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Cancer & Treatment

Breast Cancer Early Detection and Diagnosis

Can Breast Cancer Be Found Early?

Getting regular screening tests is the most reliable way to find breast cancer early.



What are screening tests?

Screening is the best way to improve your chances for survival. Screening refers to tests and exams used to find a disease in people who don't have any symptoms.


Early detection means finding and diagnosing a disease earlier than symptoms start.


The goal of screening tests for breast cancer is to find it before it causes symptoms like a lump that can be felt.


Breast cancers found during screening exams are more likely to be smaller and still confined to the breast.


Screenings recommendations for women at average breast cancer risk:

These guidelines are for women at average risk for breast cancer.


Women between 40 and 44 have the option to start screening with a Mammogram every year.


Women 45 to 54 should get Mammograms every year.


Women 55 and older can switch to a Mammogram every other year, or they can choose to continue yearly Mammograms. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.


Breast cancer screening tests:

1) Mammography


2) Clinical Breast Exam


3) Breast MRI


Mammograms

Regular Mammogram can help find breast cancer at an early stage, when treatment is most successful.


Clinical breast exam and breast self-exam.

Women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.


Screening recommendations for women at high risk

Women who are at high risk for breast cancer based on certain factors should get an MRI and a Mammogram every year, typically starting at age 30. This includes women who:


  • Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below)
  • Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)
  • Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
  • Had radiation therapy to the chest when they were between the ages of 10 and 30 years
  • Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes


If MRI is used, it should be in addition to, not instead of, a screening mammogram This is because although an MRI is more likely to detect cancer than a mammogram it may still miss some cancers that a mammogram would detect.


Most women at high risk should begin screening with MRI and mammograms when they are 30 and continue for as long as they are in good health. But a woman at high risk should make the decision to start with her health care providers, taking into account her personal circumstances and preferences.


Talk to your Doctor


The best way to know when to begin screening for mammograms and how often to get screenings is to talk to your medical provider.


  • Begin talking to your medical provider about breast cancer screening by age 40.
  • Share your family history and personal medical history to determine whether you are at average risk or higher risk for breast cancer.
  • Understand the benefits, risks, and limitations of breast cancer screening.

Imaging Tests to find Breast Cancer

Different tests can be used to look for and diagnose breast cancer.


(A) Mammogram

(B) Breast Ultrasonography

(C) Breast MRI


(A) What is a Mammogram?

A Mammogram is an x-ray of the breast.


The advantages of having a Mammogram at Sterling Cancer Centre are:


  • It's True Digital Technology with Prime mode which gives lower radiation.
  • It's fast, less painful and every women receives personalized dose.
  • Avaibility of latest 3D Tomosynthesis Technology which can detect small cancer at early stage with precision.
  • Facility of stereotactic biopsy for diagnosis of small cancers which are not palpable.
  • Highly trained female technologist.
  • All mammogram can be archived and can be retrieved in future for comparison.
  • One stop specialist assessment and reports.


When scheduling a Mammogram

Schedule your mammogram after your period when the breasts are less painful and you will have less discomfort.


Do not use deodorant, antiperspirant, perfumes or talcum powder as this can interfere with the interpretation of the mammogram.


Remember to bring your previous Mammogram for comparison.


Mammograms for Women with Breast Implants

If you have breast implants, you can and should get mammograms as recommended. Inform the technologist about it. You might need to have extra pictures taken so the doctor can see as much breast tissue as possible.


Understanding your Mammogram Results

Doctors use a standard system to describe Mammogram findings and results and this system is called the Breast Imaging Reporting and Data System (BI-RADS).


Breast Density and Mammograms

The density of your breasts is important. High breast density has two fold risk as women with dense breast are at increased risk of cancer and small cancers may be harder to find on mammograms in women with dense breasts.


Pregnancy, Breast Feeding, and Mammography

Screening mammography is not used in pregnant women because radiation may cause harm to the foetus.


Pregnant women may get clinical breast exam as part of their routine prenatal care.


If a lump is found during first trimester, tests such as breast ultrasound can be done to evaluate it further.


If lump is found after first trimester, a diagnostic mammography may be done with a shield covering the abdomen to protect the foetus.


Breast Feeding: During breast feeding period the tissue of the breast are dense on Mammogram, making it hard to read. So wait until after you stop breast feeding to get a routine mammogram.


Discuss the best timing to get Mammogram with your health care provider.


(B) Breast Ultrasound

Breast ultrasound uses sound waves to make images of the breast. High frequency ultrasound is a very essential tool in diagnosis of breast disease.


It is non- invasive and often used in follow up tests after an abnormal findings on mammogram.


We at sterling cancer centre are equipped with very high resolution ultrasound machine which is dedicated to breast ultrasonography.


If needle biopsy may needed, breast ultrasound may be used to help the guide the procedure.


