Breast Awareness
Breast lumps are very common and most women will experience one or more at some time in their lives. The vast majority (at least nine out of ten) are benign i.e. not cancerous.
Early Detection
Early detection of breast cancer is vital as it increases the chance of successful treatment. Women are therefore encouraged to be ‘breast aware’. This means knowing how your breasts look and feel and the normal changes that occur at different times of your menstrual cycle. Visit your doctor if you feel a lump, or if one of your breasts changes shape or becomes constantly painful. There is no need to examine yourself to a strict routine, but it is sensible to look at and feel your breasts from time to time. It would probably be sensible to do this while taking a shower or bathing or when standing in front of a mirror.
What to look for
Even though most lumps are not cancerous, if you find a lump in your breast or notice any of the following changes you should arrange to see your GP as soon as possible.
- Change in size of your breasts (after puberty is complete)
- Dimpling or in-drawing of the skin (skin looks like texture of orange peel)
- Lumpiness or thickening
- Newly inverted nipple
- Bloodstained discharge from nipple
- A rash, often eczema-like, on the nipple or surrounding area
- Swelling or lump in the armpit
The next step
Once you have been examined by your GP he or she will arrange for you to have any tests that may be necessary.
Breast Screening
Breast screening can show up abnormalities at an early stage when they are too small for you or your doctor to feel. A mammogram only takes a few minutes and involves only a small dose of radiation – much less than an X-ray for a broken bone. The health risk is therefore very small.
Breast screening for women under 50 is currently under investigation in the UK to determine how effective it is in reducing deaths from breast cancer, however screening is available privately for women over 35. Those who are over 70 (or over 65 in an area where the screening is not extended to 70) will not be invited for NHS screening. However, if a request is made for an appointment, this will continue to be provided free, on the NHS every three years.
IMAGING TESTS
MAMMOGRAPHY
A mammogram is a low dose x-ray technique which has been developed specifically for breast examination. It is one of the ways of detecting breast cancer at an early stage before there are any signs or symptoms of disease.
Not all breast cancers can be detected by mammography and/or ultrasound.
Preparation
If you experience significant breast discomfort at a specific time during your menstrual cycle, it may be best to schedule your mammogram to avoid this time.
Procedure
You will be asked to stand in front of the x-ray machine. To obtain clear pictures it is essential to compress the breast as flat as possible (some patients find this causes a little discomfort). Initially four views will be taken. It may be necessary to undertake further views to completely assess the whole breast or to clarify appearances on the initial views.
How long will the procedure take?
You should allow approximately 30 minutes for the procedure.
You may be required to have an ultrasound after the mammogram. This is quite routine and assists with your mammogram diagnosis.
The Consultant Radiologist will examine the films and send a report to your GP or Consultant.
The films
All mammogram x-ray films should be kept so that they may be compared with each new examination. It is often a minor change in the appearance that leads to correct and early diagnosis.
If you have any previous mammograms please bring these with you on the day of examination.
ULTRASOUND
Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images from inside the human body through the use of high-frequency sound waves. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging. Ultrasound is a useful way of examining the breasts and of guiding the needle used during tissue biopsies. The ultrasound image is viewed on a screen by the consultant radiologist who will capture images during the examination.
How is the procedure performed?
You will be asked to lay on an examination couch. A clear gel is applied to the area to be examined to help the transducer (a hand-held device that sends and receives ultrasound signals) make secure contact with the skin. The sound waves produced by the transducer cannot penetrate air so the gel helps eliminate air pockets between the transducer and the skin. The consultant radiologist presses the transducer firmly against the skin and sweeps it back and forth to image the area of interest.
When the examination is complete the patient may be asked to dress and wait while the ultrasound images are reviewed either on film or on a TV monitor. In general, for patients under 35 years of age, ultrasound scanning will be the initial test performed.
MRI (Magnetic Resonance Imaging)
MRI uses a very powerful magnet and radio-frequency pulses to collect signals that are then processed by a computer to form a picture of the body part being studied.
MRI gives detailed pictures of the soft tissues of the body.
MRI can also be used for patients with silicone implants and where leakage is suspected.
Who cannot have an MRI scan?
Patients with a pacemaker or other cardiac devices, clips in the brain, cochlear implants or possible metallic fragments in their eye and patients with hip replacements and metal rods should report this at the time of their safety questionnaire to the radiographer.
Safety
MRI uses no x-ray radiation. The radiowave pulses are of similar frequency to your radio. The powerful magnet does not have any known side effects.
Is it painful?
MRI is painless but is noisy. Scans usually take 30 to 40 minutes and you may become a little uncomfortable lying still for that period. Music can be played to help you relax during the procedure.
Procedure
On arrival, you will be asked to complete a safety questionnaire to ensure that you are eligible to be scanned. You will be asked to change into a hospital gown to avoid any metallic objects being inadvertently taken into the scanner. The locker where you will change is secure and your belongings may be left there during your scan.
The scanning process
You will be asked to lie on a movable table on your front. Your breasts will be positioned in the centre of the tunnel. During the examination you will hear a series of loud knocking noises but you will be provided with headphones to listen to music or if preferred earplugs. Constant communication, both verbal and visual, is maintained throughout the scan to ensure that you are comfortable. It is important to remain as still as possible during the scan otherwise the images taken will appear blurred.
There is a possibility you will be given an injection of contrast agent halfway through the procedure to assist in visualisation.
The results
MRI investigations contain specialised and complex information and a large number of images are produced. The review of these images may take several hours, but in almost all cases the report will be with the referring doctor within 48 hours.
NEEDLE ASPIRATION (FNA)
A fine needle and syringe is used to take a sample of cells from any suspicious area in the breast and this sample is sent to the laboratory for testing.
CORE BIOPSY OF THE BREAST
This procedure involves taking a core biopsy of an area of the breast, and is carried out under local anaesthetic. It may be performed using ultrasound or mammographic guidance. The Consultant Radiologist will insert a needle to take a sample of cells, which are then sent to our pathology laboratory. The report will then be sent on to the referring doctor.
Procedure
It is essential that your previous mammogram and ultrasound films be available at the time of the biopsy. In this procedure you will be lying on your back. A small ultrasound probe will be placed on the breast to find the particular area of interest. A local anaesthetic will be given and a small cut is made in the skin enabling a biopsy to be performed with a needle and a tissue sample to be removed. The tissue will be sent to the laboratory for examination. The procedure will take approximately 20 minutes.
EXCISION BIOPSY
This is a surgical procedure involving the lump being removed under general anaesthetic in our operating theatres and sent to the laboratory for examination.
REMEMBER – While breast x-rays detect most breast cancers, they do not find all of them. It is important that you examine your own breasts every month and have regular breast checks with your doctor.
