1. 1 MAMMOGRAPHY RADIOGRAPHIC IMAGING OF THE BREAST Part 2 -Statistics A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it. A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it. No screening tool is 100% effective. Good quality mammograms can find 85-90% of cancers No screening tool is 100% effective. Good quality mammograms can find 85-90% of cancers

2. 2 Regular breast screening can find cancer when it is small which means: there is a better chance of treating the cancer successfully there is a better chance of treating the cancer successfully it is less likely to spread it is less likely to spread there may be more treatment options there may be more treatment options

3. 3 MAMMOGRAM REMAINS THE SINGLE MOST SENSITIVE TECHNIQUE IN DETECTION OF BREAST CANCER (ACR) REMAINS THE SINGLE MOST SENSITIVE TECHNIQUE IN DETECTION OF BREAST CANCER (ACR) OTHER MODALITIES: ULTRASOUND ULTRASOUND MRI MRI OTHER - thermography OTHER - thermography

4. 4 PATIENT FEARS PAINFUL PAINFUL FIND SOMETHING FIND SOMETHING WRONG / DENIAL WRONG / DENIAL UNINFORMED UNINFORMED “causes cancer”

5. 5 RISK FACTORS SEX 99% WOMEN SEX 99% WOMEN 1 % MEN 1 % MEN AGE – INCREASE WITH AGE* AGE – INCREASE WITH AGE* YOUNGER WOMEN- FASTER GROWING CELLS YOUNGER WOMEN- FASTER GROWING CELLS

6. 6 MORE RISK FACTORS HISTORY HISTORY PREGNANCY & ABORTIONS PREGNANCY & ABORTIONS OBESTIY OBESTIY EARLY MENSES EARLY MENSES LATE MENOPAUSE LATE MENOPAUSE

7. 7 ACS GUIDLINES women age 40 to 49 have a routine screening mammogram women age 40 to 49 have a routine screening mammogram every one to two years every one to two years with the first one beginning at age 40 with the first one beginning at age 40 BASELINE - for comparison BASELINE - for comparison

8. 8 Breast cancer – ACS Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over. Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over. Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self- exam (BSE) is an option for women starting in their 20s. Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self- exam (BSE) is an option for women starting in their 20s. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

9. 9 EDUCATION BSE – breast self exam - MONTHLY BSE – breast self exam - MONTHLY CBE –clinical breast exam – CBE –clinical breast exam – 3-6 months 3-6 months MAMMOGRAM – ANUALLY * BEGIN AGE 35 MAMMOGRAM – ANUALLY * BEGIN AGE 35

10. 10 Best Time For BSE The American Cancer Society urges women to perform breast self-examination (BSE) once a month about a week after the menstrual period about a week after the menstrual period Post-menopausal women should choose a set day, such as the first of the month, to practice self-examination. Post-menopausal women should choose a set day, such as the first of the month, to practice self-examination.

11. 11 Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here's what you should look for: Here's what you should look for: Breasts that are their usual size, shape, and color. Breasts that are their usual size, shape, and color. Breasts that are evenly shaped without visible distortion or swelling. Breasts that are evenly shaped without visible distortion or swelling. If you see any of the following changes, bring them to your doctor's attention: If you see any of the following changes, bring them to your doctor's attention: Dimpling, puckering, or bulging of the skin. Dimpling, puckering, or bulging of the skin. A nipple that has changed position or become inverted (pushed inward instead of sticking out). A nipple that has changed position or become inverted (pushed inward instead of sticking out). Redness, soreness, rash, or swelling. Redness, soreness, rash, or swelling.

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14. 14 Some cancers are not found until they reach this size A mammogram can find cancer when it is only this size

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16. 16 Cancer statistics Breast cancer strikes about 180,000 American women yearly Breast cancer strikes about 180,000 American women yearly and kills about 44,000 and kills about 44,000 Next to skin cancer, breast cancer is the most frequently diagnosed cancer in women in the United States Next to skin cancer, breast cancer is the most frequently diagnosed cancer in women in the United States It is second only to lung cancer in cancer- related deaths It is second only to lung cancer in cancer- related deaths

17. 17 RISK "Lifetime risk is the likelihood that a newborn girl will develop breast cancer sometime during her entire life. "Lifetime risk is the likelihood that a newborn girl will develop breast cancer sometime during her entire life. The 1-in-9 statistic does not apply to women of all ages The 1-in-9 statistic does not apply to women of all ages

18. 18 RISK VS REALITY chance of being diagnosed with breast cancer 30-year-old woman has a 2% (1 in 50) in the next 20 years 30-year-old woman has a 2% (1 in 50) in the next 20 years a 40-year-old has a 4.5% (1 in 20) a 40-year-old has a 4.5% (1 in 20) 50-year-old woman's risk of developing invasive breast cancer--the most serious kind--in the next 5 to 20 years 50-year-old woman's risk of developing invasive breast cancer--the most serious kind--in the next 5 to 20 years ranged anywhere from 1 in 15 to 1 in 133 depending on her ethnicity. ranged anywhere from 1 in 15 to 1 in 133 depending on her ethnicity.

19. 19 four major ethnic group Asian/Pacific Islanders Hispanic African American Caucasian

20. 20 "For women currently aged 50 the estimated risk of developing invasive breast cancer within 5 years 0.8% (1 in 133) among Hispanics 0.8% (1 in 133) among Hispanics 1.3% (1 in 75) among Caucasians 1.3% (1 in 75) among Caucasians Within the next 20 years 3.7% (1 in 27) among Hispanics 3.7% (1 in 27) among Hispanics 6.6% (1 in 15) among Caucasians 6.6% (1 in 15) among Caucasians 5% (1 in 20) among African Americans 5% (1 in 20) among African Americans 3.9% (1 in 26) among Asian/Pacific Islanders 3.9% (1 in 26) among Asian/Pacific Islanders

21. 21 TYPES OF BREAST TISSUE can you name them?

22. 22 15 – 30 YO 15 – 30 YO NO CHILDREN OVER 30 NO CHILDREN OVER 30 PREGNANT/LACTATING PREGNANT/LACTATING UNDER 25 – ULTRSOUND RECOMMENDED UNDER 25 – ULTRSOUND RECOMMENDED Why? Why? What does US show? What does US show? FIBROGLADULAR (DENSE) POSITION? 19-year-old woman who has never been pregnant. Note the dense glandular tissues with small amounts of fat

23. 23 FIBRO-FATTY AVERAGE DENSITY AVERAGE DENSITY 50% FATTY 50 % GLANDULAR 50% FATTY 50 % GLANDULAR 30 – 50 YRS OLD 30 – 50 YRS OLD YOUNG WOMEN W/ 3 PREGNANCIES YOUNG WOMEN W/ 3 PREGNANCIES POSITION?

24. 24 FATTY MINIMAL DENSITY = FATTY MINIMAL DENSITY = FATTY OVER 50 YRS OLD OVER 50 YRS OLD POSTMENOPAUSAL ATROPHIC POSTMENOPAUSAL ATROPHIC MALE BREAST MALE BREAST CHILD BREAST CHILD BREAST POSITION? 68-year-old woman. Most of the glandular tissue is atrophic