Breast Disorders

Duration 11:24

aapko basic science video topic breast
00:02
disorders breast disease encompasses a
00:05
wide spectrum of disorders that range
00:07
from benign to malignant disease the
00:09
different ideologies of breast disease
00:11
fluctuate depending on a patient’s age
00:13
with benign disorders more common in
00:14
premenopausal women and malignancy more
00:17
common in older patients the objectives
00:19
of this video include understand normal
00:22
breast anatomy and histology identify
00:24
common benign breast disorders and
00:26
breast cancer and describe the mechanism
00:28
of action for hormonal therapies used in
00:30
breast cancer treatment to review the
00:32
clinical aspects and management of
00:34
breast disorders please see the aapko
00:36
educational topic number 40 on disorders
00:38
of the breast let’s meet our patient
00:40
she’s a 50 year old who presents to
00:42
clinic for routine GYN exam
00:44
she has no particular concerns but would
00:47
like a referral for screening mammogram
00:48
before you do her exam let’s review the
00:51
normal anatomy and histology of the
00:53
breasts breast tissue is composed of
00:55
both stromal and epithelial tissue the
00:57
stromal tissues comprise the majority of
00:59
breast volume and include adipose and
01:01
fibrous connective tissue the epithelial
01:03
tissue is a ductal system which
01:05
transports milk from the lobules to the
01:07
nipple each breast has about 12 to 20
01:10
lobes let’s zoom in each low of consists
01:13
of lobules which is drawn here
01:15
they consist of alveoli or SNI sac-like
01:18
structures where milk is synthesized and
01:20
secreted the lobules drain into a
01:23
terminal duct the lobules and the
01:25
terminal duct in which they drain is
01:26
known as the terminal duct lobular unit
01:28
or TDL you remember this term as it will
01:31
come up again later the ducts are
01:34
surrounded by myoepithelial cells to
01:36
allow for milk ejection let’s take a
01:38
look at normal histology in this image
01:41
you can see a TDL you with both lobules
01:43
and the duct in higher power with a
01:46
special scene myoepithelial cells are
01:49
brown and surround the inner ring of
01:50
ductal cells the terminal ducts then
01:53
drain into larger collecting ducts prior
01:55
to the nipple there is a dilation of the
01:57
duct known as electa for a sinus which
01:59
then opens to the nipple there are about
02:01
six days openings to the nipple let’s go
02:04
back to our patient her breast exam is
02:06
normal and no suspicious masses are
02:08
palpated you order a mammogram a couple
02:11
days later her is
02:13
come back there’s an abnormal area seen
02:15
on the mammogram and biopsy is
02:16
recommended she is nervous and would
02:19
like to know of its cancer you discuss
02:22
with her the possibility of benign
02:23
versus malignant disease let’s start by
02:25
reviewing benign breast disorders they
02:28
are classified histologically into three
02:30
categories non-proliferation
02:32
proliferative without a tibia in a
02:34
typical hyperplasia the risk of
02:36
developing breast cancer increases as we
02:38
move to the right non proliferative
02:40
disorders are generally not associated
02:42
with increased risk of breast cancer and
02:44
include breast cysts and fibrocystic
02:46
change breast cysts are most common in
02:48
women between the ages of 35 to 50 they
02:51
are fluid-filled and round or ovoid in
02:53
shape fibrocystic change is very common
02:56
in reproductive age women and can cause
02:57
cyclic pain in palpably nodular tissue
02:59
what does it look like under the
03:01
microscope on the left is a normal t dlu
03:04
and on the right is fibrocystic change
03:07
with fibrocystic change there is
03:09
dilation of sni and ducts with dense
03:11
stroma proliferative without atypia
03:15
disorders increase the risk of
03:16
developing breast cancer by 1.5 to 2
03:18
they include intraductal papillary
03:21
adenoma unusual ductal hyperplasia
03:24
intraductal papillary present with
03:27
Sarris or bloody nipple discharge they
03:29
are most commonly found less than 2
03:31
centimeters from the nipple if this is a
03:34
duct wall imagine a broccoli stalk
03:36
shaped growth inside the duct they are
03:39