(C) Breast Biopsy

Biopsy is done when mammography, other imaging tests or a physical examination shows a breast change might be cancer. Biopsy is the only way to confirm if the changes are cancer or not. Needing a breast biopsy doesn't mean that you have a breast cancer.


During biopsy few cells are removed from the suspicious area and sent for pathologist to see if cancer cells are present.


There are two main types of biopsies:


  1. Needle Biopsy: In Needle biopsy doctor removes tissue or cells with a needle.
  2. Surgical Biopsy: In Surgical biopsy surgeon put cut (Incision) on the skin to remove small tissue.


Types of biopsies offered at our centre are:


  • Ultrasound Guided Procedure

    • FNAC ( Fine needle aspiration cytology)
    • Core needle biopsy.
    • Hook wire localization of the lesion.
    • Clip marker placement.
    • Axillary node biopsy.

  • Mammography Guided Procedures

    • Stereotactic core needle biopsy.
    • Stereotactic hook wire localization.
    • Stereotactic clip marker placement.


FNAC(Fine needle Aspiration Cytology)


In FNA Biopsy, a thin very hollow needle attached to a syringe is used to withdraw (aspirate) a small amout of tissue form a suspicious area.


Core Needle Biopsy


A core needle biopsy uses larger needle to sample breast lesion.


Hook Wire Localization


This procedure is done to localize the lesions which are very small and not felt by hand.


This procedure is done under ultrasonography of mammography guidance. A thin hair like hook is placed at the site of abnormality so that surgeon can remove the abnormal area along with hook during surgery


This procedure helps the surgeon know where exactly the lesion is present in the breast. The surgeon uses the wire as a guide and removes the lesion, mammography of the removed part (specimen) is again done to confirm the removal of the cancer.


Stereotactic Biopsy


Stereotactic biopsy is specially helpful for those women in whom the lump is not seen or felt by hand or not seen on ultrasonography. This type of biopsy is done for the lesions which are only seen on mammography.


In this procedure, the precise localization of the lesion is done with mammography machine measuring X, Y and Z direction of the lesion and biopsy is done with the help of this measurement.


Under mammography guidance hook wire localization and clip markers can also be placed.


Sterling Cancer Centre is the only centre in Gujarat at present to offer this facility.

Imaging Tests to find out if Breast Cancer has Spread

If you have already been diagnosed with breast cancer, you might need more tests if your doctor thinks the cancer might have spread based on your symptoms, physical examination and size of the tumour.


  • Chest X-ray
  • CT Scan
  • MRI
  • Ultrasound
  • PET Scan
  • Bone scan


Breast Cancer

Multicentric (>1 in different sectors) of the breast are usually, barring exceptional cases, treated with mastectomy.

Breast Conservation Surgery

Breast Conservation Surgery


It is technique in which only the tumor with a rim of surrounding normal tissue is removed and the breast is preserved.


Patients need post-operative Raditherapy to the preserved breast.


It is safe and as effective as total removal of the breast (Mastectomy) for properly selected cases.


We offer this option in all appropriate situations.


With rigorous quality control the re-excision rates in our series is near zero.


The pic shows a specimen of breast cancer removed by BCS technique which has been cut open; note that the margins are wide and are inked for proper assessment.


Breast- Neo-Adjuvant Chemotherapy- Oncoplasty

Breast- Neo-Adjuvant Chemotherapy- Oncoplasty


Locally advanced breast cancers (LABC) are usually treated first chemotherapy before surgery (Neo-Adjuvant Chemotherapy-NACT) .


Sometimes , breast cancers which are not advanced may be too large relative to size of the breast itself so that a breast conservation surgery may not yield ideal results; in such situation also Neo-Adjuvant Chemotherapy is used.


Neo-adjuvant chemotherapy may shrink the tumors so much that they may not be palpable (felt) anymore (pic2).


To ensure proper and adequate surgery in such situations a metallic marker to act as guide and confirm adequate surgery is placed before chemotherapy (arrow pic 2 & 3)


Breast Cancer in Male

Breast Cancer in Male


Yes, breast Cancers can occur in males too.


Sometimes, to surface after radical surgery, tissue may need to be borrowed from nearby areas.


The case in pic had a Latissimus Dorsi flap to resurface the wound created by removal of the breast cancer.


A case of male breast cancer in the family warrants evaluation for risk of hereditary breast cancer.


Breast Conservation Surgery (BCS)

Mammogram


After Oncoplastic Breast Conservation Surgery


Breast Conservation Surgery (BCS) is followed by Radiotherapy (RT) to the breast. This changes the mammographic appearance of the treated breast for a considerable period of time.


After a proper ‘Oncoplastic Surgery’ (OPS) the breast is a little smaller but the shape and projection are well preserved.


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