Breast Cancer Flashcards
(19 cards)
Breast screening
involves testing healthy people for early signs of cancer using a mammogram (involves taking an x-ray of the breast tissue)
Allows for potential earlier treatment and improves quality of life
How often is there a positive result for a cancer screen in women
9 out of 1000
Who has breast screening
• all women age 50 to 70 registered with a GP are screened every 3 years
• If you’re older than 70, can still be screened but won’t automatically be invited
• If younger than 50 there is a low cancer risk and mammograms are harder to read due to denser breast tissue, so aren’t eligible
• Breast screening is also available to trans men and non-binary people assigned female at birth who have not had a bilateral mastectomy as well as trans women and non-binary people assigned male at birth who have taken feminising hormones
Between which ages are mammograms conducted
50 to 70
How does a mammogram work
- Take off clothes from waist upwards and put a gown on
- Radiographer positions one breast at a time between 2 flat plates on the machine
- The plates press your breast firmly between them for a few moments
- There are 2 x-rays of each breast: one from the top and one from the side
- It usually lasts around 1 minute
Results of a mammogram
If the results are clear, the patient will receive a letter
If the results aren’t clear or show any abnormal areas, they will be called back again for a magnified mammogram which can show up particular areas of the breast more clearly and can show borders of any lumps or thickened are as well as areas of calcium (calcification). An ultrasound or biopsy may also be performed. MRI scans can also be performed
When were the Wilson and junger principles formed
1968
What are the Wilson and Junger principles for
Outline principles of a good screening program
What are the Wilson and Junger principles
- Important health problem
- Natural history well understood
- Recognisable at early stage
- Treatment better at early stage
- Suitable test exists
- Acceptable test exists
- Adequate facilities to cope with abnormal results
- Screening at interval for insidious onset
- Chance of harm is less than chance of benefit
- Cost balanced against benefit
Number of Wilson and Junger principles
10
Risk factors for breast cancer
• age– the risk increases as you get older
• a family history of breast cancer
• a previous diagnosis ofbreast cancer
• a previous non-cancerous (benign) breast lump
• being tall, overweight or obese
• drinking alcohol
Genetic risk factor for breast cancer
People without a personal history of breast cancer can be managed in primary care if they have only one first-degree relative (mother, father, daughter, son, sister, or brother) or second-degree relative (grandparents, grandchildren, aunt, uncle, niece, nephew, half-sister, or half-brother)diagnosed with breast cancer when over 40 years of age, provided that none of the following are present in the family history:
◦ Bilateral breast cancer.
◦ Male breast cancer.
◦ Ovarian cancer.
◦ Jewish ancestry.
◦ Sarcoma in a relative younger than 45 years of age.
◦ Glioma or childhood adrenal cortical carcinomas.
◦ Complicated patterns of multiple cancers at a young age.
◦ Two or more relatives with breast cancer on the father’s side of the family.
Secondary care referral is indicated for people without a personal history of breast cancer who have any of the following:
• One first-degree female relative diagnosed with breast cancer under the age of 40 years.
• One first-degree male relative diagnosed with breast cancer at any age.
• One first-degree relative with bilateral breast cancer where the first primary was diagnosed under the age of 50 years.
• Two first-degree relatives, or one first-degreeandone second-degree relative, diagnosed with breast cancer at any age.
• One first-degree or second-degree relative diagnosed with breast cancer at any ageandone first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative).
• Three first-degree or second-degree relatives diagnosed with breast cancer at any age
Specific gene mutations for breast cancer
They are far less common than BRCA1 or BRCA2, and they do not increase the risk of breast cancer as much. Some of these genes and syndromes are:
• Lynch syndrome, linked with the MLH1, MSH2, MSH6, and PMS2 genes
• Cowden syndrome (CS), linked with the PTEN gene
• Li-Fraumeni syndrome (LFS), linked with the TP53 gene
• Peutz-Jeghers syndrome (PJS), linked with the STK11 gene
• Ataxia telangiectasia (A-T), linked with the ATM gene
• Hereditary diffuse gastric cancer, linked with the CDH1 gene
• PALB2 gene
• CHEK2 gene
• TP53 gene
When should specialist advice be sought for a patient with breast cancer
Any of the following are present in the family history in addition to breast cancers in relatives not fulfilling the above criteria: bilateral breast cancer, male breast cancer, ovarian cancer, Jewish ancestry, sarcoma in a relative younger than 45 years of age, glioma or childhood adrenal cortical carcinomas, complicated patterns of multiple cancers at a young age, and two or more relatives with breast cancer on the father’s side of the family.
If a faulty gene (for example BRCA1 orBRCA2, PALB2) has been identified in the family, direct referral to a specialist genetics service should be offered.
Most common gene mutations for breast cancer
BRCA1
BRCA2
How to check your breasts
• remember to check all parts of the breasts, right up to the collarbones and into the armpits
• Look at your breasts in the mirror with your arms by your side and with them raised
• Run a hand over each breast and up under each armpit
• Look for:
• A change in size or shape
• A change in skin texture such as puckering or dimpling
• A lump or thickening that feels different from the rest of the breast tissue
• Redness or a rash on the skin and around he nipple
• If the nipple becomes inverted or changes its position or shape
• A swelling in the armpit or around the collarbone
• Discharge from one or both of the nipples
• Constant pain in the breast or armpit
Barriers to trans patients accessing breast screening
• may not be automatically invited to a screening test if not registered as female with GP
• Not knowing when and where to undergo breast cancer screening may put transgender people at higher risk for delayed diagnosis and worse outcomes
• Staff ignorance
• Transphobia
• Fear of being mis-gendered or having to ‘out’ themselves
• Not knowing about screening
• Embarrassment
• Fear of the test causing dysphoria/anxiety
• Many clinics describe breast cancer screenings as “women’s health” procedures. A transgender person may immediately feel excluded or misgendered when they seek a treatment that is categorized for women.
• Breast cancer campaigns are doused in pink, a colour often associated with femininity. When campaigns limit their marketing to pink, they may dissuade transgender people. Transgender men and nonbinary people are often misgendered as women, and so they may avoid breast cancer campaigns that use ‘girly’ colors
Ways to overcome barriers to trans patients accessing breast screening
• gender-inclusive breast cancer representation.
• Use a variety of colors other than pink
• Advertise breast and chest exams as a general health service rather than a woman’s health option
• Include models of diverse genders and body types in breast cancer awareness campaigns
• Incorporate gender-neutral language such as “patients” instead of “women” and “they/them” instead of exclusively using “she/her” pronouns
• Demonstrate how transgender people with smaller chests, at different stages of hormone therapy, or who have had top surgery can check their chests for lumps
• Use the phrase “breast and chest examinations” or “breast and chest checks” to include people of various body types and genders
Long term effects of breast cancer treatment
• breast and arm changes- pain, change to appearance, problem with strength or movement, swelling, cording
• tiredness and fatigue
• Effects on heart eg congestive heart failure, coronary artery disease, arrhythmia
• Effects on lungs eg difficulty breathing, inflammation
• Bone thinning
• Pain in joints and muscles (arthralgia)
• Weight gain
• Peripheral neuropathy
• Diabetes
• Sex life and fertility
• Concentration and memory problems
• Menopause or menopausal symptoms
• Depression, anxiety
• Concerns about body image
• Fear of breast cancer recurrence
• Post traumatic stress disorder
• Limited mobility eg shoulder