the proliferation of epithelial cells
03:41
within the ducts appearing as fronds and
03:43
attached to the inner wall of the duct
03:45
with a central fiber vascular stalk
03:47
surgical excision is generally
03:49
recommended fibroadenomas are common
03:52
from age 15 to 35 and present as a
03:54
well-defined mobile mass they generally
03:57
do not increase the risk of cancer but
03:59
can slightly increased risk such as if
04:01
they have complex features
04:03
microscopically there’s a dense stromal
04:05
component with compressed ducts you can
04:08
see a sharp interface with normal breast
04:09
tissue which makes the mass well
04:11
circumscribed fibroadenomas can be
04:14
observed or be surgically excised usual
04:17
ductal hyperplasia and retained
04:19
psychological features of benign cells
04:21
no additional treatment is needed
04:23
microscopically there are increased
04:25
cells in parts of the duct the last
04:28
category and benign breast disorders is
04:30
atypical hyperplasia these disorders
04:32
increase the risk of subsequent breast
04:34
cancer with a relative risk of 3.7 to
04:36
5.3 and include atypical ductal
04:38
hyperplasia or ADH atypical lobular
04:41
hyperplasia or a LH and often includes
04:44
lobular carcinoma in situ or LCIS but
04:47
note that the relative risk of breast
04:49
cancer is different
04:50
LCIS is associated with a 7 to 10 times
04:53
increased relative risk of breast cancer
04:55
ADH is similar to low grade DCIS which
04:58
we will discuss later in this video but
05:01
is a less extensive lesion measuring
05:02
less than 0.2 centimeters is the
05:05
proliferation of low-grade neoplastic
05:07
ductal epithelial cells filling part but
05:10
not the entire involved duct surgical
05:13
excision is generally recommended as
05:14
rates of pathology can be upgraded to
05:16
more severe disease in 10 to 20 percent
05:18
of cases atypical lobular hyperplasia is
05:22
similar to LCIS but with less extensive
05:25
disease proliferation of low-grade
05:27
neoplastic cells feel less than 50% of
05:30
Vasa Knight in an involved lobule with
05:32
slight distension since the rate of
05:34
upgrade of pathology is low less than 5%
05:37
treatment can be observation let’s
05:40
compare a lh2 lobular carcinoma in situ
05:42
or LCIS as noted previously
05:45
LCIS is associated with a 7 to 10 times
05:48
increase relative risk of breast cancer
05:49
it has greater extent of disease than
05:52
alh with increased S&I distension in the
05:55
majority of cases nuclear grade is low
05:57
in this histopathology image you can see
06:00
LCAs compared to a benign TDL you
06:03
zooming in you can see intraductal
06:05
proliferation of cells that are fairly
06:07
homogeneous and are loosely arranged or
06:09
disco hee Civ LCIS is poorly understood
06:12
and is not clear how it directly leads
06:14
to breast cancer like alh treatment is
06:17
typically close observation rather than
06:19
surgery our patients biopsy comes back
06:22
as ductal carcinoma in situ or DCIS
06:25
sometimes referred to as stage zero
06:27
cancer this is typically diagnosed after
06:29
there are micro calcifications on
06:31
mammogram as seen in this image cancer
06:34
cells fill the ductal system without
06:35
beyond the basement membrane unlike in
06:38
LCIS the cells are cohesive in this
06:41
image cells are low nuclear grade in
06:43
cells are homogeneous this image
06:46
demonstrates a higher grade DCIS lesion
06:48
there’s variability in size of the cells
06:51
and prominent nucleoli comedo necrosis
06:54
is when there’s a necrotic core in the
06:55
center of a duct filled with cancer
06:57
cells high nuclear grading and presence
07:00
of comedone acrosses increases the
07:01
recurrence risk of DCIS or invasive
07:03
disease treatment is surgical excision
07:06
when found on core biopsy 10 to 20% of
07:09
patients will have an invasive cancer
07:10
and subsequent excision let’s discuss
07:13
invasive breast cancers prognosis and
07:15
treatment decisions are based on hormone
07:17
receptor status nuclear grade and her2
07:19
new expression her2 new is a type of
07:22
receptor tyrosine kinase that promotes
07:25
the growth of cancer cells and is
07:26
present and 25% of breast cancer
07:28
patients in addition two-thirds of cases
07:31
