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Cervical and Breast Cancer
Screening
Sophia K. Apple MDDirector of Womens Health & Breast
PathologyUCLA Medical Center
USA
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Dr. George Nicolas Papanicolaou
1883-1962
In 1960, it was estimated by theAmerican Cancer Society that
atleast 6 million women in the UnitedStates alone had received the
Paptest. As a consequence of this
monumental discovery of the Papsmear, deaths in women fromcancer
of the cervix have beenreduced by at least 70 percent.
This test is a single most
successful discovery in medicalhistory. Sensitivity and
specificityoutnumbers any other tests inmedicine.
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Summary recommendations on who should getcervical screening
test
Should begin at age 21 Q2 yrs for 21-29 yrs Q1 yr for >30 yrs
for 3 consecutive yrs
women c HIV: 2x/yr for the 1st
yr, and Q1 women c h/x of HG CIN or cancer: Q1/yr for thenext 20
yrs
Age >65 with negative hx: discontinue
s/p hysterectomy s HG CIN: discontinue s/p hysterectomy c HG
CIN: continue even ppostmenopausal surveillance
www.asccp.org
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Conventional Pap
Liquid-Based Pap (SurePath or ThinPrep)Automated Image assisted
PapHPV testingHPV Vaccine: HPV 16 (54%) + HPV 18 (13%)
20 yrs
Liquid Based Pap smears
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Breast screening
American Cancer Society (ACS)
Yearly mammograms are recommended starting at age 40and
continuing for as long as a woman is in good health
Clinical breast exam (CBE) about every 3 years for womenin their
20s and 30s and every year for women 40 and over
The American Cancer Society recommends that somewomen - because
of their family history, a genetic tendency,or certain other
factors - be screened with MRI in addition tomammograms. (The
number of women who fall into this
category is small: less than 2% of all the women in the US.)
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Imaging modalities
Mammogram:CalcificationsMassArchitectural distortion
Ultrasound:CystMassArchitectural distortion
MRI:MassEnhancing lesionsArchitectural distortion
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Abnormality: CalcificationsMass Other
Comments:
Pathology Requisition
R L
(310 206-9611)
XX
Patient ID number: ______________
Requesting physician: ______________________ ID ____________
Referring physician: ______________________ ID ____________
43
Bassett
01868
Mary
201-68-22
Last Name_______________First04203
Smith
Jones Age
Imaging final assessment: 2 3 4A 4B 4C 5
Biopsy specimens contain calcifications
(Placed in bag in specimen container)
Most likely DCIS
Date _ 4/15/07___
Tea bag contains calcifications. All cals removed via
Mammatome bx
http://www.phototour.minneapolis.mn.us/cgi-bin/quote.cgi?image=4110http://www.phototour.minneapolis.mn.us/cgi-bin/quote.cgi?image=4110http://www.phototour.minneapolis.mn.us/cgi-bin/quote.cgi?image=4110http://www.phototour.minneapolis.mn.us/cgi-bin/quote.cgi?image=4110
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Screening Mammogram: abnormality
Do Core Needle biopsy for pathology diagnosis
No incisional bx necessary
Wire localization of abnormal area
Do lumpectomy for DCIS, T1 and T2 tumors
Do mastectomy for larger /multifocal/multicentric tumors
No frozen sections for diagnosis or margins
Plan for multidisciplinary conference
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Multidisciplinary breast conference group
Surgical oncologists
Pathologists
Oncologists
Radiologists
Radiology oncologists
Psychosocial group
Weekly conference to discuss all patients with DCIS or
Cancer.
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