Breast screening Flashcards
When are women screened for breast cancer
Offered every 3 years between 50 and 70
Can request over 70
What have to do with breast in mammogram
Compress - spread breast tissue in order to visualise
Results from mammogram
Routine recall
Technical recall - if not clear enough image
Assessment clinic
Results from mammogram
Routine recall
Technical recall - if not clear enough image
Assessment clinic
Assessment clinic
Further imaging+/- biopsy, magnification views - calcium, Tomo
Clinical examination
Ultrasound - benign or malignant
Cyst aspiration
Core biospy solid lesions/sus findings
Advantages breast screening
Reassurance
Early detection, diagnosis and intervention
Increased prognosis
Less radical treatment and more options
Improved breast awareness
Disadvantages breast screening
Radiation from mammogram
Disadvantages breast screening
Radiation from mammogram
Anxiety
Discomfort during mammogram
Can miss cancers
Over-diagnosis/treatment
What is a mammogram
X-ray
What is high risk screening programme
Annual screening programme
If have BRAC1/BRAC2 gene, have mammogram and MRI every year
Radiation therapy -> annual screening aswell
When does GP refer to symptomatic clinic
Breast lump
Lump in axilla
Nipple discharge
Pain
Puckering
Abscess - pp/smoking
Trauma
Shape/size
Sebaceous cyst
Implant rupture/change/shifted
CT - incidental finding
Breast symptoms
Indentation
Redness/heat
Skin erodion
Asymmetry
Nipple retraction
Oaeu de oramge
What is triple assessment
Mammogram >40
US +/- core biopsy
Clinical examintation
What do under 40 and why with symtpomatic
US only, no mammogram - dense breast tissue, less risk from radiation expsoeure
Where do US in breast
Quadrant that symptoms are in
US benigin tumour
Well defined, encapsulated, wider than taller, homgenous, hyperchoic, anechoic (black itself), acoustic enhancements - whiteness at back - accelerated by fluid so faster behind it
US malignant tumour
Ill defined, irregular, taller than wider, heterogenous, hypoechoic, acoustic shadowing, disrupting breast tissue, acoustic shadowing
Palpating benign lump
Firm/rubbery, painful, regular, smooth, mobile, no skin dimpling, green and yellow, milky, clear discharge, no nipple retraction
Palpating malignatn lump
Hard, painless, irregular, fixed to skin/chest wall, skin dimpling, bloody discharge/unilateral discharge, nipple retraction
Differentiate between lumps in men on US
Behind nipple often gynaecomastia
breast cancer - away from nipple, irregular
Lipomas - rubbery away from nipple
How do implants complicate mammograms
Implant hides breast tissue
Minimal compression
Breast reduction can also disrupt lines of normal breast tissue
Why is there a risk of breast cancer in males but not if had masectomy
Men still have some breast tissue
If have masectomy - no breast tissue left
Why are lobular cancers more dangerous
Easier to miss
Increased chacnes multifocal and bilateral
More difficult to excise with clear margin
More chance masectomy
Always go on to investigate with MRI
Why are lobular cancers more dangerous
Easier to miss
Increased chacnes multifocal and bilateral
More difficult to excise with clear margin
More chance masectomy
Always go on to investigate with MRI
Microcalcifications - malignant or benign
Benign - teacupping
Popcorn - calcified fibroadenomas
DCIS - dont leave duct - Intracellular
See on X ray not US
Stereo biopsy on X ray
Areas score on breast cancer
Examination P1-5
Imaging - M1-5, U1-5
Histology score - H1-5
1 is normal
Managment of breast cancer after biopsy
Definitive diagnosis
Durther imaging/biopsies
-Treatment plan
Masectomy/WLE
Treatment options
RR, benign, surgery, WLE (breast conservatiion surgery)/masectomy
Neo-adjuvant chemo
Seed guidede wide locla excision
Radio
Oestrogen blockade
What is radio iodine seed used for
Mark where cancer is in breast using X ray in advance to surgery
Geiger counter picks up where it is in breast for surgeon
Increased surgical accuracu
How big margin of cancer free tissue around cancer excision
5mm
Indications for MRI
Dense breast tissue
Lobular carcinoma, extensive DCIS
malignant axillary lymph nodes but no tumour
Pre and post chemo response
High risk annual screening - BRAC1
