Breast screening and anatomy Flashcards
Which is the most common female cancer in the UK?
Breast cancer
Which cancers in females are the biggest cause of death?
- lung cancer
2. breast cancer
What is improved survival of breast cancer due to?
New chemotherapy agents
Tamoxifen (for treatment of ER+ cancer)
NHS Breast screening programme
What is the lifetime risk of diagnosis of breast cancer?
1 in 9
Is breast cancer commoner in older pts or younger pts?
Risk of getting breast cancer increases with age so more common in older pts
What are the risk factors for breast cancer development?
- BRCA 1 and 2 gene carriers
- HRT
- moderate-high alcohol consumption
- nulliparous
- not breast feeding
- radiotherapy treatment <35yrs old esp to chest
- Li Fraumeni syndrome (a syndrome that predisposes to a lot of cancers)
- alcohol consumption
- oral contraceptive use
- obesity - post menopausal
- dense breast tissue
How doess breast feeding reduce the risk of breast cancer?
breast feeding suppresses the proliferation of breast tissue
What age group of women are normally invited for breast cancer screening and how often?
50-70
Every 3 years
After the age of 70, can request to have breast screening
What does breast cancer screening involve?
Mammography- (X-ray)
What proportion of women will be recalled after their breast cancer screening mammography and what is done in clinic?
5%
They will have an USS of their breast and a biopsy if necessary
What proportion of women who are recalled have breast cancer?
1 in 4
What are the 4 stages of the breast cancer screening programme?
- Invitation
- Screening mammography
- Assessment - 5% recalled, USS, biopsy
- Results, surgery and further treatment
What features on mammorgram would lead to a pt being recalled?
- mass: poorly defined or well defined or spiculate (star-shaped)
- microcalcification
- parencymal deformity or distortion
- assymetric density
- enlarged axillary lymph nodes
- skin thickening
- clinical recall - if pts reports that she has a lump when she goes for her mammogram
- technical recall - haven’t got a good enough image
How do we grade lesions on mammorgrams?
1 - normal: no abnormality 2 - benign: 3 - indeterminate 4 - probably malignant 5 - almost certainly malignant
What methods are used to help breast surgeons localise lesions easily during surgery?
Wire localisation - inserting a wire under USS guidance
What is ductal carcinoma in situ and how does it look on mammorgraphy?
It is a precancerous stage
New microcalcification
What screening test is used in high risk pts groups with BRCA 1 and 2 genes or strong FH or history of radiotherapy and from what age are those with BRCA genes tested?
MRI with contrast to assess enhancement
From age 30
What proportion of breast cancers are picked up by mammography?
95%
What are the advantages and disadvantages of breast cancer screening?
Adv:
- Identifies breast cancer earlier, so increases survival
- node positivity rates lower
- picks up DCIS (ductal carcinoma in situ) which is asymptomatic and pre-cancerous and can be removed
- Reduces chance of needing a mastectomy or chemotherapy
Disadv:
- overdiagnosis of cancers that may have not progressed
- Anxiety when recalled
- discomfort/pain during mammogram
When is mammography used other than in the breast screening programme?
To characterise or further assess symptomatic abnormalities
Follow-up and surveillance of women who have been treated for breast cancer
What are the two main types of views obtained in mammography?
Mediolateral oblique
Craniocaudal
Which areas of the breast should the MLO view contain to be considered adequate?
Pectoral muscle at least to the level of the nipple
The inframammary fold
Lower axilla
Which areas of the breast should the CC view contain to be considered adequate?
Retromammary fat space
When is MRI used for assessment?
Screening high risk women e.g. genetic mutations, following radiation therapy for previous lymphoma
Assessing for recurrence after breast cancer surgery
Detecting suspected multifocal breast carcinoma
Assessing chemotherapy response for breast cancer
Assessment of breast implant integrity or the presence of suspected malignancy in women with breast implants
