Podcast
Questions and Answers
What is the hereditary risk percentage of breast cancers related to family history?
What is the hereditary risk percentage of breast cancers related to family history?
5-10%
Which group has an increased risk of breast cancer?
Which group has an increased risk of breast cancer?
Mutation of the tumour suppressing gene is associated with ____ gene.
Mutation of the tumour suppressing gene is associated with ____ gene.
BRCA
Match the breast density level with its description:
Match the breast density level with its description:
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Breast compression helps reduce scatter and dose, increasing contrast in mammograms.
Breast compression helps reduce scatter and dose, increasing contrast in mammograms.
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How often should females aged 45-69 have screening mammograms?
How often should females aged 45-69 have screening mammograms?
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What do Cooper's ligaments in the breast help to maintain?
What do Cooper's ligaments in the breast help to maintain?
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What do Montgomery glands on the areola provide?
What do Montgomery glands on the areola provide?
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Which type of breast cancer cell does not have receptors for estrogen and progesterone hormones?
Which type of breast cancer cell does not have receptors for estrogen and progesterone hormones?
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What is the purpose of a face shield during mammography?
What is the purpose of a face shield during mammography?
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Study Notes
Risk Factors
- 5-10% of breast cancers are hereditary, increasing risk if:
- Parent/sibling/child have breast/ovarian cancer, especially under 50 years old
- Multiple close relatives are affected by breast or ovarian cancer
- Relatives have both breast and ovarian cancer
- Relatives were diagnosed with breast cancer before menopause
- Relatives have bilateral breast cancer
- Are of Ashkenazi (Eastern European) Jewish ancestry
- BRCA gene: hereditary, Ashkenazi (Eastern European) Jewish ancestry, mutation of the tumor-suppressing gene
Breast Density
- BI-RADS (Breast Imaging Reporting and Data System) levels of breast density:
- A: Almost entirely fatty (1 in 10 women)
- B: Scattered areas of fibroglandular tissue (4 in 10 women)
- C: Heterogeneously dense (4 in 10 women)
- D: Extremely dense (1 in 10 women)
MIQ Classification
- Perfect:
- Maximum breast tissue imaged
- Appropriate exposure
- Appropriate compression
- Absence of movement/geometric blur
- Absence of artifacts
- Skin fold free
- Symmetrical images
- Correct annotations
- Good:
- As with excellent, but with minor exceptions
- Moderate:
- As with good, but with minor exceptions
- Inadequate:
- Part of breast not imaged
- Inadequate identification/annotation
- Incorrect exposure
- Inadequate compression
- Movement/geometric blur
- Overlying artifacts
Views
- CC:
- Medial aspect shown
- As much axillary tail as possible
- Pectoral muscle shadow at chest wall
- MLO:
- Pectoral muscle shadow to nipple level
- Pectoral muscle at appropriate angle
- Nipples in profile
- Infra-mammary angle clearly demonstrated
- Additional views:
- Lateral: better localize medial or lateral lesions, shows effects of gravity on air-fluid levels
- Extended view: for imaging axillary tail
- Cleavage view: for imaging medial and posterior breast tissue
- Compression spot views: provides better tissue separation and visualization
- Magnification views: similar to spot views, but with additional platform to reduce SID
- Tomosynthesis: 2D views taken at multiple angles to provide a 3D view
- Push back views: for breast implants
Breast Compression
- Advantages:
- Immobilizes breast, reducing chance of movement unsharpness
- Reduces scatter and dose, increases contrast
- Decreases OFD, reducing geometric unsharpness
- Breast tissue is more evenly distributed, making it easier to diagnose
- Decreases exposure time, reducing movement unsharpness and dose
Screening vs Diagnostic
- Screening:
- Every 2 years for females aged 45-69
- Have not had a mammogram within the previous 12 months
- Not pregnant or breastfeeding
- Free from cancer
- Asymptomatic
- Eligible for public health services in NZ
- Diagnostic:
- For males or females who are symptomatic, of any age
- Referred by GP
- Additional imaging used initially
- Under 35 will have U/S first
Anatomy
- Cooper's ligaments: help maintain structure and shape of breast, connecting lobules to skin surface
- Montgomery glands: protrusions on the surface of the areola, providing lubrication during lactation
Pathologies
- Ultrasound:
- For women under 35
- Assess lesions for size, shape, density
- Useful for helping to diagnose cancer in people with dense breast tissue
- Best modality for looking at lesions and localized areas
- Appearance on U/S:
- Benign:
- Cysts: fluid accumulation inside gland/s in the breast
- Fibroadenoma: lumps from excess proliferation of connective tissue
- Malignant:
- DCIS: ductal carcinoma in situ, cells lining milk ducts become cancerous
- Lobular carcinoma: starts in milk-producing glands (lobules) of the breast
- Inflammatory breast cancer: rare, aggressive, occurs in younger women, worse prognosis
- Triple-negative breast cancer: a type of breast cancer where cells lack receptors for estrogen and progesterone hormones and the HER2 protein
- Benign:
Symptoms of Breast Cancer
- Lumps
- Pain
- New nipple inversion
- Swelling
- Dimming
- Orange peel skin
- Enlarged axillary lymph nodes
MRI
- Advantages:
- For high-risk patients
- Patients with extremely dense breast tissue
- Gold standard for implant ruptures
- Assessing chest wall invasion and axillary pathology
- No compression necessary
- Disadvantages:
- Expensive
- Does not show calcifications
- Low specificity for malignant vs benign lesions
- Metal contraindications
- Long scan times
Sentinel Node
- First lymph node to receive lymphatic fluid from the breast
- Sentinel node is biopsied (sentinel node biopsy) and tested to determine breast cancer staging
Treatment
- Surgery
- Chemotherapy
- Radiation therapy
- Hormone replacement therapy
Equipment
- kVp range: 24-35 kVp
- Tube angle: 20-24 degrees
- Tube heads: tilted to cover entire image field, utilize anode heel effect, and get tube parallel to chest wall
- Filters: commonly made of Molybdenum (Mo) or Rhodium (Rh)
- Target material: made of Molybdenum (Mo) or Rhodium (Rh)
- Ideal target/filter combinations: Rhodium/Rhodium or Tungsten/Rhodium
- AEC: positioned behind the detector to reduce OID and improve spatial resolution
- Detector: composed of Cesium Iodide crystals (Indirect) or Amorphous silicon (Direct)
- Preferred detector composition: Direct
- Focal spot sizes: 0.1mm or 0.3mm
- Face shield: to ensure no artifacts from the head in the x-ray beam and to reduce dose to the eyes and thyroid
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Description
Learn about the risk factors associated with breast cancer, including family history, genetics, and more. Identify the signs that may indicate a higher risk of developing breast cancer.