Download A Formidable Challenge

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.
Introduction
Even though there is paucity of nation wide
data the various institutional and localized
data are quite concerning.
Data of New Breast
Cancer Patients
Total Breast Cases
Total Number of cases
4000
3500
3000
2500
2000
1500
1000
500
0
1998
2000
2002
2004
2006
Data of patients below
40 yrs.
patients below 40 yrs.
300
250
200
150
100
50
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
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.
1600
1400
1200
1000
800
600
400
200
0
2003
2005
2007
Mammographies
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.
25
20
15
Minimal
Cancers
10
5
0
2003
2005
2007
Conclusion
“ through our involvement
and commitment we can
revolutionize breast cancer
management in our
communities ”
Thank You