Breast cancer: Screening + Family hx Flashcards
Breast cancer screening: Overview
The NHS Breast Screening Programme is being expanded to include women aged 47-73 years from the previous parameter of 50-70 years. Women are offered a mammogram every 3 years. After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’.
Breast cancer screening: PURPOSE
The purpose of breast cancer screening is to reduce the number of deaths from breast cancer.
The effectiveness of breast screening is regularly debated although it is currently thought that the NHS Breast Screening Programme may save around 1,400 lives per year.
What happens to 100 women each time they have breast screening:
- 96 women have a normal result
- These women will receive further investigation for screening every 3 years
- 4 need more tests
- 1 woman is diagnosed with cancer
- 3 woman have no cancer found
- These women will receive further investigation for screening every 3 years
FAMILIAL breast cancer: When to refer on
NICE published guidelines on the management of familial breast cancer in 2013, giving guidelines on who needs referral.
If the person concerned only has one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history:
- age of diagnosis < 40 years
- bilateral breast cancer
- male breast cancer
- ovarian cancer
- Jewish ancestry
- sarcoma in a relative younger than age 45 years
- glioma or childhood adrenal cortical carcinomas
- complicated patterns of multiple cancers at a young age
- paternal history of breast cancer (two or more relatives on the father’s side of the family)
FAMILIAL breast cancer:
Women who are at an increased risk of breast cancer due to their family history may be offered screening from a younger age. The following patients should be referred to the breast clinic for further assessment:
- one first-degree female relative diagnosed with breast cancer at younger than age 40 years, or
- one first-degree male relative diagnosed with breast cancer at any age, or
- one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years, or
- two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age, or
- one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative), or
- three first-degree or second-degree relatives diagnosed with breast cancer at any age
Breast cancer screening: Key points
- Breast cancer = most common type of cancer in the UK.
- Breast screening uses a x-ray called a mammogram to check the breast for signs of cancer.
- Patients receive results in the post within 2 weeks.
- A mammogram is required every 3 years.
- Patients will need to undress to the waist so they might prefer to wear a top and skirt or trousers rather than a dress.
- Women are normally advised not to wear talcum powder or deodorant as these can cause artefacts on the mammogram.
- Patients will be asked some questions about previous breast history, HRT use and family history.
- All mammographers in the NHS breast screening programme are female.
- At the breast screening unit, mammograms are read independently by two film readers.
Disadvantages + limitations of breast cancer screening
- Mammography is uncomfortable + involves a small amount of radiation.
- False-positive results may cause unnecessary anxiety.
- Breast screening occasionally misses a cancer.
- Breast cancer may occur in the interval between screening appointments.
- Screening may diagnose a cancer which never needed treating.
Why are screening mammograms read by two people?
All breast screening mammograms are ‘double read’ which means they are read independently by two trained film readers, who may be radiologists, breast physicians or radiographers.
Independent double reading increases the cancer detection rate, as there will be cancers that are detected only by one reader.
Most units also use a process of consensus and/or arbitration. This means that if there is disagreement between two readers, they may discuss the case to come to an agreement (consensus) or it may be read by a third reader who makes a final decision (arbitration).
MICROCALCIFICATION in the breast
Microcalcifications are small specks of calcium salts that form in the breast tissue. They are too small to feel and they don’t cause any pain.
- Common
- Usually develop naturally as the breast ages.
- Can also be seen in association with benign changes, such as fibroadenomas and cysts.
- In addition, they can occur in response to trauma or surgery to the breast.
Important diagnosis to consider: microcalcifications in the milk ducts due to ductal carcinoma in situ (DCIS).
Breast cancer: Invasive vs. non-invasive
NON-INVASIVE:
- 1 in 5 women diagnosed with cancer.
- Cancer cells are limited to milk ducts.
- Have not spread any further.
- Also called DCIS.
- This can progress to invasive cancer or remain as DCIS.
INVASIVE:
- 4 in 5 women diagnosed with cancer.
- Cancer has grown outside milk ducts + into surrounding breast tissue.
STEREOTACTIC breast biopsy
Uses mammography – a specific type of breast imaging that uses low-dose x-rays — to help locate a breast abnormality and remove a tissue sample for examination under a microscope.
It’s less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound.
EMOTIONS following cancer diagnose
- Confused
- Shocked
- Anxious
- Frightened
DCIS: Requirement for further surgery following WIDE LOCAL EXCISION (2)
- An adequate margin of surrounding healthy tissue is not achieved.
- A area of invasive cancer is found within the DCIS.
DCIS: Follow up (2)
- Annual clinic appointment
- Annual mammogram
FACTORS affecting ATTENDANCE of screening
- Level of encouragement by GP
- Knowledge of disease
- View + experiences of family + friends