are estrogen receptor and progesterone
07:33
receptor positive a tumor that is er
07:36
positive has a better prognosis than er
07:38
negative her2 new cancers are generally
07:41
highly aggressive but respond to
07:42
targeted therapies and have good
07:44
prognosis breast cancer usually presents
07:46
as a breast mass or mammographic
07:48
abnormality spread is to regional lymph
07:51
nodes and can metastasize to the brain
07:53
bone liver lung and ovaries
07:54
let’s pause read and apply which lymph
07:58
nodes are most likely affected in breast
08:00
cancer the axillary lymph nodes are
08:03
likely affected in metastatic disease
08:05
for lymphatic drainage the majority of
08:08
the breast drains to the axillary Chane
08:09
drainage also occurs through the super
08:12
Kovach euler nodes and internal mammary
08:14
nodes invasive ductal carcinoma accounts
08:17
for 80% involved breast cancers and
08:19
neoplastic cells invade the basement
08:21
membrane there is usually a solitary
08:23
firm mass with poorly defined margins
08:25
histologically is an infiltrate of
08:28
growth invasive cells often form ducts
08:30
or clusters pictured here they are often
08:33
found with background DCIS which is
08:35
circled in red 75% are er positive
08:38
invasive lobular carcinoma counts for
08:41
15% of all breast cancers neoplasic
08:44
cells usually form chords or are
08:45
arranged in a single-file orientation
08:48
and higher power you can see the
08:50
single-file pattern greater than 90% re
08:52
r+ less command breast cancer types
08:55
included inflammatory breast cancer and
08:57
Paget disease of the nipple Paget
08:59
disease of the nipple presents as a
09:01
examiners patch on the nipple and is
09:03
usually associated with underlying DCIS
09:05
or invasive breast cancer there’s intra
09:07
epidermal proliferation of mammary type
09:09
carcinoma cells look at the difference
09:12
between the area of Pageant disease
09:14
compared to normal skin on higher power
09:17
these cells appear as large and pale
09:18
with a clear halo and appear differently
09:20
than normal keratinocytes treatment of
09:23
breast cancer often involves surgical
09:25
management with lumpectomy versus
09:26
mastectomy radiation to reduce local
09:29
recurrences and chemotherapy depending
09:31
on if there are high-risk
09:32
characteristics of the tumor adjuvant
09:34
hormonal therapy is typically
09:36
recommended in ER positive tumors her
09:39
biopsy demonstrated a low grade DCIS as
09:41
er positive she undergoes lumpectomy and
09:44
radiation therapy since the tumor was er
09:47
positive she also decides to proceed
09:48
with hormonal therapy to decrease risk
09:51
common hormonal therapies include
09:53
selective estrogen receptor modulators
09:54
and aromatisse inhibitors let’s pause
09:57
read and apply how disarms work they
10:01
bind to estrogen receptors and exert
10:03
tissue specific effects shown here is
10:06
the estrogen receptor with estrogen at
10:07
its binding site terms competitively
10:10
bind at the receptors interestingly they
10:13
have mixed agonist and antagonist
10:14
activity depending on the target tissue
10:16
for instance a common term is tamoxifen
10:19
it has an antagonist effect in breast
10:22
tissue making it protective against
10:24
invasive breast cancer but has agonist
10:26
effect on bone which makes it protective
10:28
against bone loss an agonist activity in
10:31
the endometrium this is why women and
10:33
tamoxifen are at higher risk for
10:34
development of endometrial polyps
10:36
hyperplasia in cancer aromatase
10:39
inhibitors are typically used in
10:40
postmenopausal women in postmenopausal
10:42
women most of the circulating estrogen
10:44
is from peripheral conversion of
10:46
androgen to estradiol by the enzyme
10:48
aroma taste aroma taste inhibitors
10:51
reduce circulating estradiol and
10:53
postmenopausal women which is protective
10:55
against breast cancer
10:56
but associated with greater rates of
10:57
bone loss and fractures
10:59
this concludes the aapko basic science
11:01
video on breast disorders we have
11:03
covered a lot including normal breast
11:05
anatomy and histology different types of
11:07
breast disorders and cancer and hormonal
11:09
therapy is used in breast cancer
11:11
[Music]
11:23
you


