Malta Breast Screening Programme

Breast Cancer Information Site
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Breast Health Info

Below find userful breast health information.

Family history of breast cancer.

Many women enquiring about a family history of breast cancer will not have a significant history. There is also a public and professional misunderstanding of the likely impact of recent advances in the genetics of breast cancer and an unreasonable expectation that they will become readily available. The majority of breast cancers are not genetic and the importance of genetic factors has been over emphasised. There is also an assumption that identification of breast cancer gene mutations in an individual will result in a reduction in mortality. This is unproven. Referal to a family history clinic provides an opportunity for risk assessment, counseling, and the opportunity to take part in screening or prevention studies and the opportunity to take part in screening or prevention studies and any other research programme.

Management of high risk group.

The high risk group is defined as:

  • Breast/ovarian families with four or more relatives on the same side of the family affected, at any age.
  • Breast cancer (only) families with three affected relatives with an average age at diagnosis of < age 40 years.
  • Breast/ovarian families with three affected relatives with an average age at diagnosis of breast cancer < age 60 years.
  • Families with one member with both breast and ovarian cancer.0

These patients should be referred to a specialist cancer genetic consultation at a regional genetic centre. Gene testing may be appropriate for some of these patients.

Management of moderate risk group.

The moderate risk group is defined as:

  • One first degree relative with breast cancer diagnosed under the age of 40.
  • Two first or second degree relatives with breast cancer diagnosed under the age of 60, or ovarian cancer at any age.
  • Three first or second degree relatives with breast cancer or ovarian cancer diagnosed at any age.
  • A first degree relative with bilateral cancer under the age of 60.
  • A first degree male relative with brest cancer at any age.

The relative risk of breast cancer for women in this group is at least three times that of the general population. Given the sparsity of evidence for intervention in this group it is recommended that patients should be managed with in the context of clinical studies.

A possible age dependent screening protocol could be:

Below the age of 30 No Mammography.
Ages 35-49 Annual Mammography (consider screening from 5 years prior to age at diagnosis in relative if this age < 39.
Over the age of 50 Mammography every 18 months (ie additional mammogram between three yearly NHSBSP mamography.

Management of low risk group.

The strategy for these women should be to discuss the difference between familial and non-familial cancer and to explain that that individual’s risk is not significantly elevated. They should be informed that the risk of non-familial breast cancer (the most common type) remains and be encouraged to participate in the National Breast Screening Programme at an appropriate age.

It is essential that the advice offered to women is the same, whether in primary care, the Breast Unit or regional Cancer Centre.

Breast Care: Ultrasound

Ultrasound is a diagnostic technique that involves the use of high frequency sound waves from a probe, which is passed over the body. The structures within the body bounce these waves back to the probe and the resulting signals are converted into images on a screen from which pictures can be taken and interpreted, and a diagnosis made.

The benefit of ultrasound scanning is that it is useful in distinguishing more solid lesions form cysts, and so aids diagnosis.

You will be asked to undress and given a gown to wear. In the ultrasound room you will lie down on a couch; the radiologist or radiographer will tell you exactly how to lie and where to position your limbs. Gel will be applied to the area of the body to be scanned for ease of movement of the probe. There are no risks involved in having an ultrasound scan, as the procedure is quite painless and safe.

Breast Care: Mammography.

Mammography is an X-ray procedure used to examine the breast. It is most useful to investigate breast problems and to detect small changes within the breast tissue.

The benefit of having mammography is that it is simple and safe, as only low dose X-rays are used, and it aids the doctor to make a diagnosis.

For the mammogram to be done, you will be asked to undress to the waist for this examination. Talcum powder, creams, sprays or roll on deodorants should not be used under the arms or on the breast ( or should be removed before the mammogram) as they can cause problems with the sensitive X-ray films.

The radiographer will explain the procedure to you and will be pleased to answer any questions you may have.

You will be asked to stand facing the X-ray machine and the radiographer will position your breast in the machine. Gentle compression will be applied from a compression plate anpve. wotj tje nreast restomg pm tje X-ray plate below. This is a most important part of the examination as it enables the best films to be obtained for diagnosis. Several views of each breast may be taken.

There may be some discomfort but only for a short time. The procedure will be carried out as quickly and efficiently as possible to minimise any discomfort.

Additional films are often required after the first mammogram to assist in the diagnosis of breast problems. these may involve re-positioning you and compressing the breast in a different way using a different compression plate.

A magnified view of a certain area of the breast may be needed.

Breast Care: Fibroadenoma.

You have attended the breast clinic and have ben diagnosed as having a fibroadenoma.

A fibroadenoma is a benign breast lump (non-cancerous) caused by an increased growth of the fibrous and glandular tissue within the breast.

They are sometimes known as ‘breast mice,’ as they move around easily under the skin, unlike breast cancer which is usually fixed.

Fibroadenoma can vary in size and are usually smooth edged, and can be found anywhere in the breast.

Fibroadenoma are common between the ages of 16-35, though they can occur in women older than this.

If left, there is no evidence to suggest that a fibroadenoma can become cancerous, and there is a 50% chance that it will disappear. However, some can increase in size. You can request to have it rremoved surgically, and this is usually done as a daycase under general anesthetic.

It is important to be ‘breast aware’ and check your breast monthly.

There is an information booklet available on breast awareness, which gives advice on how to examine your breasts; please ask your breast care nurse for a copy.

Breast Care: Fine Needle Aspiration (FNA).

Fine needle aspiration involves the doctor taking a sample of cells from the breast in order to assist in making a diagnosis. it may be done if you have a breast lump. The benefit of having this procedure is that it can aid in diagnosis in some instances.

