Download Screening tests for the prevention and early detection of breast and

Screening tests for the prevention and early detection of breast and cervical cancer. An
appointment not to be missed.
Since 1998 Valle d’Aosta Region collaborating with USL Company have been carrying out
screening programs in order to detect types of cancer suffered mostly by women throughout the
whole region. The results of these procedures, periodically checked and validated by specially
appointed technical Committee consisting of experts that meet requirements of national
standards, place Valle d’Aosta Region on the top in the whole Italy when it comes to quality of the
procedures offered as well as patients’ evaluation.
Nevertheless, it is essential not to neglect the women’s alertness and to have their constant
attention to the prevention matter.
This handbook to show that, together with other tools, our object is to achieve an increasing
number of the adherence to our screening tests.
Chief Executive,
Carla Stefania Riccardi
Councillor of Welfare and Health Service,
Albert Lanièce
Early detection means effectiveness of the treatment
Breast and cervical cancer are extremely dangerous for women’s health.
National and international clinical research indicates that the full recovery is possible only when
the diagnosis and treatment are conducted on time.
In case of cervical cancer, it is the prevention that is the most effective way to avoid the disease.
The aim of the screening tests is to help women choosing the prevention as a tool for their health
determinant.
Valle d’Aosta Region offers women in the age range, for whom the protective effectiveness of the
screening is the most suitable, the program of periodic check-ups for precocious diagnosis of
female cancers.
This handbook is to provide women with all the useful information, in order to take a conscious
decision according to their own reasons, experience and emotions.
Adhering to free check-ups is very important, because of the effectiveness of interventions that
depends on the continuity of check-ups in the correct time. What’s more, being well informed
about our own health leads to the peacefull life and the knowledge about the prevention concerns
to all generations of women.
Mammography
It is the process of using X-rays to examine the human breast that allows to detect the premature
abnormalities (lumps, thickenings or other), even in the smallest dimensions.
How the procedure is executed
The radiological examination is conducted with the specialist appliance by the medical radiation
technologist. The radiation doses are so low that there is a minimal risk related to the harm caused
by the radiation.
The standard examination provide two different screenings of each breast. The breast is
compressed by two parallel-plats for about 10- 15 seconds for each screening.
The compression of the breast may be tiresome and often painful. The breast is flatted as much as
possible in order to even the thickness of the tissue to enable a better vision of any anomalies and
to submit the required radiation dose.
To make the examination more bearable, it is advised to conduct it just after the menstruation
when the breast is less taut.
In what age, how often, and where
Women between 50 and 69 years of age should repeat the mammography regularly every 2 years.
Also women between 45 and 49 years of age can freely adhere to the screening. The
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mammography is conducted in Beauregard Hospital in the Department of Radiology or in any of
the mobile units of senology in health centres throughout the whole region.
The examinations conducted in the period different than advised are very often useless and do not
reflect the effectiveness of the screenings. What’s worse, they depict unnecessary exposition to
the radiation and represent the risks followed by close examinations.
“Dense breast”
By “dense breast” we mean the radilogical image of the breast where clear areas prevail over the
dark ones caused by the presence of mammary gland in relation to the fat. It is much more difficult
to identify the damage that may be caused be the cancer for women with “dense breast”, which
can lead to the expansion of the breast cancer.
For women with particularly dense breasts, the regional screening program offers, other than
mammography, the possibility to submit for the profound and free of charge ultrasound scan, which
is conducted in the Department of Radiology only by appointment and personal invitation by
phone. There is nothing to be concerned about, as it is to verify and confirm the correctness of the
mammography.
After the mammography
If the result is negative, the next check-up should take place in 2 years. But if the result is
abnormal (lumps, thickenings or other) or there are any doubts, then the patient is asked to
conduct a close examination (detailed mammography, ultrasound, magnetic resonance scans, cell
samples or tissue samples) which is free of charge and takes place in the Department of Radiology
only by the appointment and the the referral made personally on the phone.
Taking part in such close examinations may understandably bring worries and fear;
however in most cases of these verifications, the existence of the cancer was excluded;
in other cases there were some different, free of charge check-ups recommended which were
reconciled with the limited time prior to the usual way of carrying out the examinations.
However, if the results of the examinations confirmed the suspicions for the appearance of the
cancer, doctors establish together the course of the diagnosis and the follwing treatment, the way it
was estimated in the screening program.
The quality and the limits
The mammography is the currently available and most effective test in diagnosing premature
breast cancer in its incipient stage thanks to the periodicity of the screening. Like all the diagnostic
techniques, the mammography has narrow bounds with the difficulty in understanding the
characterisctics of the breast tissue as well as with such a small dimension of the harm that is not
recognizable.
It is rare (about 1 woman out of 1.500 who had mammography), but possible that after the
negative test and prior to the following check-up, the “interval cancer” can develop. That is why, it
is essential for every woman to pay attention for possible breast changes during the intervals
between the two consecutive mammography tests and promptly report anything to an appropriate
doctor.