Duration 17:18

Breast Disorders

Breast Development

At puberty, the female breast develops, under the influence of estrogen, progesterone, growth hormone, prolactin, insulin and probably thyroid hormone, parathyroid hormone and cortisol. This complex process typically begins between ages 8 to 14 and spans about 4 years.

The breast contains mostly fat tissue, connective tissue, and glands that following pregnancy, will produce milk. The milk is collected in the ducts and transported to 15- 25 openings that exit through the nipple.

During the menstrual cycle, the breast is smallest on days 4-7, and then begins to enlarge, under the influence of estrogen and later progesterone and prolactin. Maximum breast size occurs just prior to the onset of menses.

The breast is not round, but has a “tail” of breast tissue extending up into the axilla (or armpit). This is clinically significant because abnormalities can arise there just as they can in other areas of the breast.

Breasts are never identical, comparing right to left. One is invariably a little larger, slightly different in shape, and located differently on the chest wall. The nipples are likewise never identical but show minor differences in size, location and orientation.

The breast is divided into quadrants to better describe and compare clinical findings. The upper outer quadrant is the area of greatest mass of breast tissue. It’s also the area in which about half of all breast cancers will develop.

Adolescent Breast Problems

During adolescence, several breast growth patterns can be troubling to the adolescent and her family. Among these are:

    • Unusually early breast development
    • Unusually delayed breast development
    • Unusually large breasts (Mammary hypertrophy)
    • Unusually small breasts
    • Asymmetrical breast growth
    • Breast lumps

Initial breast development occurs on average at age 9, with the appearance of a breast bud. The normal range for breast bud appearance is from ages 8 to 13. It is common for one bud to appear up to 6 months prior to the second bud appearing.

Breast growth is then progressive, with enlargement of the breast tissue, areala and papillae, and change in shape and contour. By age 18 breast development is usually complete.

Premature thelarche is breast development prior to the age of 8 in the absence of pubic hair development. We evaluate these children to rule out estrogen-producing ovarian tumors, ingestion of estrogen-containing compounds, and the rare, true precocious puberty.

Delayed thelarche reflects absence of any breast development by age 13.

Asymmetrical breast growth during adolescence is the rule rather than the exception. Reassure the patient that the asymmetry usually evens out by the time of full maturation. Even at maturity, breasts are rarely 100% symmetrical, so minor degrees of asymmetry are expected. Because the breasts are continuing to grow and change, we usually delay any surgical intervention for asymmetric breasts until after age 18.

Mammary hypertrophy can be a distressing symptom. Because growth and development continues for a long time, if we are contemplating surgical intervention, we generally delay this surgery until the breasts are fully mature.

Breast masses in adolescents are essentially 100% benign. Because of this, surgery (excisional biopsy or fine needle aspiration) is almost never warranted.

Further, the surgical disruption of architecture can be disfiguring as the breast continues to mature.

Supernumerary breasts

Supernumerary breasts are relatively common. They are found along the “milk line,” extending from the axilla to the groin.

