Session 7 - Group Work Flashcards
In your usual groups, using online resources available to you, please make short summaries on the following:
- Summary of UK Breast Screening Programme
a) • When was it established?
a) 1987, but began inviting woman in 1988
In your usual groups, using online resources available to you, please make short summaries on the following:
- Summary of UK Breast Screening Programme
a) • When was it established?
b) • Who does it target?
c) • How effective is it
d) • Examples of where the UK Breast Screening fails
c) Out of all the women who attended breast screening, 1 in 25 women are called back following further investigation follow their mammogram. Out of those pts that are called back, 1 in 4 are diagnosed with breast cancer. That gives it a positive predictive value of 25%.
In your usual groups, using online resources available to you, please make short summaries on the following:
- Summary of UK Breast Screening Programme
a) • When was it established?
b) • Who does it target?
c) • How effective is it
d) • Examples of where the UK Breast Screening fails
d) - Failure of call back for last mammogram in 2009-2018: computer failure to call back 135-270 women
- There is a low specificity of the mammogram, 75% of women that are called back don’t actually have cancer
- Mammogram cannot be performed if you have a breast implant.
- Not sensitive enough to pick up if it’s a small problem
- Types of breast cancer – to consolidate learning from the lecture
a) Which are the common histological types of breast cancer?
Ductal
Lobular
Tubular
Mucinous
- Types of breast cancer – to consolidate learning from the lecture
b) What other systems exist for classification of breast cancers?
TNM staging and bloom Richardson grading scale
- Types of breast cancer – to consolidate learning from the lecture
b) What other systems exist for classification of breast cancers?
TNM staging and bloom Richardson grading scale
- Types of breast cancer – to consolidate learning from the lecture
c) Please take this opportunity to understand how the common histological types of cancer arise? To make this activity more integrative, referring to previous units’ knowledge of neoplasia process is important.
- Due to environmental or endogenous insult
- Mutations of tumour suppressor genes or proto-oncogenes to become oncogenes
- Find out what are the 5- and 10-year Survival rate figures for breast cancer in women in the UK
NB: Always ask the group to comment and be aware of which wider information sources you accessed for finding out this information (e.g. Cancer Research UK, Office for National Statistics, Cochrane reviews)
Almost 90 out of every 100 women (almost 90%) will survive their cancer for 5 years or more after diagnosis (86.6%)
Almost 80 out of every 100 women (almost 80%) will survive their cancer for 10 years or more after diagnosis (78.4%)
(Cancer Research UK)
- What is the Angelina Jolie effect? Very brief task simple to raise the point of the influence of public figures on the uptake of treatment or screening
A spike in genetic tests for breast cancer after actress’ public disclosure, but no corresponding increase in mastectomies
https://hms.harvard.edu/news/angelina-jolie-effect
Therefore, both positive and negative influences - increases awareness but also increase demand on NHS on people who didn’t need
https://youtu.be/rE6DBA4wLY0 - Now have a look at this link of breast surgeon from Mayo institute commenting on the BRCA gene testing and the Angelina Jolie effect.
Case 1
A 50-year-old patient comes to see you concerned about discovering a lump in her left breast. She also reveals a family history of breast cancer both in her mum and maternal aunt (who were both diagnosed with breast cancer in their 50s). There are no other symptoms of note. Patient is a smoker but does not drink alcohol, she has a BMI of 29 and no other medical problems of note. Not on any regular medications. Examination confirms a lump in the outer upper quadrant of
the left breast but no axillary lymphadenopathy.
You are clinically concerned about the breast lump and decide to refer this patient without delay to the breast service
.
Using this patient case as an example, in your groups, please consider the following question and create a mind map to help you consider it as broadly as possible:
‘The discussion with people with suspected cancer and their families and/or carers should include the following aspects…’
Some general pointers to get you started …
- You may find it useful to consider very practical considerations
- Try and relate it to wider life experiences/ early clinical experiences
- Need to consider this in the context of the real state of play within the modern NHS
- Consider which resources may be important
At the end of the mind map exercise, rather than a formal presentation, each table should be prompted to contribute one or two issues which are
5 important to consider with the patient and their family /carers and WHY those issues are important.
As you can appreciate from the mind map exercises, the scope of discussion is incredibly broad, and this is daunting for the patient.
The onward patient journey is only just beginning at the point of referral and this journey is complex and full of uncertainty. It is part of the role of a doctor to support the patient on navigating this journey.
x
Case 2
You see a 52-year-old female, usually fit and well, who underwent the UK breast screening programme and mammography features suggest that this patient has Ductal Carcinoma in Situ (DCIS).
a) Please follow the link to listen to Patient experience upon receiving the diagnosis of DCIS:
http: //www.healthtalk.org/peoples-experiences/cancer/ductal-carcinoma-situ-dcis/feelings-about-diagnosis-dcis
What stages of Kubler-Ross model may the patient be going through?
x
Case 2
You see a 52-year-old female, usually fit and well, who underwent the UK breast screening programme and mammography features suggest that this patient has Ductal Carcinoma in Situ (DCIS).
b) In your group, using lecture materials and other resource, familiarise yourself with the presenting features and histological features of DCIS.
Presenting features
- breast lump
- pain/discomfort unlaterally
- fluid/discharge from the nipple
- rash or itching on/around the nipple
- can present with mammographical abnormalities
- complications include Paget’s disease of the nipple
Histological
- neoplastic population of cells
- limited to ducts and lobules near the basement membrane
- cannot metastasise at this point
Case 2
You see a 52-year-old female, usually fit and well, who underwent the UK breast screening programme and mammography features suggest that this patient has Ductal Carcinoma in Situ (DCIS).
c) What challenges does the diagnosis of DCIS create for the patient in making treatment decisions? What sources of information might help the patient to guide their decision making?
It’s not as well known
- Macmillan Cancer Support
- Cancer Research UK
- NHS
- Breast Cancer.org
- Breast Cancer Care.org
Case 2
You see a 52-year-old female, usually fit and well, who underwent the UK breast screening programme and mammography features suggest that this patient has Ductal Carcinoma in Situ (DCIS).
x
