Breast Cancer Assessment and Diagnosis

Triple Assessment is one of the ways in assessing breast cancer which consists of clinical assessment, imaging, and pathology. (9)
*Tests depend on the specific clinical situation

There are a few treatment options available for breast cancer patients (10):

1) Surgery

Some breast cancer patients might require surgery to remove a portion of their breast that has cancer cells (called lumpectomy) or to remove their whole breast (mastectomy).
The types of surgery required will depend on the size of the tumour, the risk of recurrence and other factors.

2) Radiotherapy

Radiotherapy utilizes high-energy radiation from x-rays to kill cancer cells.

3) Chemotherapy

Chemotherapy uses drugs to destroy cancer cells.
Chemotherapy drugs kill fast growing cells. This includes cancer cells and normal cells.

4)Hormonal Therapy

Hormonal therapy targets tumours that are tested positive for either oestrogen or progesterone receptors (ER +ve, PR +ve).

5) HER2-Targeted Therapy

HER2-Targeted Therapy is drug therapy that specifically treats HER2+ breast cancer.

CLINICAL EXAMINATION (11)

BREAST SELF-EXAMINATION

Step 1: Look

Stand in front of a mirror and check your breast shape, skin, nipples and vein pattern.

Look at 3 different positions.

1. Arms by your side.
2. Arms raised above your head bending forward.
3. Place hands on hips and hunch over.

Step 2: Feel

Feel your breast using a firm smooth touch with the first few fingers keeping flat together. Cover the entire breast, follow a pattern so that you cover the whole breast.

Feel either lying or standing

You can feel your breast while lying down. Many women find the easiest way to feel their breast is while showering.

If you notice a lump or unusual change

Do not panic. See your doctor promptly for further evaluation.

COMMON PRESENTATIONS OF BREAST CANCER

Imaging

Breast ultrasound is used to screen for presence of any breast abnormalities. Ultrasound doesn’t use radiation, hence it is safe for pregnant women. It is recommended as the initial imaging tool for women younger than 35 years old. (9)

A mammogram is a low-dose X-ray of the breast. It can be used to identify early signs of breast cancer. Importantly, it can act both as a screening tool (for women who don’t have breast symptoms) and a diagnostic tool (for women who have breast symptoms). In fact, for symptomatic women above 35 years old, combined mammography and ultrasound can improve the breast cancer detection. (9)

Magnetic Resonance Imaging (MRI)

MRI is also used to detect breast abnormalities. It is only used in specific clinical situations. For example, it might be used to evaluate the extent of breast cancer. (9, 12)

Preparation for your MRI Appointment. (12)

You might need to

1) Tell your doctor

About your menstrual cycle
If you have any allergies
If you have kidney problems
If you are pregnant
If you are nursing
If you have implanted medical devices
If you are scared of being in confined spaces.

2) Don't wear metallic things during the MRI procedures.

What to expect during your MRI appointment? (12)

1) You will be given a gown to wear.

2) You will be asked to remove any metal objects like jewelleries and hair clips.

3) A dye (contrast material) may be injected through an intravenous line in your arm so that the details of the breast tissue can be seen clearly.

4) You will be asked to lie face down on a table. Your breast will hang down into an opening in the table so that they won’t get compressed while getting the scan.

5) The table will then slide into the opening of the machine.

6) You may hear loud noises coming from the machine. You might be given earplugs to help block the noise out.

7) You will need to lie still on the table.

8) The whole test usually takes around 30 minutes to an hour.

BIOPSY OF BREAST TISSUE

Pathology Examination

▪ Fine needle aspiration cytology (FNAC) - a simple procedure that involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass

▪ Core needle biopsy - a procedure that removes a piece of tissue from a lesion or mass which can remove more tissue than a fine needle biopsy.

The biopsy procedures may cause some discomfort.