It is also possibile that the mammography can point out some small cancers, growth of which is
very slow and therefore not harmful for woman’s health. This phenomenon called “overdiagnosis”
is unfortunately inevitable, because all the techniques we acquire, do not let us to distinguish from
the very beggining which cancers will develop and which not.
Moreover, the mammography can induce the suspicion for the appearance of the cancer which
during the second time was not founded. These so-called “false positives”, which lead to the close
examinations, can also in some cases lead to major operations in order to remove lesion that
turned out to be benign, causing unjustified distress.
The number of cases typical for this type of cancer is higher for younger women and has the
tendency to drop with the age.
Finally, it is to verify the “false negatives”. Very rarely (5 women out of 1000 who conducted the
mammography every 2 years for 10 years), even after the hormonal therapy and after the
menopause, the breast cancer is so dense and unnoticeable for the x-rays that the test cannot
verify its appearance, so the in-depth ultrasound has to be conducted for better identification and
afterwards for reducing the possibilities of ““false negatives”.
The quality of the screening program is guaranteed by:
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constant monitoring of every stage of the diagnosis and the treatment
national and international standards of the examination
use of modern technologies, submitted for periodic quality inspections
specific trainings and experience of the technical personnel of radiology that conduct the
mammography
the “double reading” which means that every result of the mammography is revised by two
professional radiologists and produced in the specific format
the examination of any suspicious case by an interdisciplinary medical team that may allow
for close assessments
discussion with the team of experts in rare cases
Pap test
It is a simple examination of the cells in the endocervical canal that allows to prematurely detect
the presence of the possible alterations, even the ones that cannot contribute to any disorders.
Thanks to this it is possible to treat and avoid cancer.
How the procedure is executed
The obstetrician, using a simple medical tool (speculum), collects a few cells from the outer
opening of the cervix with a small wooden spatula or a small endocervical brush. The cells are
then examined under a microscope. Samples are carefully collected and usually with only a mild
feeling of inconvenience.
For the best results of the test, it is advised not to use the any cream, candelette or thorough
vaginal cleaning 5 days before the procedure and abstain from unprotected sexual intercourses at
least 24 hours before the procedure.
At times when the number of the collected cells is insufficient or when the inflammation occurs,
which can prevent from the correct results of the procerure, it is advised to take the test again.
In what age, how often, and where
Women between 25 and 64 of age should repeat the test every 3 years. It is performed in health
centres throughout region.
The tests conducted in the higher frequency than advised is useless and do not increase the
effectiveness of the screening as well as represent the unnecessary risks followed by close
examinations.
Particular cases
It is possible to conduct the test for women who never had sexual intercourses, are pregnant and
for women just after the operation of the cervix removal. In these cases, it is enough to inform the
medical personnel just before the examination.
After the Pap –test
If the result of the test is negative, the following check-up is advised after 3 years. If the Pap-test
indicates the presence of the abnormal cells, beyond the repetition of the test, the patient is
referred for colposcopy. It is a painless procedure with the use of optical instrument that provides a
better vision of the cervical canal. The results of the colposcopy can be normal (negative) or there
may be some evidence of the abnormal aspect which leads to the small procedure of collecting
cellular tissue (superficial biopsy).
Consequently, on the base of the results of the colposcopy and possible biopsy, the doctors
establish together the course of the diagnosis and the follwing treatment, the way it was estimated
in the screening program.
The quality and the restrictions
Similarly to the mammography, also in Pap-test it is possible to verify “overdiagnosis” for the precancer lesions, which in many cases not only do not develop into more advanced ones but also
decrease naturally.
It can also happen that despite the non pathological results of the Pap-test, during the interval
between both tests, the development of the lesion occurred (“interval cancer”).
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It concerns to very rare cases, generally connected with the types of cancers undetectable during
the tests.
The quality of the screening program is guaranteed by:
- constant monitoring of every stage of the diagnosis and the treatment
- national and international standards of the examination
- technologies in use
- specific trainings and solid experience of the technical personnel, the doctor and a person
who perform the screening.
Adhering to the screening. Simple and free of charge.
The program ensures that every woman between 25 and 69 years of age receives a letter with all
the necessary information about the test (the date and the hour with the location of the
appointment). It is enough to receive such letter and make a phone call to confirm or change the
date of the appointment and afterwards arrive in the exact place on time.
The tests with possible close examinations are free of charge and do not require the doctor’s
authorization of medical treatments for the patient.
The letter sent to the patient contains all the necessary information about the results of the test.
Respond with trust and serenity for our invitation
For information call 199.199.944
Monday to Friday 8:00-16:30
Based in USL
1 G. Rey Street, Aosta
Opening hours: Monday to Friday 9:30-11:30 and 15:00-16:00
Collection of Cytopathologic analysis results: 14.00-16.00
Based in the Beauregard Hospital ,
5 Vaccari Street, 11100 Aosta
Opening hours: Monday- Friday 13.00 – 20.00
Based in mobile units of mammography in health centres of Morgex, Châtillon and Donnas
www.ausl.vda.it/screeningtumorifeemminili
email [email protected]
Printed in August 2011
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