Breast health and screening

Transcription

1 Breast health and screening Dr Kathy Wong MBBS (HK), FRCR (UK), FHKCR FHKAM (Radiology) Clinical Radiologist Department of Diagnostic and Interventional Radiology Kwong Wah Hospital

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3 Questions regarding breast cancer What? How severe? Why? Who? When? How to detect?

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6 Pink Tree infrared by MichiLauke

7 Top Cancers in Hong Kong in 2012 Hong Kong Cancer Registry 2014

8 Top Female Cancers in Hong Kong 2012 Hong Kong Cancer Registry 2014

9 Increasing incidence over time Hong Kong Cancer Registry 2014

10 Incidence, mortality, sharp rise at , increase mortality with age

11 Median age of incidence compared with the world Hong Kong Cancer Registry 2014

12 Age

13 US Trends: Female Breast Cancer Incidence and mortality rates* by Race and Ethnicity Cancer Causes & Control. November 2010, Volume 21, Issue 11, pp

14 Female Breast Cancer Incidence and Mortality Rates* by Race and Ethnicity, US *Rates are age adjusted to the 2000 US standard population. Persons of Hispanic origin may be any race. Sources: Incidence: Copeland et al. 15 Mortality: Howlader et al. 14 American Cancer Society, Surveillance and Health Services Research, 2013

15 Age-specific incidence rates of breast cancer among selected countries, Cancer biology and medicine. Vol 11, No 2: June 2014

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17 Detection at early stage

18 Trends Increasing incidence over time, mortality remains similar: because of? better treatment, earlier detection, screening Mostly detected at early stage (Stage 1, 2) Asian low incidence and mortality but with younger age of onset compared with rest of world: sharp rise after years old

19 Relative Risk factors for Female Breast Cancer

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22 How to detect? Self examination Clinical examination Imaging: Mammogram, Ultrasound, MRI Tissue diagnosis: Cytology, Tissue biopsy

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24 Mammogram 2D Analog film 2D Digital 3D Digital Tomosynthesis >= 27% increase cancer detection rate >=40% invasive cancer detection rate 115% increase in PPV for recalls 20-40% reduction in recall rates

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32 3D Tomo Cross-sectional slices through breast

33 Ultrasound

34 MRI

35 Tissue diagnosis Imaging guidance Stereotactic Ultrasound MRI Sampling technique Fine needle aspiration Core biopsy Vacuum assisted biopsy Excisional biopsy INTACT Surgical: localisation by palpation, hookwire, isotope, skin or lesion mark

36 Stereotactic localisation

37 Injection of marker for surgical excision

38 Breast lesions Types Increase risk for breast cancer Intraductal proliferative lesion e.g. ADH (3-5 folds) Papillary lesions: diagnostic difficulties, admix with other lesions Precursor DCIS Lobular neoplasia Carcinoma

39 WHO Classification of breast lesions, 4 th edition

40 WHO Classification, 4 th edition

41 Breast Cancer Staging Size, skin or pectoralis involvement Satellite lesions Node Metastases

42 Treatment for breast cancer Multidisciplinary meeting Surgery: lumpectomy, mastectomy +/- reconstruction Radiation therapy Chemotherapy Hormonal therapy

43 Breast Cancer Screening Why? Important, treatable, known latent/ presymptomatic stage of disease, acceptable test or examination facilities for diagnosis and treatment, agreed policy on whom to treat, cost vs expenditure, continuous case finding Where? No population wide screening in HK Who? Women years old What? Mammogram +/- USG or MRI When? Biannual or annual

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45 MARIA TRIA TIRONA. AAFP February 15, Volume 87, Number 4

46 Benchmarks for Sensitivity and Specificity for 2,061,691 Screening Mammography Examinations from * -- based on BCSC data through 2009 NCI-funded Breast Cancer Surveillance Consortium (HHSN C). Downloaded xx/xx/xxxx from the Breast Cancer Surveillance Consortium Web site - statistics/benchmarks/screening/2 009/table7.html

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49 ACR appropriateness criteria for breast cancer screening

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54 Early diagnosis = better survival?

55 Interval cancer

56 Individuals with little gain from screening Women with less than 5 years life expectancy, as unlikely to reduce morbidity or mortality End-stage renal disease Severe dementia Terminal cancer Severe co-morbid disease with functional dependencies <40 years old and average risk Men

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58 What can be done? Increase awareness Avoid risk factors: e.g. smoking, overweight Self check and clinical examination Seek help if abnormality detected Stratify risk Consider breast screening particularly if high risk group

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60 Cancer biology and medicine. Vol 11, No 2: June 2014

61 Local tumour staging for breast cancer AJCC CANCER STAGING HANDBOOK - 7th Ed. (2010)

62 Regional nodal staging

63 Distant metastases M0 cm0(i+) M1 No clinical or radiographic evidence of distant metastases No clinical or radiographic evidence of distant metastases, but deposits of molecularly or microscopically detected tumor cells in circulating blood, bone marrow, or other nonregional nodal tissue that are no larger than 0.2 mm in a patient without symptoms or signs of metastases Distant detectable metastases as determined by classic clinical and radiographic means and/or histologically proven larger than 0.2 mm

64 Breast cancer ANATOMIC STAGE/PROGNOSTIC GROUPS Stage 0 Tis N0 M0 Stage IA T1* N0 M0 Stage IB T0 N1mi M0 T1* N1mi M0 Stage IIA T0 N1** M0 T1* N1** M0 T2 N0 M0 Stage IIB T2 N1 M0 T3 N0 M0 Stage IIIA T0 N2 M0 T1* N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0 Stage IIIB T4 N0 M0 T4 N1 M0 T4 N2 M0 Stage IIIC Any T N3 M0 Stage IV Any T Any N M1