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1. BREAST HEALTH AND BREAST
CANCER SCREENING
Dr Lee Phaik ImDr Lee Phaik Im
Sarawak General Hospital

2. BREAST HEALTHBREAST HEALTH

3. BREAST HEALTH FACTSBREAST HEALTH FACTSBeing breast aware is an art
D l iti ttit dDevelop a positive attitude
Give our breasts some attention as well , besides
four face
No one will know your breasts as intimately as you
ould because e “li e ” ith our breasts dailwould, because we live with our breasts daily
Breasts are organs in plain sight of you, therefore
the best chance to detect a growth earlierthe best chance to detect a growth earlier.

4. WHAT CAN YOU DO?WHAT CAN YOU DO?
1: monthly self breast examination ( SBE) beginningy ( ) g g
at age of 18
2: annual physical exam from your doctor after age of
40
3: consider regular screening mammograms from
the age of 40 onwardsthe age of 40 onwards
4: ask your doctor how to determine your personal
risk for breast cancerrisk for breast cancer
5: if you suspect any abnormalities, see your doctor
immediately .Be responsible for your own breasty p y
health!

5. MEN TOO!Know your own breasts. It is the first step towards
being breast awarebeing breast aware.
Everyone ‘s breasts are different in texture, shape and
sizesize
Self breast exam ( SBE) is one way of knowing your
breastsbreasts
SBE should be done ONCE a month.

7. BREAST CANCER SCREENINGBREAST CANCER SCREENING

8. Breast cancer screening refers to
“testing” the breast in asymptomatic
women (with no symptoms) for thewomen (with no symptoms) for the
purpose of detecting unsuspected
b h lbreast cancer at a stage where early
intervention can affect outcome.intervention can affect outcome.

9. Breast cancer takes years to develop.
Early in the disease, most breast cancer cause noy
symptoms.
When breast cancer is detected at a localized stageWhen breast cancer is detected at a localized stage
(has not spread to lymph node), the 5-year survival
rate is 98%ate s 98%
If cancer has spread to regional LN, rate drop to
83%83%
If cancer has spread to distant organs (liver, lung,
bone brain) rate is only 26%bone, brain), rate is only 26%

10. Screening mammogramg g
Is an x-ray exam of the breast in a woman who has no
symptoms.
The goal is to find cancer when it is too small to be felt
by a woman or her doctor.
Finding such small cancer by a screening mammogram
greatly improves a woman’s chance for successful
treatment.

11. What is Mammography?
A mammogram is a special X-ray image of
the breast Two X rays are taken for eachthe breast. Two X-rays are taken for each
breast. The X-rays are usually done by a
trained woman radiographer Thetrained woman radiographer. The
mammograms are then reported by a
radiologist.g
Radiologists are doctors who have specialg p
training in diagnosing diseases by looking at
images of the inside of the body produced
d f ldusing x-rays, sound waves, magnetic fields,
or other methods.

12. How Do I Prepare for a Mammogra
1. It is a simple procedure and there is no need to fast. Wear a 2-
piece outfit, either pants with blouse or skirt with blouse. This
is not absolutely essential but helps so that you only need to
remove your upper clothing.
2. You should not apply any talcum powder, perfume or
deodorant to your upper body, and armpit areas. These may
cast “white spots” on the mammogram, which may affect the
interpretation of the mammogram by the radiologist.

13. 3. If you have breast pain, you may wish to schedule your
mammography after your period is over. This is normally
h h f h l l h h bthe phase of the menstrual cycle where the breasts are
less tender.
4. If you have previous mammograms, please bring themg g
along with you so that a comparison can be made
between them. This helps the radiologist reading your
films, especially in the detection of subtle abnormal
details on your mammogram. It helps to improve the
accuracy of the report.

21. When Should I Go For a Mammogram?
The present guidelines for screening of
t ti ( h d t hasymptomatic women (women who do not have
any symptoms related to the breast) are:
b lAt age 35-40: baseline mammogram
At age 40-49: annual mammograms
At age 50 and above: mammograms at one or two
year intervals depending on several factors such asy p g
hormone replacement therapy, risk profile

22. Can I have a mammogram if I am younger
h 35 ld?than 35 years old?
Symptomatic women, that is women who have
signs or symptoms related to the breast like a lump,
i l di h l i (b i )nipple discharge, mastalgia (breast pain),
unexplained decrease or increase in breast size or
appearance will require a mammogram to resolveappearance, will require a mammogram to resolve
the particular problem.
Th i li i h h iThere is no age limit when there is a symptom or
sign in your breast. The above guidelines are for
women without any symptoms or signs of breastwomen without any symptoms or signs of breast
problems.

