Frequently Asked Questions (FAQs)

Extensive research has shown that early detection with routine/annual mammograms will improve survival rate of 5 years by 100%.

Annual mammograms

• Aid in the early detection of cancers

• Can detect cancers less than 2 mm in size- which respond well to treatment.

• Have conclusively shown that annual screening mammography, over the age of 40 yrs., significantly increases survival and decreases morbidity from breast cancer.

It is important to remember that body cells are changing throughout one's life.

As a result, routine mammograms should be a MUST, for your own wellbeing.

Routine screening mammography, for the general female public, should commence at 40 years of age (except where there is a significant family history) and be performed annually thereafter.

However, where there is a family history of a first-degree maternal relative having been previously diagnosed with breast cancer, the screening should commence 5 years prior to the age of diagnosis of the relative but not commence earlier than 25 yrs. of age and older than 40 yrs. of age.

Breast cancer can occur in any age especially these days when people are more health conscious and live longer. Early detection is most vital at any age as treatment is effective no matter what your age is.

It has been substantially proven that an annual mammogram saves lives as cancers grow quickly. This is usually a financial decision by medical aids, and not a medical one.

It has been substantially proven that an annual mammogram saves lives as cancers grow quickly. This is usually a financial decision by medical aids, and not a medical one.

2D mammograms are the regular standard procedures. Simply put it means that the breast image is obtained from top to bottom or from side to side.

However, there have been advances in breast imaging and early detection of breast cancer has been improved by 40% by Tomosynthesis or 3D Digital Breast Imaging (DGB) This is fast becoming the gold standard for imaging breast tissue.

For women with dense tissue breast, this form of imaging has undoubtably improved the peace of mind for both the Radiologist and patient.

Tomosynthesis or 3D technology is performed on the standard mammogram machine, allowing for a layered or sliced breast tissue acquisition of images.

The Radiologist is then able to view these layers one by one. Not only does this improve the overall result, but also allows for overlaying tissue folds to be fully visualised.

The advantages of Tomosynthesis include:

• The technology is more sensitive with detection of breast cancer.

• Fewer recalls for patients especially regarding further biopsies.

• Potential less compressing or 'squashing' of the breast thereby reducing the discomfort associated with having a mammogram.

3D mammograms have proved to be a highly effective technique in diagnosing breast cancer.

Multiple images are captured in one exposure – whilst the machine gently glides over the breast enhancing the overall in-depth viewing of the breast. This form of imaging assists in pinpointing small underlying abnormalities.

Dense breasts are far easier to image using 3D and research has shown that women with dense breast- are at a higher risk for breast cancer.  Dense breasts appear white on the mammogram- and often cancers or microcalcifications are not seen on a standard 2D mammogram due the “whiteness” of the dense breast.

If you have breast implants, it remains vitally important to have your annual mammogram. However, do tell the mammographer before your mammogram about your implants, as further views may be needed to see as much of the breast tissue behind the implants as possible.

Improved imaging is obtained with additional views, where the implant is pushed back against the chest wall and the breast is pulled forward over it and then compressed.

Very rarely an implant can rupture during a mammogram.

If you are pregnant and under 35, then it will be suggested that you have an Ultrasound rather than a mammogram.

With the advent of ergonomic improvements in mammography units and improved imaging techniques, this factor is far less of a problem now than before.

Everyone experiences mammograms differently. Some women may feel pain during the procedure, and others may not feel anything at all.

Most women feel some discomfort during the actual X-ray process. The pressure against your breasts from the testing equipment can cause pain or discomfort but it will never be beyond what you are capable of dealing with.

• Do not apply deodorant, perfume, powder before your mammogram.

• Make sure you can undress easily and redress after procedure.

• Bring all previous mammograms with you for comparison.

• Women should pay attention to their monthly cycle when booking mammograms, as certain times of the month will be uncomfortable when compressing the breast tissue.

