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Useful Information for Patients

Quick, handy information for you on pre-authorisation, downloading consent forms, examination preparation as well as what to bring along for your appointment.

What is breast Cancer?

Cancers are an overgrowth of cells and tissue that starts in one organ e.g. the breast, and then spreads (metastasizes) to other parts of the body where it usually leads to death. There are many different types of breast cancers and they don’t necessarily behave in the same way or respond to the same treatments. These days, a diagnosed cancer is studied in great detail so that the treatments are tailored to best destroy that particular cancer.

CAUSES OF BREAST CANCER

In 99.9% of breast cancer, there is NO known cause. There are risk factors that increase a person’s chances of developing a cancer but almost never an actual cause. The risk factors include family history, hormone replacement, obesity, smoking and having not had children.

LUMP IN THE BREAST

Feeling a lump in the breast is the single most important symptom of a breast cancer! A lump usually feels like a pea / stone / marble under the skin. Any time that a woman feels a lump in the breast she must come in for a mammogram and/or ultrasound immediately. Nonetheless, the vast majority of palpable lumps are not breast cancer. Benign growths, cysts and normal lumpy breast tissue may all present as lumps.

SKIN AND BREAST CHANGES

Skin thickening and dimpling (looks like the peel of an orange), or a newly developed asymmetry of the breasts – one is higher/pulled up or has a dent in it. These signs always need to be further evaluated with mammogram and ultrasound.

NIPPLE CHANGES

Nipple discharge – the most concerning discharges are bloody or clear. Green/yellow/milky discharges are usually harmless. A discharge that comes out on its own is more worrying than one that comes out only when the nipple is squeezed. Discharges from both nipples are almost always harmless.

Pulling in of the nipple can be a sign of cancer but only if it is something new (weeks – months)

A peeling, dry rash of the nipple and areola is always a concern. Itching of the nipple without any visible change is harmless – usually due to hormonal change.

Even though most nipple problems are benign, evaluation with imaging is advised in all cases.

BREAST EXAMINATION

The purpose of a breast examination is to try find breast cancer as early as possible. Regular (monthly) self examination is an extremely valuable tool, although many women find it difficult on account of naturally lumpy breasts. If this is the case, do not stress. Make sure you come for your annual mammogram in addition to visiting your gynaecologist or general practitioner who will also perform a manual breast examination.

BREAST CYSTS

A breast cyst is a bubble of water that can vary in size from several millimetres to 5 centimetres in diameter. They are extremely common and almost always benign. Breast cysts can occasionally be painful, particularly if very large or inflamed. In that case, we will aspirate (draw out) the fluid from the cyst. If they are asymptomatic, we leave cysts alone.

Who Is At High Risk For Breast Cancer?

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Most women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. If a woman has a high risk of developing a breast cancer, she may need more intensive screening e.g. annual MRI or possibly genetic testing. If you have breast cancer risk factors, talk with your doctor about screening options.

Who is at high risk?

Family history of breast cancer are the most important risk factors for developing a breast cancer https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/brca_gene_mutations.htm
Being overweight or having obesity after menopause – older women who are overweight or have obesity have a higher risk of getting breast cancer than those at a normal weight.
Taking hormones – some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Oral contraceptives are not known to increase breast cancer risk.
Reproductive history – having the first pregnancy after age 30, or never having a full-term pregnancy can raise breast cancer risk.
Previous biopsy that showed a high risk lesion e.g. Lobular Carcinoma in Situ(LCIS) or Atypical Ductal Hyperplasia (ADH)
Previous breast cancer – women who have had a previous cancer, and still have breast tissue i.e. they had a lumpectomy instead of a mastectomy, are at higher risk of developing a second breast cancer. Especially if they are younger than 50 and have dense breast tissue

Breast cancer risk factors:

Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50.
Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
Previous treatment using radiation therapy.Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

Swellings under the arms - what are they?

Accessory breast tissue is the most common cause of lumps under one or both arms. It is usually soft and frequently tender especially during a woman’s period. The condition is congenital, although it usually only presents after puberty or even later in life. It is common for these lumps to grow as a person gains weight, or as a woman’s baseline hormone levels change (usually in her 40s)

Usually this tissue is composed of fat, sometimes breast glands and very occasionally there are extra nipples on the skin surface of the under arm. The concern for under arm swellings, is whether there are enlarged lymph nodes. Most enlarged lymph nodes represent viral infection and are not dangerous. However, enlarged nodes under the arms can be due to breast cancer that has spread. It would be very unsual for those nodes to be big enough to cause a visible swelling, and they are usually not soft and not tender.

Nonetheless, it’s always a good idea to let a doctor have a look at any swellings under your arms, preferably with an ultrasound. If accessory breast tissue becomes very uncomfortable or unsightly, it can be removed relatively easily – usually by a plastic surgeon.

Are Mammograms dangerous?