23. Is Mammography Perfect?Is Mammography Perfect?
Mammography may be the key to successful
treatment and cure of the disease. However,
mammography can fail in detection of some cancers
since not all breast cancers produce a recognizable
change in the mammogram and this occurs more
often when the woman has dense breast tissue.
Palpable cancers are not always visible and visible
cancers are not always palpable.

25. Wh t d di l i tWhat do radiologists
look for on yourlook for on your
mammogram?mammogram?

26. l ifi i1: calcifications
tiny mineral deposits within the breast tissue,
hi h l k lik ll hi h filwhich look like small white spots on the films.
This may or may not be caused by cancer
(a): macrocalcifications: coarse calcium deposits,
most likely caused by aging of the breast arteries,
ld fl l d
g g
old injuries or inflammation. Related to non-
cancerous condition, do not require a biopsy
(b): microcalcifications: tiny specks of calcium, may
appear alone or in clusters. More concerning, butpp g,
still do not always mean that cancer is present. The
shape and layout of the microcalcifications helps
radiologist judge how likely it is that cancer isradiologist judge how likely it is that cancer is
present.

28. Examples of cancerous calcifications –
magnification (enlarged close up views)

29. 2: MASS
Mass can be caused by many things, including cysts, non-
cancerous solid tumours and cancerous tumours.
If the mass is not a simple cyst( non-cancerous, fluid-filled
sacs), further imaging tests are required.g g q
Your prior mammogram may help show that a mass has not
changed for many years, which would be mean that thechanged for many years, which would be mean that the
mass is likely a benign condition and biopsy would not be
needed.
If the mammogram show something suspicious, tissue
must be removed and looked at under the microscope to
ll f h b d h dl btell if it is cancer. This can be done with a needle biopsy
or an open surgical biopsy.

31. What happens if there is some abnormality onpp y
my mammogram?
A palpable lump or an abnormality detected onp p p y
screening mammogram may require further
examination like breast ultrasound or specialexamination like breast ultrasound or special
mammographic procedures such as stereotactic
guided fine needle aspiration cytology (FNAC) coreguided fine needle aspiration cytology (FNAC), core
biopsy or wire localization.

32. Breast Ultrasound
Also known as sonography
high frequency sound waves are used to look inside a
f h b dpart of the body.

36. Role of ultrasound of the breastRole of ultrasound of the breast
in screeningg
Mammography is NOT perfect and picks up on
average 85% of the breast cancers. As the densityaverage 85% of the breast cancers. As the density
of the breast increases, the cancer pick up rate for
mammograms decreases.
Women who do not have much fatty tissue in
th i b t b fit f lt dtheir breasts can benefit from ultrasound
screening examinations in addition to routine
mammogram. It has been used as a standarda og a . as bee used as a s a da d
adjunct to mammography in many centers.

37. Current evidence does not recommend ultrasound
alone as a reliable screening tool for breast canceralone as a reliable screening tool for breast cancer.
It l k fi d t il t d t t t l iIt lacks fine detail, cannot detect most calcium
deposits, is largely dependent on the operator (the
di l i t lt d t h l i t l kradiologist or ultrasound technologist, also known as
the sonographer), and cannot document how much
b i h b i d d l h i h fbreast tissue has been imaged and also has its share of
false pick-ups or missed cancers.

38. Mammography continues to be the most
i i l f bimportant screening tool for breast cancer
and combining the mammography withg g p y
ultrasound may prove to be an important
t i iti it i ithway to increase sensitivity in women with
dense breast tissue.

39. In Malaysia,

43. What happens if there is some abnormalitypp y
on my mammogram?
A palpable lump or an abnormality detectedp p p y
on screening mammogram may require
further examination like breast ultrasoundfurther examination like breast ultrasound
or special mammographic procedures such
t t ti id d fi dl i tias stereotactic guided fine needle aspiration
cytology (FNAC), core biopsy or wire
localization.

44. Ultrasound guided biopsyg p y
If the mass is too small or too deep within
h b b f l l d i ithe breast to be felt, ultrasound imaging can
be used so that the doctor can see the needle
on a screen as it moves toward and into the
massmass

48. Wire localizationWire locali ation
Is a procedure used to guide a surgical/excisional
b t bi f ll th t ld b h dbreast biopsy of a small mass that would be hard
for the surgeon to locate.
It can also be useful with areas that look suspicious
on the x-ray ( microcalcifications) but do not haveon the x ray ( microcalcifications) but do not have
a distinct lump
Can be done under ultrasound guidance or
mammographic guidance

51. Ultrasound guided wireg
localization

60. Usually for suspiciousUsually for suspicious
microcalcifications, not seen on
l dultrasound.