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Approved by the "Fondation Vaudoise pour le Dépistage du cancer du sein"

Full field microdose digital mammography with computed assisted diagnosis!

About one quarter of Swiss population deaths are due to cancer; breast cancer represents half of the total number of cancers in women aged more than 40. But it has been shown that breast cancer screening after age 50 lowers breast mortality by 30% to 50%. Screening should take place even earlier if risks factors are known, such as family history of cancer.

Screening mammography may reveal non palpable very small tumours, when only marked by tiny calcifications or subtle mammary architecture distortion on a mammogram. At this stage, treatment often allows complete cure with minimal sequelae.

Breast self examination: click on the image or see Breastcancer.org explanations

Are included in the breast cancer screening:

1. breast self examination, which should be done monthly during one's whole life
2. annual careful medical breast palpation
3. screening mammography at least every two years after age 50, eventually earlier if risk factors are known.

Mammography is conducted by a radiologist and consist of three complementary steps:

• patient history (antecedents) looking for risk factors, nipple discharge, pain, mass or other symptoms, first day of last menses, hormone replacement therapy (which sometimes induces benign breast changes), operations, etc.
• breast examination, which orientates mammogram reading
• the mammography itself, consisting of two roentgenograms of each breast; when done carefully, this procedure should not be painful.

Digital Mammography: this fairly new technique allows image acquisition with a selenium convertor without using any film. Advantages of digital mammography:

• Brightness and contrast of a digital image can always be modified, allowing better lesion detection in dense breasts
• X-ray dose to the patient is lower than conventional technique and a view has never to be taken again because of overexposition or underexposition. Microdose® photon counting technique (Philips) is able to reduce further the dose by 50%
• Image formation is immediate and results can be viewed on a screen by the technician and by the radiologist
• Computed assisted diagnosis (CAD) works like a "second look" in helping the radiologist to detect the tiniest lesions
• The images may be printed on a film, on paper, burned on a CD-ROM or sent electronically to the physician. A copy is usually retained in the machine for future comparison.

If palpation and mammograms results are not conclusive, the radiologist may perform breast ultrasound for additional information. A detailed report will be sent to the physician in charge of the patient. If the patient is given the films, she has to keep them in a safe place and bring them back next time, to allow comparative study.

Specimen of bilateral mammogram (oblique view)

1= breast gland 2= subcutaneous fat 3= pectoralis muscle

Stereotaxy is technique using two films of the same breast region obtained with a slightly different angle to determine exact puncture location by geometrical effect. When a lesion is not palpable, this procedure allows precise needle biopsy or placement of a metallic anchor to enable surgical removal. Alternatively, ultrasound allows the same procedure under direct guidance, especially when breast lesion contains no calcifications.

Hormone Replacement Therapy (HRT) & Breast Cancer

Estrogen, the major component of HRT helps relieve menopausal symptoms such as hot flushes. More importantly, it is effective in preventing osteoporosis: HRT has been found to prevent or slow down bone loss when taken after menopause. It reduces the risk of fractures of the hip and spine which can cause serious disability and sometimes, even death.

There have been a great number of studies that have looked at the relationship between estrogen and the risk of breast cancer. Within the medical community, it is generally agreed that HRT does not increase the risk of developing breast cancer for women who have used estrogen for less than 5 years or who take conjugated estrogens at doses of 0.625 mg or less. Some studies have reported that breast cancer developed more often in women who used estrogens for long periods of time (more than 5 years) or who used high doses for shorter time periods. On the other hand, there are reports stating that current use of HRT may reduce the chance of breast cancer detection by mammography. How does HRT interfere with a mammogram? One of the actions of estrogen is to increase the density of breast tissue in some patients. This makes it more difficult to detect lumps or small tumors in the breast. The cancer is able to hide in the dense breast tissue. Although HRT does not directly cause breast cancer, it may affect and lower the efficacy of screening. It is therefore recommended that women taking HRT be closely and properly followed. In difficult cases, ultrasound is a powerful adjunct to diagnosis.