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Breast cancer is a major cause of morbidity and mortality in women in many parts of the world. One of the most important elements of modern breast cancer treatment is a high-level pathology service. Today breast cancer is divided into an increasingly complex number of categories based on sophisticated molecular markers, special stains and subtle differences that were simply not available a few years ago. Pathologists play a crucial role in the treatment planning conferences as the treatment options available for a given patient frequently change after careful review by these experts.
There are several methods physicians can utilize to assess a woman's risk for breast cancer, including personal and family history, statistical models, pedigree construction, and genetic mutation analysis. Researchers have found the women who get breast cancer often have certain risk factors in common. These risk factors include:
- Have had breast cancer in the past
- Have close relatives who have had breast cancer
- Have a 5-year Gail Risk Model of 17% or greater
- Have a BRCA1 or BRCA2 gene mutation
Combining a patient's history with atypical cytologic findings allows you to know more now about your patient's individual breast cancer risk.
Detection of breast cancer while it is still small and confined to the breast provides the best chance o effective treatment for women with the disease. There are benefits to early detection including increased survival, increased treatment options and improved quality of life. There is constant ongoing research to improve existing and create new techniques. Here are some of the diagnostic tools currently available:
Mammography:
High-quality mammography is the most effective technology presently available for breast cancer screening. There are efforts to improve mammography which focus on refining the technology and improving how it is administered and how x-ray films are interpreted.
Digital Mammography:
Digital mammography is a technique or recording x-ray images in computer code instead on x-ray film, as with conventional mammography. The images are displayed on a computer monitor and can be enhanced before they are printed on film. Images can also be manipulated by magnifying or zooming onto a specific area.
There are some advantages of digital mammography verses conventional mammography: improved accuracy, ability to adjust images, and electronic storage and retrieval.
Fine Needle Aspiration:
A fine needle aspiration is done to remove tissue or fluid from the suspicious area. That material is then examined under a microscope to check for any signs of disease.
Ultrasound:
Ultrasound imaging of the breast is used to distinguish between solid tumors and fluid-filled cysts. Ultra sounds can be used to evaluate lumps that are hard to see on a mammogram. An ultrasound can also be used as part of other procedures
MRI:
Each MRI produces hundreds of images of the breast from side-to-side, top to bottom, and front-to-back. Breast MRI is not used for routine breast cancer screening. MRI is used primarily to assess abnormal areas that are seen on a mammogram or are felt after breast surgery or radiation therapy. It can be used after breast cancer is diagnosed to determine the extent of the tumor in the breast. MRI is also useful in imaging dense breast tissue and in viewing breast abnormalities that can be felt but are not visible with conventional mammography or ultrasound. It is also useful in patients who are "high risk" for breast cancer.
PET Scan:
The PET scan may play a role in determining weather a breast mass is cancerous. PET scans are more accurate in detecting larger and more aggressive tumors. They may detect cancer when other imaging techniques show normal results.
Image-Guided Breast Biopsy:
Imaging techniques play an important role in helping physicians perform breast biopsies, especially of abnormal areas that cannot be felt but can be seen on a conventional mammogram or with ultrasound. An example of this would be a sterotactic-guided biopsy. Stereotactic refers to the use of a computer and scanning devices to create three-dimensional images. During this biopsy a needle is inserted into the precise location of the abnormal area. This is possible because of the three-dimensional images. Multiple samples can be taken from various locations within the abnormal area.
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