Screening

Question 1

What are microcalcifications?

Answer 1

Small specks of calcium salts that form in the breast tissue, they are too small to feel and don’t cause any pain. They are common and usually develop naturally as the breast ages. They can also be used in association with benign changes e.g. cysts and fibroadenomas. In addition they can occur in response to trauma or surgery to the breast.

Question 2

What investigation should be done if there are microcalcifications?

Answer 2

Patient should undergo a stereotactic core biopsy - performed using mammography guidance as calcification can’t usually be seen on USS.
When a core biopsy is obtained it is always x-rayed to determine whether they contain representative calcification from the area of concern.

Question 3

What is stereotactic wire localisation?

Answer 3

If the area of calcification is impalpable, the area will be localised on the morning of the excision surgery by inserting a fine wire into the area of calcification via mammographic guidance.

Question 4

What is DCIS?

Answer 4

• Necrotic cancer cells within the centre of the duct often calcify to produce microcalcification seen on the mammogram. Therefore, classically the DCIS microcalcification follows the linear, branching pattern of the milk ducts.
• In some cases the cells invade through the lining of the milk duct into the surrounding breast tissue, becoming invasive and often forming a lump.
• They can then spread to other parts of the body, if an area of invasive cancer is found on the excised DCIS the patient will be offered a sentinel node biopsy of the axilla
• Invasive ones are usually from the high grade DCIS

Question 5

How is DCIS treated?

Answer 5

DCIS can be removed by local excision with a safe margin of healthy tissue around it. Since there is little to see macroscopically with DCIS it is not always possible to completely remove the area with an adequate margin of tissue. The patient can be offered re-excision where further tissue is removed from the margins of the surgical cavity in an attempt to completely remove the DCIS.

Question 6

How is DCIS followed up?

Answer 6

Annual clinic appointment and mammogram for 5 years

Question 7

What is breast arterial calcification?

Answer 7

‘Tramline’ appearance on a mammogram, associated with increasing age, diabetes, CVD

Question 8

What women are at high risk of breast cancer?

Answer 8

• BRCA gene mutations
• tp53 gene mutation
• Previous supradiaphragmatic radiotherapy

Question 9

When do high risk women start breast screening?

Answer 9

Start screening at around age 35 and undergo it annually. They also have an MRI on top of mammography.