The term anamnesis implies an interview during which the doctor collects data from the patient, which is essential for any valid assessment. In case of breast disease, the following data will be required: date of birth, age at first menstruation, date of the last menstrual period, age at the last menstrual period (menopause), number of pregnancies, number of deliveries, average duration of breast-feeding, diseases and breast surgeries to date, family history of breast cancer, use of hormonal contraceptives, use of hormone replacement therapy, and, of course, breast problems such as pain, lumps or nipple discharge.
Breast self-examination and clinical examination
Breast self-examination is a good health habit that should be done on a regular monthly basis between the 5th and the 10th day of the menstrual cycle by breast palpation. This way you can get to know what is normal for your breasts so you can easily notice any changes that might develop on and within them. However, the value of clinical examination, which is actually the first and unavoidable step towards diagnosing for breast disease, is undoubtedly higher as it is performed by an experienced professional. Breast self-examination, YES - but only between regular medical check-ups.
In the last ten years, ultrasonography continues to gain importance thanks to ever-improving ultrasound technology using high-frequency probes and sophisticated software. With over a 90 percent of accuracy, ultrasonography is an excellent diagnostic tool, and not for breast cancer detection alone. It is especially powerful for interpreting benign breast changes and distinguishing them from malignant lesions, which often cannot be achieved with mammography, particularly in dense breast tissue. Ultrasound examination is therefore the first method of choice for women under 40 years of age, and also for those over 40 with dense breast tissue.
It operates within the principle of harmless, high-frequency sound waves that are translated into images by an appropriate computer software. Actually, sound waves pass through the breast tissue, bounce off various breast structures and reflect back to the probe that is cable-connected to the computer software for producing the ultrasound diagnostic image. As tissues vary in structure, the bounced-off sound waves are also of various distinguishing features. The examination technique is nonaggressive, i.e. it does not produce any tissue damage or involves no ionizing radiation.
Mammography, which is a recommended method for early detection, can identify breast cancer as many as two years before the lesion becomes palpable. Regular mammography screenings have been demonstrated to reduce breast cancer mortality by 30% among women aged 50-69, and in accordance with some statistics, it could produce comparable benefit to women between 40-50 years of age as well. For screening mammography to be viewed as effective, many criteria of equal value should be met.
A fundamental prerequisite is primarily a quality mammography machine, then technically well-performed scanning, image development using high-quality films, and indispensable skill required from the physician who must be able to precisely interpret a mammogram. So, for proper diagnosis, not any mammography but good quality mammography is required.
Sonography and mammography are standard breast imaging techniques. Any breast changes are assessed upon their morphology, or shape, and only indirectly upon their structure. To gain an in-depth insight into the type and nature of the cells involved, cytologic evaluation of either material obtained by fine-needle aspiration (cytologic puncture), or breast nipple discharge (cytologic analysis of breast nipple discharge), or scraped material from the skin of the nipple or areola (the pigmented skin around the nipple) in case of changes in this area. At our Polyclinic, specimens for cytologic analysis, if any, are taken under ultrasound guidance, and this painless and quick procedure can be done during the ultrasound examination itself. Specimen analysis is entrusted only to experienced experts in the field of cytology. The results are available the next day, which greatly reduces suspense-related stress.
Thanks to the state-of-the-art mammography equipment available at the Eljuga Polyclinic, we are able to provide a stereotactic breast biopsy of even the tiniest, mammographically visible breast abnormalities that otherwise cannot be seen. A tissue specimen of the suspicious area is taken using a specially designed, mammography-guided needle, and then sent for pathologic evaluation. False cytological or pathohistological results that might require a more extensive surgery are thus avoided.
If cytologic puncture cannot yield adequate material for analysis, which actually happens in about 10-15% of the cases due to either the structure and consistency of the change or its location within the breast, a larger amount of tissue should be taken to obtain an accurate diagnosis. If, on the other hand, there is a raised suspicion that the process within the breast is malignant and advanced to the extent requiring early start of chemotherapy, a specimen of the abnormal tissue is taken for detailed pathohistological evaluation to determine the optimal combination of cytostatic chemotherapy agents. Core needle biopsy has therefore been used with increasing frequency to obtain such specimen and avoid more aggressive surgery. Core needle biopsy or biopsy that involves the use of a large-bore needle is performed under ultrasound guidance to obtain a tissue sample for pathohistological analysis. The complete biopsy results, given by eminent breast pathologists, can be obtained in only 5-6 days.
A bloody discharge from the nipple rarely is a sign of breast cancer or in 10% of the cases alone. However, if cytologic evaluation reveals positive findings, galactography is indicated, and this diagnostic procedure can also be performed at our Polyclinic. After injection of a contrast agent into the discharging milk duct, a contrast mammogram of the involved breast is made to analyze the content of the secreting duct.
If any of the tests made at our Polyclinic reveal a pathological finding that requires surgical treatment, we are able to perform the required procedure at the time that suits you best. To facilitate extirpation of a nonpalpable breast lesion or if, for any reason, its precise and complete removal looks uncertain, presurgical marking, i.e. marking of breast changes under ultrasound or mammography guidance will be done directly before the surgery. The technique of choice depends on which of the two could better visualize the change. The marking is done with a specially designed needle having an anchor at one end, which firmly anchors the needle in the tissue portion to be removed. During the procedure, the needle guides the surgeon right to the site.
If you seek counseling, advice and recommendations in our specialist field, you are always welcome to turn to any member of our breast care team. If you need any further oncology treatment including chemotherapy, hormone therapy or radiation therapy, we are ready to help you receive the therapy at one of the most prominent local clinics providing specialist breast cancer care.