Radiation induced cancer:  although it is true that excessive radiation may induce a cancer the risk of the latter is far outweighed by the benefit of early detection of breast cancer. This is borne out by scientific research. In addition, state-of-the-art mammography units deliver far less radiation dose than those of previous eras.

There is a constant search for more acceptable methods of breast imaging with greater sensitivity & no or less radiation risk. A number of modalities are available, including thermography, electrical impedance, optical imaging, nuclear imaging, positron emission tomography.  NONE OF THESE LISTED HAVE BEEN SHOWN TO COME ANYWHERE CLOSE TO MAMMOGRAPHY IN DIAGNOSTIC ABILITY. A negative result in these less sensitive methods may lull the patient into a false sense of security.

The risk of a women developing breast cancer in her lifetime is sufficiently significant to warrant a greater awareness and to encourage the appropriate surveillance.

At well women we do a routine mammogram with tomosynthesis and ultrasound.

In women with dense breasts, adding either tomosynthesis (a form of 3-D mammography) or ultrasound scans to standard mammograms may assist in detecting breast cancers that may have been missed in a standard 2D mammogram.

This term is used in daily mammogram reports. It means Breast Imaging Reporting and Database System score.

This system sorts the results into categories which are numbered 0-6:

0 - Incomplete - additional imaging evaluation is needed- or comparison imaging.

1 - Negative - no abnormal imaging noted.

2 - Benign (non-cancerous finding) – no sign of cancer.

3 - Possibly benign however should require follow up within 6 months.

4 - Suspicious Abnormality – Findings do not look like cancer but may be. A biopsy may be necessary for further definition.

5 - Highly Suggestive of malignancy – 95% of cancer – and biopsy very strongly recommended.

6 - Known Biopsy – proven malignancy- these mammograms are necessary to see how well cancer is responding to treatment.

Our cells sometimes grow old and become damaged. These are called malignant cells. When these malignant cells multiply repeatedly, a cancerous lump or tumour may form.

These cells may spread to the rest of the body if left untreated.

Although breast cancer mainly occurs in women, men can sometimes get breast cancer. This is rare though.

Although more women today are being diagnosed with breast cancer than in recent years, more women are surviving breast cancer than ever before as well.

Men can also get breast cancer although it is fairly rare.  Breast cancer mostly occurs in women.

Recent studies show.

• 1 in 8 women will be diagnosed with breast cancer.

• 3/4 of women with breast cancer will survive more than 10 years.

• 2/3 of women with breast cancer will survive more than 20 years.

• Puckering of the skin of the breast.

• A lump in the breast or armpit.

• A change in the skin around the nipple.

• Nipple discharge.

• Dimpling of the nipple or nipple retraction.

• An unusual increase in the size of the breast.

• One breast being unusually lower than the other.

• An enlargement of the gland.

• Nipples being at different levels.

• Pain in any area of the beast.

It is important to get to know your body as then you know what your breasts feel like when they are healthy and in their normal state which makes will be easier to notice abnormalities if they occur.  Therefore, monthly Breast self -examinations should routinely be practiced. A good time is when you are in the shower or lying on a bed. Many cancers have been detected this way and early treatment plans created and therefore saved lives.

Here's how to perform a breast self-examination

What genetic factors that may lead to Breast Cancer?

Generally, your genes can only increase your risk of getting breast cancer by 5-10%, although there are a few exceptions. Certain genes, particularly the BRAC1 and BRAC2 genes, drastically increase your risk of cancer. Studies show that a woman with the BRAC1 gene is 72% more likely to get breast cancer before the age of 80, and the BRAC2 gene increases the likelihood of developing cancer before the age of 80 by 69%.

The known risk factors for breast cancer are:

It is unknown what exactly causes breast cancer but, certain risk factors can increase your chances of developing it.

• Being older than 40

• Having a close family member who has been diagnosed with breast cancer.

• Having a personal history of cancer and its treatment.

•If you have never had a baby or your first pregnancy was over 35.

• If you have used contraceptive pills for a long time.