Most of them are not noticed clinically until pregnancy occurs. Then, under the influence of the pregnancy hormones, the breasts enlarge in preparation for lactation. It is at this time that soft swellings along the milk line occur, representing supernumerary breasts. During lactation, the extra breasts may produce milk.

These are not dangerous and are generally ignored. If they prove to be a cosmetic problem, they can be removed surgically.

More common than supernumerary breasts are supernumerary nipples. Like extra breasts, these are located in the milk line and are not dangerous.

Unless they are large, they are usually not noticed until a pregnancy. At that time, like the normal nipples, they enlarge and darken.

Inverted Nipples

Usually nipples point outward. Sometimes, they invert. When they persistently point inwards, they are called inverted nipples. This can be unilateral or bilateral.

With stimulation and nipple erection, most inverted nipples will evert. Occasionally, they remain inverted despite all efforts to evert them.

Other than for cosmetics, nipple inversion is not usually a problem. For breast-feeding, most inverted nipples will evert. Even those that do not evert may still function normally enough to allow for satisfactory infant nursing.

Non-cyclic Breast Pain

Among the common causes of non-cyclic breast pain are trauma, infection, and chest wall pain underlying the breast tissue (muscle strain or overuse of the pectoralis major muscle). Breast cancer rarely causes breast pain in the early stages and is not usually suspected unless the symptoms persist. Hormonal causes include functional ovarian cysts and pregnancy.

Women complaining of non-cyclic breast pain should have a careful examination. Common areas of tenderness include the pectoralis muscle distribution over the anterior chest wall. In this case, the muscle itself will be sore and the breast, if palpated with two hands and not pressed against the tender muscle, will be non-tender. Pain or soreness in the pectoralis major muscle is frequently found among women who have recently engaged in strenuous physical activity, and it represents a muscle strain. Chest wall pain does not involve the nipple or areola, while cyclic breast tenderness usually does. Treatment is symptomatic, with rest, some stretching exercises, and non-steroidal anti-inflammatory medication such as ibuprofen or naproxen.

A second common area for chest wall pain is along the costal margin. Direct pressure on the costochondral cartilage, without compressing breast tissue, will duplicate the pain. Compressing the chest wall with your hands placed laterally to the breasts will also duplicate the pain. This costochondritis has similar etiologies to the pectoralis major muscle tenderness, and the treatment is the same. and if the pain persists, referral will likely be necessary.

Trauma can include vigorous coughing or vomiting. The resulting strong, sustained contractions of the intercostal muscles can lead to chest wall tenderness that may be perceived by the patient as breast pain.

Cyclic Breast Pain

During the days leading up to the menstrual flow, the breasts normally are somewhat engorged and may be somewhat tender. Following the onset of menstrual flow, these changes spontaneously resolve. If the tenderness is more than mild or is clinically bothersome, it is called cyclic breast pain or mastodynia.

If examined during this time, these women also often have significantly enhanced nodularity of the breast tissue. The combination of cyclic breast pain and symmetrically thickened nodularity of the breast tissue is often called fibrocystic disease (misnamed because it’s not really a disease) or fibrocystic breast changes.

While not dangerous, women with cyclic mastodynia find it annoying and in its most severe form, interferes with some normal activities.

Some women find that by reducing or eliminating their intake of caffeine (coffee, tea, cola drinks) and taking Vitamin E supplements (400 IU daily) has seemed to improve their symptoms. Whether such improvement is pharmacologic or placebo in nature is still under debate.

Any pharmacologic approach that suppresses ovulation will be very helpful in treating cyclic mastodynia. Among these, birth control pills are the simplest. Taking BCPs in the usual fashion generally improves the pain significantly. For those who still experience significant pain, continuous birth control pills will usually suppress the pain completely.

Also effective, by virtue of ovulation inhibition, are depot medroxyprogesterone acetate, Lupron, or Danocrine, the latter two usually justified only in severe cases due to their significant side effects.

