11

MAMMOGRAPHYMAMMOGRAPHYRADIOGRAPHIC IMAGING OF THE BREAST

Part 2 -Statistics

A mammogram can find breast cancer when it is very A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it.small -- 2 to 3 years before you can feel it.

No screening tool is 100% effective. Good quality No screening tool is 100% effective. Good quality mammograms can find 85-90% of cancersmammograms can find 85-90% of cancers

22Regular breast screening can find cancer when it Regular breast screening can find cancer when it

is small which means:is small which means:

there is a better chance of treating the there is a better chance of treating the cancer successfullycancer successfully

it is less likely to spreadit is less likely to spread

there may be more treatment options there may be more treatment options

33

MAMMOGRAMMAMMOGRAM

REMAINS THE SINGLE MOST REMAINS THE SINGLE MOST SENSITIVE TECHNIQUE IN DETECTION SENSITIVE TECHNIQUE IN DETECTION OF BREAST CANCER OF BREAST CANCER (ACR)(ACR)

OTHER MODALITIES:OTHER MODALITIES:ULTRASOUNDULTRASOUNDMRI MRI OTHER - thermographyOTHER - thermography

44

PATIENT FEARSPATIENT FEARS

PAINFULPAINFULFIND SOMETHING FIND SOMETHING

WRONG / DENIALWRONG / DENIALUNINFORMEDUNINFORMED

““causes cancer”causes cancer”

55 RISK FACTORSRISK FACTORS

SEX 99% WOMEN SEX 99% WOMEN 1 % MEN1 % MENAGE – INCREASE WITH AGE*AGE – INCREASE WITH AGE*YOUNGER WOMEN- FASTER YOUNGER WOMEN- FASTER

GROWING CELLSGROWING CELLS

66

MORE RISK FACTORSMORE RISK FACTORS

HISTORYHISTORY PREGNANCY & ABORTIONSPREGNANCY & ABORTIONSOBESTIY OBESTIY EARLY MENSESEARLY MENSES LATE MENOPAUSELATE MENOPAUSE

77

ACS GUIDLINESACS GUIDLINES

women age 40 to 49 have a routine women age 40 to 49 have a routine screening mammogram screening mammogram

every every one to twoone to two years years

with the first one beginning at age 40with the first one beginning at age 40

BASELINE - for comparisonBASELINE - for comparison

88

Breast cancer – ACS Breast cancer – ACS

Yearly mammograms are recommended starting at age 40Yearly mammograms are recommended starting at age 40 and and continuing for as long as a woman is in good health. continuing for as long as a woman is in good health.

Clinical breast exam (CBE) should be part of a periodic health Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over. every year for women 40 and over.

Women should know how their breasts normally feel and report any Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s. exam (BSE) is an option for women starting in their 20s.

Women at high risk (greater than 20% lifetime risk) should get an Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is recommended for women whose lifetime risk of breast cancer is less than 15%. less than 15%.

99

EDUCATIONEDUCATION

BSE – breast self exam -BSE – breast self exam -MONTHLYMONTHLY

CBE –clinical breast exam – CBE –clinical breast exam – 3-6 months3-6 monthsMAMMOGRAM – ANUALLY * MAMMOGRAM – ANUALLY *

BEGIN AGE 35BEGIN AGE 35

1010 Best Time For BSEBest Time For BSE

The American Cancer Society urges women The American Cancer Society urges women to perform breast self-examination (BSE) to perform breast self-examination (BSE) once a monthonce a month

about a week after the menstrual periodabout a week after the menstrual period Post-menopausal women should choose a Post-menopausal women should choose a

set day, such as the first of the month, to set day, such as the first of the month, to practice self-examination.practice self-examination.

1111

Begin by looking at your breasts in the Begin by looking at your breasts in the mirror with your shoulders straight and mirror with your shoulders straight and your arms on your hips.your arms on your hips.

Here's what you should look for:Here's what you should look for: Breasts that are their usual size, Breasts that are their usual size,

shape, and color. shape, and color. Breasts that are evenly shaped without Breasts that are evenly shaped without

visible distortion or swelling. visible distortion or swelling. If you see any of the following If you see any of the following

changes, bring them to your doctor's changes, bring them to your doctor's attention:attention:

Dimpling, puckering, or bulging of the Dimpling, puckering, or bulging of the skin. skin.

