By: Apffelstaedt  11-11-2011
Keywords: Ultrasound, Breast Cancer, Mammography

Screening for breast cancer

Mammography is the "Gold Standard" of breast cancer screening.

Screening mammography is regarded as one of the most important contributing factors for halving breast cancer mortality over the last decade in countries that have introduced population screening. This is also the reason why leading international organisations such as the National Institutes of Health in the USA and the American Cancer Society, as well as leading organisations in Europe and Australia, recommend an annual mammography for women over age 40.

High quality mammographic screening by specialised centers with stringent quality control is the best method proven to decrease breast cancer mortality by early detection.

Ultrasound of the breast is not a primary screening tool, but plays an important role in the further characterization of abnormalities identified at mammography.

The screening interval is an important consideration. The longer the screening interval (i.e. the period of time between screening visits), the more cancers are discovered in the interval between screening visits and the less the benefit will be to the patient, as cancers could have been detected earlier.

Correct interpretation of a mammogram is crucial and it is therefore essential that the practitioner is not only experienced in his/her field, but remains at the forefront of scientific and technical advances in breast health.

Screening mammography changes breast cancer from a
deadly disease to a manageable condition.

Full field digital mammography, breast ultrasound and clinical examination for women.

High quality mammography is the single most efficient imaging modality for diagnosis of breast disease

Through continued improvement in equipment and techniques, the quality of the images produced has improved and the radiation dosage has been decreased.

Mammographers are Radiographers that have been specially trained to do mammograms as mammography is a highly specialised area of radiography defined by the quality of equipment used, the technical skills required to perform the procedure correctly, various anatomical deformities of the patients and the expertise of the professional interpreting the x-rays.

Maintaining excellent quality control is very important as it enables the Mammographer to produce clearer images that results in the earlier detection of cancers.

Early breast cancers can present in many different ways on a mammogram.

Although an experienced physician can detect a palpable mass, mammography is able to detect a non-palpable lesion up to 3 years before it becomes palpable.

A mammogram, when performed by an experienced Mammographer, is not a painful procedure.  At most, it may be a little uncomfortable. However, the short-term discomfort outweighs the long-term benefits.

Ultrasound of the breast is not a primary screening tool, but has an important role in the further characterization of abnormalities identified at mammography. Ultrasound is therefore a very important and integral part of our protocol, which we’ve included as a routine examination with each full field digital mammogram.

The most important uses of ultrasound in breast imaging are:

As a primary screening tool for women under the age of 40, who do not yet require a mammogram.

Cyst vs. solid characterisation of clinically occult mammographically detected or palpable breast masses.

Evaluation of asymmetric tissue on mammogram.

Evaluation of palpable masses in women who are pregnant, lactating or over 30 years old.

Guide for interventional procedures (cyst aspiration, preoperative localization, fine needle aspiration and core biopsy).

Ultrasound does not use ionizing radiation.

When a woman has a mammogram, we highly recommend that she undergoes a clinical examination of her breasts at the same time.

During this examination her breasts are checked for lumps, asymmetry, skin dimpling, contour changes and any discoloration. The nipples will be checked for deviation or retraction.

Our goal is to detect breast cancers at the earliest possible stage and make an accurate diagnosis of malignant changes.

Younger women are evaluated individually to determine specific needs.

Personal breast cancer risk assessment

Many women are afraid of an increased risk of breast cancer due to family history.

Often what is claimed to be a strong family history of breast cancer is only an accidental event due to the fact that breast cancer is a common disease.

Based on the medical history of thousands of women, modern risk assessment tools are able to provide an estimation of the individual women's risk of contracting breast cancer.

These tools utilise data that include: detailed family history, age at the birth of the women’s first child, a history of breast biopsies and other biologic factors that influence the risk of breast cancer. 

The result is a comprehensive risk profile.

This risk profile facilitates objective counseling and if necessary, targeted management.

As a rule of thumb, the risk of breast cancer is only significantly increased if one of your immediate family members i.e. your mother or one of your sisters suffered or suffers from pre-menopausal breast cancer, or there are male members of the family with breast cancer.  In an instance such as this, we recommend an examination by a medical practitioner with a special interest in breast disease. Genetic studies can be requested if indicated to further assess the risk of breast cancer.

Managing an identified high risk could entail:

Closer surveillance by breast ultrasound and mammography or even breast MRI prior to the recommended screening age of 40.

Anti-estrogen medication.

A bilateral risk reduction mastectomy with immediate reconstruction.

 "Most worried women I see," says Professor Apffelstaedt, "are greatly relieved when I can demonstrate that they do not have an increased risk of contracting breast cancer."

Management of benign breast concerns and breast cancer

Benign breast concerns may include such symptoms as:

breast pain (cyclic or non-cyclic).

tenderness of the breast.

feeling of heaviness (circumscribed or diffuse).

modularity (cyclic or persistent).

firmness of the breast (usually increases in the pre-menstrual period).

If you are experiencing any of these symptoms and are concerned, Prof Justus Apffelstaedt and Associates can assist you to manage the symptoms and advise you of follow up procedures.

Our practice will offer our knowledge and expertise in breast cancer management and breast cancer follow up.

Both Prof Justus Apffelstaedt and Dr Karin Baatjes have a special interest in breast cancer surgery.

Genetic screening and counseling for family risk of breast cancer

Many women believe that they will get breast cancer, simply because they are women.  However, the reality is that the majority of women will not suffer breast cancer during their lifetime!

The most important risk factor is the presence of an abnormality in breast cancer gene 1 or 2.  If such an abnormality exists, the risk of suffering breast cancer increases substantially (60 – 90%).

Women in this risk category can be identified by the presence in female family members of multiple breast cancers at a young age, and/or ovarian cancer and breast and/or prostate cancer in male family members.

It is advisable that women with a family history such as this undergo a proper assessment to establish whether their risk is significant enough to warrant a gene abnormality test.

Prof Justus Apffelstaedt and Associates are equipped with computerized pedigree assessment tools to accurately assess your risk which will determine whether gene testing is recommended. We will counsel you not only on the advisability of a gene test but also on how to handle implications of the test results.

Independent second opinion service

At Prof Justus Apffelstaedt and Associates, we offer a second opinion service.

Where applicable, to ensure that the opinion is based on a properly documented diagnosis, we ask patients to bring along all prior mammograms, other imaging studies and pathology results.

We respect the patient's autonomy in deciding where and by whom she wishes to be treated.

Keywords: Breast Cancer, Mammography, Ultrasound