any deodorants as they cause artifacts.

Indications of Mammography

To assess signs and symptoms of breast disease such as lump, nipple discharge, change in shape of breast or mastalgia.

Indications of Mammography

• Preoperative mammogram is done To establish multifocality and to plan type of surgery.

• To examine contralateral breast.

Breast Ultrasound

• It is used as a prime modality to investigate women with breast symptoms who are younger than 40.

• It is safe and very informative but always should be done by trained Radiologist as breast ultrasound is a super speciality and cannot be performed on ordinary ultrasound units.

Breast Ultrasound

• Can only be done with high resolution dedicated ultrasound units.

• Safe test with no ionizing radiation involved.

• Should only be performed by trained radiologists who are experienced in doing breast sonography.

Indications of Ultrasound• Mostly

complimentary to mammography.

• Helps in further charachterizing the type of lesion whether solid or cystic.

Indications of Ultrasound

• Also helps in predicting whether a lesion is benign or malignant.

• Primary modality in women below thirty five years of age, pregnant or lactating women.

Tissue Diagnosis

• Needle biopsy.—needle tests are essential to diagnose cancer –sometimes image guidance is used.Biopsy is a technique in which a small amount of breast tissue is taken and examined under the microscope.

• General misconception—needle biopsies DO NOT help in spreading the tumour.

Image Guided Intervention

Sometimes image guidance is required for needle tests in non palpable lesions.

Early Detection

THE EARLIER A CANCER IS DETECTED THE MORE ARE THE

CHANCES OF CURE.

Breast cancers less than 1.5cm in size have a cure rate of about 94%.

What Is Screening?

• Screening is the evaluation of women with no signs and symptoms of breast disease to detect very early cancers.

• In countries where mass screening programmes are established the mortality of breast cancer has decreased by 25-30%.

Screening Recommendations

A.C.R, A.M.A and A.C.S all

recommend :-

• Beginning at age 20, monthly self examination and clinical examination by a health care provider at least every three years

• Base line at age 35-40 years and then annual mammography

• Earlier screening for high risk women

Present Scenario ( Pakistan )

• No established National Screening programme as yet.

• However efforts have been initiated at different levels to increase awareness about breast cancer in general public and motivate women for screening.

Present Scenario

• Responsibility—clinicians—motivate and educate women for self breast examination, clinical examination and screening.

• Responsibility---oncologists—identify high risk women and encourage them for screening.

PAEC Breast Cancer Awareness Programme

Mammographies at INMOL

• Number of mammography's are rapidly increasing.

• Still only 2 to 3 % are pure screening patients while 40% are undergoing screening of contralateral breast.

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Minimal Cancers Detected

Due to establishment of breast care clinics there has been a steady increase in less than 2cm sized tumors detected at our Radiology department, during the last five years. 0

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MinimalCancers

Conclusion

“ through our involvement and commitment we can

revolutionize breast cancer management in our

communities ”

Thank You