A nipple that has changed position or A nipple that has changed position or become inverted (pushed inward become inverted (pushed inward instead of sticking out). instead of sticking out).

Redness, soreness, rash, or swelling. Redness, soreness, rash, or swelling.

1212

1313

1414

Some cancers are not found until they reach this size

                A mammogram can find

cancer when it is only this size    

1515

1616

Cancer statisticsCancer statistics

Breast cancer strikes about 180,000 Breast cancer strikes about 180,000 American women yearlyAmerican women yearly

and kills about 44,000and kills about 44,000Next to skin cancer, breast cancer is the Next to skin cancer, breast cancer is the

most frequently diagnosed cancer in most frequently diagnosed cancer in women in the United Stateswomen in the United States

It is second only to lung cancer in cancer-It is second only to lung cancer in cancer-related deathsrelated deaths

1717

RISK RISK "Lifetime risk is the likelihood that "Lifetime risk is the likelihood that

a newborn girl will develop breast a newborn girl will develop breast cancer sometime during her cancer sometime during her entire life. entire life.

The 1-in-9 statistic does not apply The 1-in-9 statistic does not apply to women of all agesto women of all ages

1818 RISK VS REALITYRISK VS REALITY chance of being diagnosed with breast cancerchance of being diagnosed with breast cancer

30-year-old woman has a 2% (1 in 50) in the 30-year-old woman has a 2% (1 in 50) in the next 20 yearsnext 20 years

a 40-year-old has a 4.5% (1 in 20) a 40-year-old has a 4.5% (1 in 20)

50-year-old woman's risk of developing invasive 50-year-old woman's risk of developing invasive breast cancer--the most serious kind--in the next breast cancer--the most serious kind--in the next 5 to 20 years 5 to 20 years

ranged anywhere from 1 in 15 to 1 in 133 ranged anywhere from 1 in 15 to 1 in 133 depending on her ethnicity.depending on her ethnicity.

1919 four major ethnic groupfour major ethnic group

Asian/Pacific IslandersAsian/Pacific Islanders

HispanicHispanic

African AmericanAfrican American

CaucasianCaucasian

2020 "For women currently aged 50"For women currently aged 50the estimated risk of developing invasive breast cancer within 5 yearsthe estimated risk of developing invasive breast cancer within 5 years

0.8% (1 in 133) among Hispanics 0.8% (1 in 133) among Hispanics 1.3% (1 in 75) among Caucasians1.3% (1 in 75) among Caucasians

Within the next 20 yearsWithin the next 20 years3.7% (1 in 27) among Hispanics3.7% (1 in 27) among Hispanics6.6% (1 in 15) among Caucasians6.6% (1 in 15) among Caucasians5% (1 in 20) among African Americans5% (1 in 20) among African Americans3.9% (1 in 26) among Asian/Pacific Islanders3.9% (1 in 26) among Asian/Pacific Islanders

2121 TYPES OF BREAST TISSUETYPES OF BREAST TISSUEcan you name them?can you name them?

2222

15 – 30 YO 15 – 30 YO NO CHILDREN OVER 30NO CHILDREN OVER 30 PREGNANT/LACTATINGPREGNANT/LACTATING UNDER 25 – UNDER 25 –

ULTRSOUND ULTRSOUND RECOMMENDEDRECOMMENDED

Why?Why? What does US show?What does US show?

FIBROGLADULAR (DENSE)FIBROGLADULAR (DENSE)

POSITION?

19-year-old woman who has never been pregnant. Note the dense glandular tissues with small amounts of fat

2323

FIBRO-FATTYFIBRO-FATTY

AVERAGE DENSITYAVERAGE DENSITY 50% FATTY 50 % 50% FATTY 50 %

GLANDULARGLANDULAR 30 – 50 YRS OLD30 – 50 YRS OLD YOUNG WOMEN W/ YOUNG WOMEN W/

3 PREGNANCIES3 PREGNANCIES

POSITION?

2424

FATTYFATTY

MINIMAL DENSITY = MINIMAL DENSITY = FATTYFATTY

OVER 50 YRS OLDOVER 50 YRS OLD POSTMENOPAUSAL POSTMENOPAUSAL

ATROPHIC ATROPHIC MALE BREASTMALE BREAST CHILD BREASTCHILD BREAST

POSITION?

68-year-old woman. 68-year-old woman. Most of the glandular tissue is atrophicMost of the glandular tissue is atrophic