Breast Cancer Screening

Dr. Fidel Rampersad

Radiologist
 Breast cancer
• According to National Cancer Institute
statistics, more than 192,000 American women
learn they have breast cancer each year.
• Cancer of the breast is the most common type
of cancer in women in T&T.
• There have been over 2,000 cases in the last 10
years.
• Mammography has been proven to reduce
mortality from breast cancer.
 Understanding Cancer
• Cancer begins in cells, • Cells from malignant
the building blocks that tumors can spread (
make up tissues. metastasize) to other
• Tissues make up the parts of the body.
organs of the body.
• Abnormal cells can
form a mass of tissue
called a growth or
tumour.
• Tumours can be benign
or malignant.
What tissues make up the breast?
 What is a screening mammogram?

• An x-ray of the breast used to detect breast

changes in women who have no signs or
symptoms of breast cancer.
• Low-dose x-rays (usually around 0.7 mSv)
• Primarily detects masses and calcification
 How are screening and diagnostic
mammograms different?
• A diagnostic mammogram is an x-ray of the breast
that is used to check for breast cancer after a lump or
other sign or symptom of breast cancer has been
found.
• The Radiologist will be monitoring each of the
additional films as they are taken to determine the
cause of the abnormal appearance.
• Ultrasound is often used at this point, as well.
• Of every 1,000 U.S. women who are screened, about
7% (70) will be called back for a diagnostic session.
What should a patient expect during
the procedure?
The CC View
The MLO View
When should women have screening
mammograms?

– Women age 40 and older should have

mammograms every 1 to 2 years.
– Some women under 40 may be advised to have a
screening mammogram.
How do breasts of younger women
differ in appearances?
 What are the common symptoms of
breast cancer?
• A change in how the breast or nipple feels
– A lump or thickening in or near the
breast or in the axilla
– Nipple tenderness
• A change in how the breast or nipple
looks
– A change in the shape of the breast
– A nipple turned inward into the breast
– The skin of the breast, areola, or nipple may be scaly, red, or
swollen. It may have ridges or pitting so that it looks like the
skin of an orange.
• Nipple discharge
• Early breast cancer usually does not cause pain.
What are the factors that place a woman at
increased risk of breast cancer?

– Age – Long-term use of

– Personal history of HRT
breast cancer – Breast density
– Family history – Radiation treatment
– Certain breast
– DES
changes on biopsy
–
– Body weight
Genetic alterations
(changes) – Physical activity
– Reproductive and level
menstrual history – Alcohol
 What are the chances that a woman
might get breast cancer?
• 13.2 percent of women (one in eight)

• Most breast cancers occur in women over the age of

50

• Not common before menopause

What age group does breast cancer
commonly affect?
Ages 30 to 39 1 in 229

Ages 40 to 49 1 in 68

Ages 50 to 59 1 in 37

Ages 60 to 69 1 in 26
 What is the best method of detecting
breast cancer as early as possible?
• Getting a high-quality mammogram and
having a clinical breast exam (an exam done
by a health care provider) on a regular basis
• Self breast exams should not take the place
of routine clinical breast exams and
mammograms
 What are the benefits of screening
mammograms?
• Several large studies conducted around the world
show that breast cancer screening with
mammograms reduces the number of deaths from
breast cancer for women ages 40 to 69
– especially those over age 50.
• Studies conducted to date have not shown a benefit
from regular screening mammograms, or from a
baseline screening mammogram (a mammogram
used for comparison), in women under age 40.
 What are some of the limitations of
screening mammograms?
– Finding cancer does not always mean saving lives
– False negatives
• Overall, mammograms miss 10-20 percent of the breast
cancers that are present at the time of screening
– False positives
• All abnormal mammograms should be followed up with
additional testing (a diagnostic mammogram, ultrasound,
and/or biopsy) to determine if cancer is present
 The Radiation Risk
• For women 50 years of age or older, the risk of radiation-
induced breast cancer was minuscule, particularly
compared with the potential benefit of mammographic
screening.
• The risk of breast cancer for women under 35 is not high
enough to warrant the risk of radiation exposure.
– However, if there is a significant risk of cancer in a particular
patient mammography may still be important.
• While screening between 40 and 50 is still controversial,
the preponderance of the evidence indicates that there is
some small benefit in terms of early detection.
What happens if mammography leads to the
detection of ductal carcinoma in situ (DCIS)?
• DCIS is when abnormal cells are confined to
the milk ducts of the breast.
– Mammography is able to detect 80 percent of
DCIS cases.
– Some of these cases later become invasive
cancers.
– It is not possible to predict which cases of DCIS
will progress to invasive cancer.
• Women who have been diagnosed with DCIS
should talk with their doctor to make an
informed decision about treatment.
 How much does a mammogram cost?

