Is Mammography equally sensitive to all Women?

Mammography is one of the widely used investigation modality of breast cancer. But is it equally sensitive to all the women. The answer is “No” due to several reasons. That is because the detection rate of a breast cancer depends on so many factors. Some of them are listed below.

·         The size, stage and grade of the tumor.

·         The age of the woman – As a women’s age increases the breast also gets changed. Reduction of the density of the breast tissue is one such change. This is good news for old women because the reduction of the density increases the sensitivity of mammography. However it is a bed news for younger women whose breasts are more denser than the old ones.

Occurrence of breast cancer in young age is very rare and therefore, the risks probably go down. For them ultrasound scan is very useful in investigating any breast apthology.

Diseases of the Nipple

1.      Absence of nipple with or without amazia (Congenital absence of breast)

2.      Supernumerary nipples

3.      Nipple Retraction

4.      Cracked Nipple

·         This usually occurs during lactation and if it occur the breast should be rested for at least 24-48 hours. It should b emptied and breast feeding should be resumed as soon as possible.

5.      Papilloma of nipple

6.      Retraction cysts of the gland of Montgomary

7.      Eczema

8.      Paget’s Disease

9.      Discharge from nipple

                                                              i.      Clear serous discharge –This is can be physiological, due to ductal papilloma or due to mammary dysplasia

                                                            ii.      Blood stained – due to duct ectasia, duct papilloma or carcinoma

                                                          iii.      Black/green – due to duct ectasia

                                                           iv.      Purulent – infection

Treatment – Microdochectomy or cone excision of the major ducts

ANATOMY OF THE BREAST
EXAMINATION OF THE BREAST
INVESTIGATION OF BREAST SYMPTOMS

Investigation of Breast Symptoms

1.      Mammography

a.      Sensitivity of mammography increases with age as the density of the breasts reduces with age.

b.      Digital mammography and tomo mammography are now available with more sensitivity.

2.      Ultrasound

a.      Used in young women with dense breasts

b.      Can be used to identify cysts from solid lesions

c.       Can also be used to impalpable areas of pathology

d.      Used to scan axillary tissues

e.      Useful in guided percutaneous biopsy

3.      MRI (Magnetic Resonant Imaging)

a.      Used to distinguish scar from recurrence

b.       Best modality to investigate women with implants

c.       Useful as screening tool for high risk women

4.      Needle biopsy/Cytology

a.      Biopsy is taken under local anaesthesia

b.      Histology – By taking a spring loaded core needle biopsy device – Core cut biopsy of the Breast

c.       Fine Needle Aspiration Cytology – 21G or 23G needle with 10 ml syringe, sample is taken by passing the needle several times through the lump with negative pressure. Then it is smeared on to slide and air dried or fixed.  

5.      Large needle biopsy with vacuum system

a.      8G or 11G needles are used

b.      Useful in the management of the micro calcification or complete excision of fibroadenomas

Triple Assessment of Breast Symptoms

1.      Clinical Assessment

a.      Age

b.      Examination

2.      Radiological Imaging

a.      Ultrasound Scan

b.      Mammography

3.      Cytology or Histology

a.      Fine Needle Aspiration Cytology

b.      Core cut

ANATOMY OF BREAST

EXAMINATION OF BREAST

Examination of the Breast

·         Inspection

o   Patient sitting

§  Assess – asymmetry

§  Visible masses

§  Distortion or skin tethering

§  Nipple discharge

§  Ulceration

§  Oedema and erythema of skin (Paeu d’orange)

·         Palpation

o   Patient lying in near supine position, or in semi recumbent position if the breast are large

§  Arms raised

§  Hand behind the head

o   Palpate the four quadrants including the axillary tail.

o   If a mass is detected examine it further with the thumb and the forefinger

§  Site

§  Size

§  Surface

§  Shape

§  Mobility

§  Consistency

§  Tenderness

§  Transilluminating or not

§   Enlargement of the lymph nodes

·         Examine axillary and cervical draining nodes

·         Examine abdominal organs for metastatic involvement 

 ANATOMY OF THE BREASTS