• If you are post-menopausal and are on HRT (Hormone Replacement Therapy).

• If you drink more than 2 alcoholic drinks per day.

NOTE: Having one or more risk factors does not mean you will get breast cancer. Also, having no risk factors does not mean you will not develop breast cancer.

Breast cancer is likely to be caused by a combination of different risk factors, rather than just one.

What are the different types of breast cancer?

There are invasive and non-invasive types of breast cancer. Breast cancer is invasive when the cancer cells have spread outside the milk ducts or lobules and into the surrounding breast tissue, therefore 2 main types being ductal and lobular cancers

Non-invasive breast cancer is called Ductal Carcinoma in Situ (DCIS) and is the earliest possible form of breast cancer, usually found during routine breast screening.

1. Ductal Carcinoma in Situ (DCIS)

This cancer occurs in the ducts of the breast and has not spread to the rest of the body or invaded deeper into the breast. This has a high chance of being cured if detected early.

2. Lobular Carcinoma in Situ (LCIS)

Although this is called a carcinoma, it occurs in the milk producing lobule cells and does not invade or spread as a true cancer does. However, women with LCIS have an increased likelihood of developing invasive breast cancer in the future.

3. Invasive Ductal Carcinoma

This is a carcinoma that begins in the duct cells but then invades deeper into the breast, with the possibility of spreading to the rest of the body (metastasizing). This is the most common type of cancer.

4. Invasive Lobular Carcinoma

This is a breast cancer that develops in the milk producing lobule cells and which also invades deeper into the breast. It has the potential to spread to the rest of the body. This is an uncommon type of breast cancer.

5 Paget’s Disease of the Breast

Paget’s Disease of the Nipple, also known as Paget’s Disease of the Breast, is a rare condition associated with breast cancer. It usually causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola). This is usually indicative of a breast cancer in the tissue behind the nipple.

6. Phyllodes Tumour

A phyllodes tumour forms in the breast and tends to grow quickly. Around 1 in 4 of these tumours are cancerous.

7. Angiosarcoma

Angiosarcoma is a rare cancer that develops in the inner lining of blood vessels and lymph vessels. This cancer can occur anywhere in the body is most often found in the skin, breast, liver and spleen.

Breast cancer mainly occurs in women who are post-menopausal but, is also prevalent in women who are at high risk and have the genetic disposition for breast cancer where a mother has had breast cancer.  Although very rare, some men can get breast cancer.

Surgery is the most common treatment for breast cancer. This involves removing the tumour and nearby nodes and margins. The surgical options may include a lumpectomy, partial mastectomy, radical mastectomy and reconstruction.

Radiation therapy. This is usually done after a lumpectomy are when lymph nodes are involved.

Chemotherapy. This can be done before or after surgery.

Endocrine therapy

Hormone therapy

Ideally a team of specialists will be involved with breast cancer treatment starting with the Radiologists who diagnose the breast cancer through various forms of imaging.

The Pathologist will confirm the cancer via laboratory testing from a biopsy sample and a breast surgeon will discuss treatment options with you relating to surgery. This discussion will include the options of a lumpectomy, mastectomy and reconstructive surgery -depending on the type and stage of the breast cancer.

Normally this is followed by chemotherapy and radiation therapy.

Treatment options will vary from patient to patient and treatment plans are adapted to best treat a particular type and stage of a cancer.

Not all cases of breast cancer can be prevented, but there are several lifestyles changes you can make that may decrease your likelihood of getting breast cancer.

• Limit alcohol intake

• Maintain a healthy weight – Weight can often be maintained through a healthy diet and exercise.

• Exercise – Studies show that exercise helps reduce the risk of breast cancer, possibly because it helps to maintain a healthy weight and possibly because it affects hormone levels in the body.

• Have more children.

• Breastfeed for longer.

• Take hormone supplements carefully – If you are concerned about your breast cancer risk, let you doctor know before using hormone replacement therapies.