• Screening mammograms generally cost

between TT $250 and $350.
• Most insurance providers cover the majority of
the fee.
• Free mammograms are also available at the
public hospitals.
 Where can women get high-quality
mammograms?

• Some Private Nursing Homes

• Hospital Radiology Departments
• Mobile vans
• Private Radiology Offices
• Doctors’ Offices
What should women with breast
implants do about screening
mammograms?

• Women with breast implants

should continue to have
mammograms.
• Steps can be taken to make
sure that as much breast
tissue as possible can be seen
on the mammogram.
 What is digital
mammography?

• Both digital and conventional mammography

use x-ray radiation to produce an image of the
breast
• Conventional mammography stores the image
directly on film
• Digital mammography takes an electronic
image of the breast and stores it electronically.
 What are the advantages
of digital mammography?

• Digital mammography allows

Radiologist to electronically
adjust, store, and retrieve digital images.
• Advantages:
– Long-distance consultations with other mammography
specialists may be easier.
– Subtle differences between normal and abnormal tissues
may be easily noted.
– The number of follow-up procedures needed may be fewer.
– Fewer repeat images may be needed, reducing exposure to
radiation.
What are the common breast diseases and
how do they appear on a mammogram?
 Breast Cancer Evaluation
Primary Signs Secondary Signs
1. Dominant mass 1. Asymmetric thickening
2. Density 2. Asymmetric ducts
3.Microcalcifications 3. Skin Changes
4. Architectural distortion 4. Nipple/areolar
abnormality
5. Interval change 5. Abnormal veins
6.Increased single duct 6. Axillary nodes
 What causes breast calcifications? Are they
associated with breast cancer?
• Breast calcifications are usually noncancerous (benign).

• The two main types of breast calcifications are:

• Macrocalcifications:
– They appear as large white dots or dashes on a mammogram.
– Almost always noncancerous and require no further follow-up.
• Microcalcifications:
– They appear as very fine white specks on a mammogram.
– Usually noncancerous but can sometimes be a sign of cancer.
– If they appear suspicious, additional mammograms and a
biopsy may be needed.
 What is a breast biopsy?
• Doctors can remove tissue from the breast in
different ways:
– Fine-needle aspiration: A thin needle to remove
tissue/fluid from a breast lump
– Core biopsy: A special cutting needle to remove
breast tissue.
– Surgical biopsy.
• Of every 1,000 U.S. women who are screened,
about 10 of these will be referred for a biopsy.
• Of the 10 referred for biopsy, about 3.5 will
have a cancer and 6.5 will not.
 Can Radiologists intervene?

Radiologists can use imaging procedures to help see

an abnormal area to remove tissue or fluid
What is a stereotactic biopsy?
And wire localization?
Should we worry about axillary nodes?
 What is the role of ultrasound in
breast radiology?
• An ultrasound device sends out sound waves
that people cannot hear.
• The waves bounce off tissues.
• A computer uses the echoes to create a picture.
• The pictures may show whether a lump is solid
or filled with fluid.
• After the test, the Sonographer/ Radiologist can
store the pictures on video or print them out.
 Breast
ultrasound
Is screening breast MRI being used?
• Magnetic resonance imaging (MRI) of the breast is a
breast-imaging technique that captures multiple
cross-sectional pictures of your breast and combines
them, using a computer, to generate detailed, 2-D and
3-D pictures.
• Breast MRI isn't used routinely for breast cancer
screening.
• Breast MRI is best used in addition to a mammogram
or other breast-imaging test.
• MRI can still miss some breast cancers that a
mammogram will detect.
Breast MRI
What about breast thermography for the
early detection of breast cancer?
• There is no evidence that breast thermography
is an effective screening tool for early
detection of breast cancer.
• Breast thermography is a way of detecting
differences in skin temperature on the surface
of the breast with the use of a special heat-
sensing (infrared) camera.
 Breast
thermography
Summary
 Summary
• The burden of breast cancer is
increasing in both developed
and developing countries,

• Women aged 50 to 74 who

received mammographic
screening had a decreased
relative risk for breast cancer
mortality of 0.74
• Comments!!!
• Questions???