Nipple Discharge

Normally, if the ducts are stripped toward the nipple, a drop or two of clear, milky, or greenish-tinged liquid will appear. This is not considered nipple discharge.This image demonstrates milk from a lactating woman. This is also considered normal.

If the nipples spontaneously leak discharge, staining the clothing, that is not normal, nor is it normal to have bloody nipple secretions.

Nipple discharge from both breasts indicates “galactorrhea.” While a few post partum women will continue to leak small amounts of milk for years following delivery, galactorrhea in general indicates the need for a serum prolactin measurement and possibly an MRI of the pituitary gland to look for prolactin- secreting pituitary adenomas. Hypothyroidism can also cause this problem, although it is rare.

Athletes may experience small amounts of galactorrhea from constant rubbing of the nipples against clothing.

Frequent sexual stimulation of the breasts may have similar effects. The serum prolactin measurement is best made after a few days of non-stimulation of the breast. Even after a breast exam, it is often helpful to wait 2 days before measuring the serum prolactin.

Persistent discharge from a single duct, particularly if bloody, rust-colored or multicolored, suggests the presence of an intraductal lesion, such as an intraductal papilloma. While these are often benign, they need further exploration with a general or breast surgeon.

Paget’s Disease

This crusty, flaking lesion is associated with an underlying breast malignancy, invasive or in-situ. The appearance may be suggestive of Paget’s disease, but the diagnosis is generally confirmed by nipple biopsy.

The onset of the lesion is often so gradual that by the time it comes to the attention of the physician, many months or years have passed since its’ onset.

Treatment depends on the character and extent of the underlying lesion.

Breast Lump

If a dominant mass is found in the breast which persists through the menstrual cycle, it is usually biopsied, either through fine needle aspiration or excisional biopsy, depending on the clinical circumstances.

Suspicious masses (large, irregular, hard, fixed in place, with redness and dimpling of the overlying skin and nipple retraction) are usually biopsied right away.

Most masses are benign, but for those found to be malignant, earlier intervention is thought by many to lead to improved chances of successful treatment.

Breast Cyst

Breast cysts present as smooth, non-tender masses. They will often disappear over the course of the menstrual cycle, but those that persist will need further evaluation.

Cyst aspiration is frequently attempted, using a small needle and syringe.

Aspiration of the cyst fluid is performed primarily to confirm the fact of the cyst and to decompress it.

Many physicians discard the cyst fluid unless it is bloody as cyst fluid cytologic examination is felt to be of little value.

Following decompression of the cyst, the patient returns for periodic follow-up to look for recurrence. Recurrent cysts in the same location are often subjected to excisional biopsy or fine needle aspiration biopsy.

Fat Necrosis

Fat necrosis presents as a breast mass with surrounding ecchymosis (bruise). It may be tender and a history of breast trauma is identified in half the cases. Even when significant trauma is not identified, it is felt to be the general cause of this condition.

This benign condition is self-resolving, but is of clinical importance because it mimics the dominant mass found in breast cancer.

Those cases with the typical presentation can be followed to make sure they completely resolve. Those cases that are not typical or if there is any doubt, can have a fine needle aspiration to confirm the diagnosis.

Fibroadenoma

These common, benign, solid, round or oval breast tumors are most common among women ages 15-35. They are rubbery in consistency, mobile and non-tender. They rarely grow larger than 2-3 cm.

The diagnosis is usually suspected on physical exam and confirmed with fine needle aspiration or excisional biopsy. When found in teenagers, they are often simply watched because of the very low risk of malignancy compared to the architectural disturbance caused by excisional biopsy.

Breast Cancer

Breast cancer is a relatively common cancer, representing about 30% of all cancers in women. In broad terms, treatment is successful in about 3 out of 4 patients in controlling or eliminating the cancer. In about one out of four, the cancer proves fatal.

The risk of developing breast cancer increases steadily with increasing age. It is rare among women under age 25 but affects nearly one in nine of those women reaching age 90.