A doctor will carry out the procedure in the breast care unit, with a nurse present. The doctor will gently introduce a fine needle into the breast tissue and, with a syringe attached to the end, will move the needle gently in and out to obtain cellular material.

The cells removed will be put into a special bottle and set to the laboratory where a cytologist, who is specially trained in the study of cells, will look at the cells under a microscope.

The results of this test will normally be available within two days in the result clinic.

The risks of the procedure are outlined below.

  • Shortness of breath.
  • Pain on inspiration (or with breathing).
  • Pain that is not relieved by simple painkillers, or is causing you distress.

Although the doctors are experts in this technique, occasionally the results are not conclusive and the test may need to be repeated or a different test recommended, such as a biopsy or excision and biopsy.

Breast Care: Breast cyst location and aspiration.

You have attended the breast clinic and have been diagnosed with a breast cyst. A breast cyst is a fluid filled sac within the tissue of the breast. They are most common in women between 40 and 50 years of age; however, they can occur in women both older and younger than this. It is more common to have more than one breast cyst. They can vary in size and can suddenly appear.

The diagram is to help you identify and locate the breast cyst(s) within your breasts, so that you will be aware if one suddenly gets bigger, or more painful, as it may require aspiration (drainage). If you are concerned, or notice a change in the cyst(s), please contact the breast care nurses so that they can arrange an appointment for you to attend the breast clinic for aspiration.

Worried about breast symptoms? Should I see a specialist?

Your family doctor (FD) will follow a set of guidelines when deciding whether or not to refer you to a breast clinic. Usually s/he will only refer you if you have a definite lump, a change in your nipple or breast discharge. Breast pain ( one of the most common complaints) is rarely a worrying symptom especially if it is cyclical and not accompanied by a persisting lump or nodularity.

If you have been referred to a breast clinic you may be feeling worried and anxious, or frightened that you may have breast cancer. Anxiety is perfectly normal and it can show itself in many ways. For example, your daily routine or your sleep pattern may be affected. This can be particularly distressing if you have to wait several weeks for your appointment. You will probably find that you develop your own way of coping during this uncertain time, perhaps by talking to family or friends or keeping yourself busy. Although these feelings are likely to continue until you get your results, it may be reassuring to know that most breast problems are bening (non-cancerous). Should you still feel unable to cope speak to your GP s/he can provide much relief by a chat, or even prescribe a bit of night sedation. Coping with a worry is difficult – learn to think about a problem only at a set time and place, for a limited period of time – rather than to mull over things all day and night. Ask your family to respect this request.

Screening appointment

The Lascaris Screening service does not accept referrals for symtomatic breast problems. Women are selected systematically by the computer system which searches the official datasets from National records, including Electoral rolls, Social Security and Health PAS databases. You will be called according to your date of birth. The first breast screening cycle will include all women born between 1950 and 1960. All eligable women within these years of birth who possesses a NationalID will be called for breast screening. The IT system starts with the ‘older’ women. Roughly speaking women who are born between 1950 and 1954 (approximate aged 57-60) will be called in 2010, the next group born between 1954 and 1957 in 2011, and those between 1957 and 1960 in 2012. It is possible this age range will be extended further when the second cycle is entered in 2012.

When you attend for your mammogram you will not be given the mammogram result immediately. Screening mammograms require a double read – an independent check on the electronic image by two qualified radiologists. This is in line with European Standards. This double read by two specialists normally takes about a week and the result will then be mailed to you. The vast majority of women receive a result in writing within two weeks. IF you wish a copy of the mammogram image on a CD, request this at the reception desk and we will prepare this for you (plus a small charge of 25 Euros to cover material costs).

Very occasionally some further Xrays or scans are requested and we will write to you with further appointment. If and where necessary the service offers a triple diagnosis, i.e. you will be examined, have mammograms or ultrasound scans and needle samples for microscope analysis. When these results are available they will be discussed at a multidisciplinary meeting where all the specialists are present. You may wish to know what the outcome of these discussions is and we will be happy to keep you fully informed.

If you have breast symptoms you may need to attend the Mater Dei breast clinic and need to be referred by your Family Doctor. Likewise, this is not a self-referral or ‘drop-in’ clinic. Results ( in particular microscope and blood tests) are normally available within 2 weeks. They are extremely busy clinics and far different from the traditional out-patient visit – more like a brief hospital stay for a few hours, depending on the number of tests. You may meet a variety of staff each with their own expertise. Again, these clinics can provide a triple or combined assessment consisting of a thorough examination, a mamogram or ultrasound and a biopsy of the area in question (if needed). Mammograms for symptoms should not normally be undertaken below 35 years of age (also subject to national guidelines) – they have a limited value in younger women and entail some radiation risk.

If you undergo a mammogram at any time you must avoid a repeat X-ray of the breast area for about a year. We will enquire about your mammogram history and when necessary rearrange your appointment if you have had a recent mammogram.

Should you wish to seek advice elsewhere and attend another clinic soon after having a screening mammogram at Lascaris make sure you let the clinic know you have recently undergone a screening mammogram. We will be very happy to forward copies of our X-rays to the clinic. Do not agree to undego a fresh set of X-rays or mammograms, especially within a short period since this can be harmful radiation. Always allow a period of 1 year.

The breast awareness 5-point code

  1. Know what is normal for you.
  2. Know what changes to look and feel for.
  3. Look and feel.
  4. Report any changes to your GP without delay.
  5. Attend routine breast screening if you are aged 50 or over

For more information check out Breast Cancer Care.