There is a common myth that mammograms cause more cancers than they detect and are therefore dangerous. The theory is that the radiation involved with a mammogram causes cell damage and cancer development. All x-rays (including mammograms) involve exposing parts of the body to x-ray radiation which allows a film or digital detector to show up the anatomy and possible abnormalities within. Radiation, in high enough doses does indeed damage cells and can induce cancer. The proof for this was learnt from the atomic bomb blasts in Hiroshima and Nagasaki in 1945, after which tens of thousand of people who were exposed to the associated radiation developed cancers.

The radiation dose from an x-ray is infinitesimally smaller than nuclear fall-out. In fact the background radiation that each of us who live on the highveld is exposed to each year is roughly 6 times that received during a mammogram.

Although there is a theoretical risk of radiation from x-rays/mammograms causing breast cancer, to date there has never been a single cancer case proven to be caused by a mammogram or any other x-ray.

In general, the odds of being diagnosed with a breast cancer at mammogram are substantially higher at the first mammogram than subsequent ones (purely a statitical likelihood of someone who’s never been tested and unknowingly has a cancer in her breast). We definitely do not see a higher breast cancer rate in older patients who have had many years of mammograms.

It is estimated that the likelihood of dying from a mammogram induced breast cancer is 1 in 70,000 (theoretical since no cases are even known). The likelihood of getting a breast cancer however is 1 in 8 over the course of a woman’s lifetime.

These days the vast majority of breast cancers are detected when they are grade 1 (less than 2cm). This is largely due to highly sensitive tests such as mammograms done on an annual bases. The result, is a 5 year survival (prognosis) of 90%. In the days before annual mammograms the cancers were almost all larger than 2cm (usually only found once large enough to feel) and the 5 year survival < 70%.*

Bottom line is that although there is a theoretical risk of radiation from mammograms causing cancer, it is so small that it shouldn’t prevent you having an annual mammogram from age 40. We are more cautious with younger patients since immature breast tissue (women younger than 35) is thought to be more sensitive to radiation. In those patients, a sonar is done instead.

Mammograms are the best screening test we have for breast cancer. The benefits of identifying cancers early is far more valuable than the extremely remote chance of this test itself creating a cancer.

*Obviously improvement in breast cancer treatment has also played a big role in reducing breast cancer mortality.

Hendrick, Edward R.Radiation Doses and cancer risks from breast imaging studies.Radiology.October 2010 Vol 257:1 p2951 – 2955

Paedriatric MRI

The Park Lane Hospital has a strong paediatric focus, with the largest private neonatal ICU in the country, as well as 12 resident paediatricians.

Our goal is to provide a specialised paediatric imaging service that fulfills the radiology requirements of the hospital and attendant doctors.

Since MRI is the gold standard when it comes to evaluating the brain and spine, we ensured that the appropriate accessories needed to optimally scan children were part of the MRI suite.

Babies in neonatal ICU are usually admitted on account of prematurity and birth asphyxia (lack of oxygen during a traumatic/prolonged delivery.) Both of these conditions can be associated with brain injuries, and as such an MRI scan of the brain should be performed on most of the ICU babies at some stage.

MRI requires patients to be absolutely still for 20 – 30 minutes. In order to achieve that with babies and young children, it is usually necessary to sedate/anaesthetise them for the duration of the scan.

With this in mind, we fitted the Parklane MRI unit out with a specialized anaesthetic machine and comprehensive vital signs monitor so that anaesthetics could be done inside the scanner room. We have a weekly anaesthetic list run by an anaesthetist with paediatric experience.

Should you have any queries, please contact us on 011 484 4642

Breast MRI - who should have one?

Breast MRI is the screening study of choice in high risk patients – those with a 20% lifetime risk of developing breast cancer. It is a Prescribed Minimum Benefit (PMB) in South Africa for high risk patients.

That means that medical schemes will pay for the procedure in eligible women.

Lung Cancer screening

Lung Cancer is the second most common cancer in men and women (after prostate and breast respectively.) Lung cancer, overall, has a poor prognosis. The 5 year survival for all types of lung cancer is only 5 – 10% (breast cancer 5 year survival is about 85%). The reason for poor survival is that lung cancers are often only picked up at a late stage when they have already metastasized. If a lung cancer is picked up early, the prognosis is similar to breast cancer. Multiple studies have proven that early detection of lung cancers will significantly improve overall survival of patients. The best tool for early diagnosis of a lung cancer is CT scan of the lungs. Therefore, in the United States there are new guidelines for annual CT scans in smokers:
1. Over the age of 55
2. Have smoked within the last 15 years
3. Have a significant smoking history (equivalent to a pack a day for 30 years)

The scans are low radiation and don’t involve contrast (iodine). If you are a long time smoker and/or have relatives who fit in that category, you/they should consider having a screening CT scan.

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