October is Breast Cancer Awareness Month

By Dr Nicholas Hall, South Coast Radiology and The Women's Imaging Centre

October, Australia’s Breast Cancer Awareness Month, provides an opportunity for us all to focus on breast cancer and its impact on those affected by the disease in our community. Breast cancer remains the most common cancer among Australian women (excluding non-melanoma skin cancer). Survival rates continue to improve in Australia with 89 out of every 100 women diagnosed with invasive breast cancer now surviving five or more years beyond diagnosis.

The diagnosis and management of breast cancer relies upon a number of specialist skills provided by a multidisciplinary team including general practitioners, breast surgeons, pathologists, medical oncologists, radiation oncologists and radiologists. Regular multidisciplinary breast cancer meetings are held across the Gold Coast and Tweed region to facilitate best management for local patients.  South Coast Radiology and The Women’s Imaging Centre provide a diagnostic breast imaging service across seven Gold Coast and Tweed locations to complement the high level breast care, surgery and oncology management provided in the region.

The aim of diagnostic breast imaging is to optimise the early and accurate diagnosis of breast abnormalities. Mammography is the primary breast imaging technique for the investigation of symptomatic women 35 years and over, and for the screening of asymptomatic women aged 50–69 years.  Ultrasound provides complementary imaging to mammography, and may be the primary and only imaging modality used for the investigation of breast symptoms in women less than 35 years and in women who are pregnant or lactating. The combination of both techniques has sensitivity for breast cancer detection of 90%. MRI provides unique, additional information on the blood supply to breast tissue and assists in the assessment of invasive carcinoma. When MRI is combined with mammography and ultrasound, sensitivity reaches 95%.

With increasing awareness of the benefits of early detection of breast cancer, and prompt reporting of breast changes by patients, there is likely to be an increase in the proportion of patients undergoing assessment of symptoms in whom a malignancy is not present. All involved are aware that investigation of a breast abnormality or assessment of a breast change can be an anxiety-inducing experience for women, and significant effort is constantly made to reduce both false negative and false positive results. It is important that patients are reminded that negative imaging findings should not preclude further evaluation of clinically suspicious findings.

For women of all ages who are at increased risk of developing breast cancer it is recommended that an individualised surveillance program be developed in consultation with the woman’s general practitioner and/or specialist. Depending on age and risk for breast cancer, this might include regular clinical breast examination and breast imaging with mammography and/or ultrasound, with or without Magnetic Resonance Imaging (MRI). There is a Medicare rebate available for the use of MRI in the surveillance and diagnosis of asymptomatic women under 50 years of age at high risk of developing breast cancer, when referred by a specialist. Eligibility criteria has to be met:
•    genetic testing has identified the presence of a high risk breast cancer gene mutation or
•    patient is at high risk of developing breast cancer, due to one of the following:
(i)  3 or more 1st or 2nd degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
(ii) 2 or more 1st or 2nd degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least one of the relatives diagnosed with: bilateral breast cancer; breast cancer before the age of 40 years; ovarian cancer before the age of 50 years; breast and ovarian cancer; has Ashkenazi Jewish ancestry; or is a male who has been diagnosed with breast cancer;
(iii) 1 or more 1st or 2nd degree relative diagnosed with breast cancer < 45 years + a  1st or 2nd first or second degree relative on the same side of the family with sarcoma <45 years.

For further information on South Coast Radiology’s breast imaging service, please contact one of our dedicated breast radiologists – Drs Gerry Bensoussan, Julie Broadfoot, Eamonn McAteer, Naomi Tracey, Rasha Al-Zuhairy or myself on 55808588.

Images: mammogram and MRI imaging of a patient with bilateral breast disease