In short NO

There is a constant search for more acceptable methods of breast imaging with greater sensitivity & no or less radiation risk. A number of modalities are available, including thermography, electrical impedance, optical imaging, nuclear imaging, positron emission tomography.  NONE OF THESE LISTED HAVE BEEN SHOWN TO COME ANYWHERE CLOSE TO MAMMOGRAPHY IN DIAGNOSTIC ABILITY. A negative result in these less sensitive methods may lull the patient into a false sense of security.

Breast Ultrasound and 3D Tomosynthesis are routinely done with every mammogram at Well Women Bone and Breast care centre.

With an ultrasound, high-frequency sound waves are used to produce an image of the breast. This process does not utilise radiation and is painless.  Ultrasound is performed by placing a probe on the breast and systematically moving the probe to view the entire breast.

Ultrasound of the breasts may not be as sensitive as tomosynthesis, or 3D imaging and is therefore used as a complementary form of imaging - to attain additional details.

Nevertheless, ultrasound of the breast is still most useful, as in the case of a pregnant women who may feel a mass or have a nipple discharge. An ultrasound would be the chosen mode of imaging, as there is no radiation involved in the procedure.

For women under the age of 35- where breast tissue is very dense – ultrasound remains the gold standard of breast imaging. Detailed imaging of the axillary nodes is clearly defined with ultrasound as are most breast cancers – as they consist of different tissue to normal breast tissue.

At Well Women, an ultrasound of the breast is routine, with every mammogram to ensure an exact diagnosis.

Ultrasound of the breast may be used after an abnormal mammogram or in women with dense breast tissue. It is not usually used in routine breast cancer screening for women at average risk.

A mammogram produces ultra- high-resolution images of the entire breast which is not found on an ultrasound. This is a scan used in conjunction with a mammogram for best diagnosis.

Women aged younger than 35 would be a good example for having an ultrasound but routine screening on women over 40 must include a mammogram for proper diagnosis.

Pregnant women also would have only an ultrasound due to the radiation safety of this form of imaging.

MRI of the breast uses a powerful magnetic field, radio waves and a computer to produce detailed images of the structures within the breast. It may be used to screen women who are higher at risk of breast cancer, to evaluate the extent of a present cancer and to evaluate abnormalities seen on the mammogram. It does not use radiation and is therefore safe.

For accurate diagnosis of breast cancers, breast MRI is the procedure of choice. It is recommended that women who are at high risk for breast cancer should have an annual mammogram and MRI of the breast. In breast cancer patients, MRI is used to assess the extent of the breast cancer and aids in complex mammogram and Ultrasound images for a final diagnosis of a cancer.

In newly breast cancer diagnosis, an MRI will assist with the determination of extent which assists the surgeon with limited surgical excision.

A breast biopsy is usually performed after a suspicious breast lesion is seen on either a mammogram or ultrasound images.

A breast biopsy will obtain breast cells which are sent to a pathology laboratory for a histological (cell) diagnosis.

The biopsy is performed under local anesthetic and a biopsy needle is inserted into the breast and several tissue cells samples are taken.

This is then sent to the laboratory for testing. Core biopsies are the most accurate way to evaluate whether a suspicious lump or portion of breast is cancerous. A breast biopsy can help determine if a lump in your breast is cancerous or benign, (non-cancerous)

However, it is important to remember that breast lumps are not always cancerous. There are several conditions that can cause lumps or growths in the breast.

When a lump is felt in the breast or a mammogram and / or ultrasound reveals an abnormality or suspicious findings, a breast biopsy will be strongly advised to investigate the lump or abnormality. This is the only definitive way to diagnose a breast cancer.

Types of breast biopsy include:

• Fine-needle aspiration biopsy. This is the simplest type of breast biopsy and may be used to evaluate a lump that can be felt during a clinical breast exam.

• Core needle biopsy - the most accurate for cell tissue sampling

• Stereotactic biopsy.

• Ultrasound-guided core needle biopsy

• MRI-guided core needle biopsy.