Breast Cancer Detection Strategies

A number of factors are associated with an increased of developing breast cancer, including:

    • Strong family history of breast cancer
    • Menopause after age 55
    • No term pregnancy prior to age 35

Despite the increased risk, most (about 80%) of breast cancer occurs in women not at increased risk for developing breast cancer. For that reason, efforts at early detection are not focused just on those with somewhat increased risks, but on all women. The primary strategy involves a three-armed effort: Periodic (annual) professional breast examination, monthly self- breast examination, and mammography at appropriate intervals.

The underlying assumption of all breast screening programs is that if we can detect a breast malignancy when it is very small, then the outcome will be better for the patient than if we discover the problem when it is bigger. Just how true that assumption is and the exact parameters of that truth are still under debate, as is the effectiveness of any of the breast cancer screening programs in improving outcome for women with breast cancer.

Breast Examination

Once a year, a woman’s breasts should be evaluated by a qualified health professional. Any significant abnormalities in texture, contour, skin, any palpable masses, retractions, dimpling or nipple discharge will require followup appropriate for the abnormality.

Professional breast exams are felt to be about 80% reliable in detecting significant breast abnormalities.

Self Breast Examination

Once a month, a woman should examine her own breasts, looking for changes in appearance, texture, or nipple discharge that was not previously present.

Examination technique is not obvious, but is a skill to be learned (and taught). Any new findings should be promptly reported to the woman’s physician or other qualified healthcare provider. Most breast cancers are first noted by the patient herself.

Some critics of self breast exams have observed that they may cause more problems than they solve. By the time a breast cancer is large enough for the woman to feel herself, it is not likely to be “early.” Further, most of the self-discovered breast lumps are benign and do not represent a threat. Nonetheless, they are often subjected to investigation, including biopsy and excision.

Mammography

The goal of mammography to to detect very early cancers or pre-cancerous changes before they have a chance to develop into a more advanced and dangerous stage. Mammography is felt to be about 80% effective in detecting significant breast abnormalities, but many of the ones that are missed by mammography can be detected by examination.

There is controversy over how frequently mammograms should be performed. If there is a clinical abnormality, mammograms can be used to gain additional information about the abnormality (a “diagnostic” mammogram). Many physicians recommend that “screening:” mammograms be performed every other year between ages 40 and 50, and annually thereafter. Some physicians dispute the usefulness of mammograms prior to age 50. Some physicians recommend mammograms more often if there is a strong family history of breast cancer. Some physicians dispute the value of screening mammograms after age 75 or 80. Some physicians dispute the value of screening mammograms at any time.

Breast Ultrasound

Breast ultrasound is used in some countries (although not commonly in the United States) to screen for breast cancer. It has the advantage that it is relatively inexpensive, quick, painless, and uses no radiation. It is particularly good at detecting cystic masses (better than mammograms). In skilled hands, it does a fair job of detecting malignancies.

Unfortunately, it is not as good at detecting malignancies as mammograms and so it is not usually used for primary screening in the U.S. It is commonly used in the U.S., however, as an adjunctive method to evaluate abnormalities palpated by the examiner or identified on mammograms.

Thermography

Thermography is a means of looking at the breast with an infrared (heat-sensitive) imaging device. It relies on the principle that cancers have increased metabolic activity, generating more heat, that can be detected with a thermographic process. While this has some theoretical advantages over other imaging techniques, in practice, thermography has not been demonstrated to be effective in early detection of significant lesions, and so is not generally used as a primary screening technique.

MRI

Magnetic Resonance Imaging is sometimes used in the diagnosis and management of breast cancer.

    • It changes the surgical management in as many as 1 in 4 patients if performed pre-operatively.
    • In high risk patients (those with a lifetime risk of greater than 20%), it seems to have greater sensitivity at detection of malignancies not found on routine mammograms, breast ultrasound, or professional breast

Unfortunately, MRI’s are significantly more expensive than other methods of detection, limiting their use for screening in the general population.

Dr. Hughey


 

Introductory Women's HealthCare