Breast Imaging
Digital Mammography
Is a low dose Xray of the breast. This is primary method used for breast screening. Both Breast Screening facilities in Wellington and Pacific Radiology offer 3D mammography (tomosynthesis). This is helpful in women with dense breast tissue or when mammogram has detected an abnormality. There is a slightly higher dose of radiation associated with tomosynthesis.
A screening mammogram is performed as part of routine screening when there are no abnormalities felt.
A diagnostic mammogram is performed when an abnormality is detected on examination.
Ultrasound
It uses sound waves to image the breast tissue and it is not substitute for mammography. It is not helpful in diagnosing calcifications.
MRI
It is only recommended in patients with high risk of breast cancer (usually due to family history or genetic predisposition). In a patient with new diagnosis of breast cancer it may be helpful in assessing the extent of the disease (especially in case of lobular cancer or when there is discrepancy in extent on mammogram and ultrasound).
MRI of the breast is associated with 10-20% of false positive (false alarm) rate - when MRI shows something suspicious and on other imaging and especially biopsy it proves to be benign. The safety of Gadolinium, a contrast agent used in breast MRI, has been called into question, but there is a limited information about this.
Is a low dose Xray of the breast. This is primary method used for breast screening. Both Breast Screening facilities in Wellington and Pacific Radiology offer 3D mammography (tomosynthesis). This is helpful in women with dense breast tissue or when mammogram has detected an abnormality. There is a slightly higher dose of radiation associated with tomosynthesis.
A screening mammogram is performed as part of routine screening when there are no abnormalities felt.
A diagnostic mammogram is performed when an abnormality is detected on examination.
Ultrasound
It uses sound waves to image the breast tissue and it is not substitute for mammography. It is not helpful in diagnosing calcifications.
MRI
It is only recommended in patients with high risk of breast cancer (usually due to family history or genetic predisposition). In a patient with new diagnosis of breast cancer it may be helpful in assessing the extent of the disease (especially in case of lobular cancer or when there is discrepancy in extent on mammogram and ultrasound).
MRI of the breast is associated with 10-20% of false positive (false alarm) rate - when MRI shows something suspicious and on other imaging and especially biopsy it proves to be benign. The safety of Gadolinium, a contrast agent used in breast MRI, has been called into question, but there is a limited information about this.
Breast Biopsy
There are several types of biopsy:
Fine need biopsy and core biopsy are performed under local anaesthetic. Excision biopsy is usually performed under general anaesthetic.
Complications following biopsy are minimal:
- Fine needle biopsy/aspiration (FNA) – mostly used for performing a biopsy of an axillary lymph node. Occasionally cyst is aspirated and contents sent for analysis.
- Core biopsy – mostly used for diagnosis of any breast abnormalities that are detected on breast examination or breast imaging. Ultrasound guided core biopsy is performed when the abnormality is seen on ultrasound. Stereotactic biopsy is performed when the abnormality is seen only on mammogram. At times MRI biopsy is performed if the abnormality is only seen on the MRI.
- Excision biopsy - surgically performed biopsy. It is performed for lesions that may be associated with malignancy/cancer like atypical ductal hyperplasia, papilloma, radial scar, fibroadenoma with cellular atypia etc.
Fine need biopsy and core biopsy are performed under local anaesthetic. Excision biopsy is usually performed under general anaesthetic.
Complications following biopsy are minimal:
- Bruising is common and disappears with time
- Wound infection is very rare
- Scarring is minimal
Benign Breast Conditions
Fibrocystic breast changes used to be called fibrocystic breast disease which was wrong. Fibrocystic changes are part of the normal breast cycle and leads to degree of breast lumpiness. At times these changes become more pronounced and lead to lumps, pains or discharge. Due to these it often leads to investigations including mammograms and ultrasounds.
Mastalgia is medical term for breast pain. This pain is often cyclical, usually more severe during the premenstrual phase of period cycle, and resolves following the period. Pain most commonly occurs in the upper outer part of the breast and may extend to the nipple and inner part of the upper arm. Non-cyclical mastalgia occurs when the pain is no related to the menstrual cycle. The pain may be consistent in nature, burning, sharp or stabbing. Often breast imaging is performed to exclude a mass. Wearing a supportive bra, using pain relief and decreasing intake of caffeine, salt and tobacco may help. Evening primrose oil, vitamin E, Vitamin B complex have also shown benefit in some patients in treating persistent pain. Any masses present should be investigated by a physician.
Breast cysts are very common and are seen as a component of fibrocystic changes. These are fluid filled sac or may be present as several sacs (cysts). They usually disappear in menopause. Most are very small and are not able to be felt. They often change is size depending on the menstrual cycle. Cysts can become quite large and then may become palpable. In this situation they can feel soft or hard and may move on examination. A breast examination and imaging are done to ensure that the cancer is excluded. Most cysts do not require any treatment. Large or painful cysts may be aspirated (fluid removed with a needle under local anesthetic). If cysts have solid components, biopsy of these needs to be performed. Simple cysts do not increase the risk of getting breast cancer.
Fibroadenomas are very common solid breast lesions. They mostly occur in young women, including teenagers. They may be tender to touch or not painful at all. They often feel rubbery. They can vary in size from few millimeters to more then 5cm. Imaging is done to exclude cancer. Often a biopsy is performed to confirm the diagnosis of fibroadenoma that has been suggested on the ultrasound. Treatment of fibroadenomas is required if they are large or are increasing in size.
Nipple discharge is also very common breast condition. Majority of nipple discharge is not associated with malignancy. The discharge may be milky, clear, yellow, green or brown. If nipple discharge is bloody in nature, then examination and imaging are indicated. At times also biopsy is performed to exclude cancer.
Any finding of new breast mass or change in the breast shape should be evaluated by a physician.
Mastalgia is medical term for breast pain. This pain is often cyclical, usually more severe during the premenstrual phase of period cycle, and resolves following the period. Pain most commonly occurs in the upper outer part of the breast and may extend to the nipple and inner part of the upper arm. Non-cyclical mastalgia occurs when the pain is no related to the menstrual cycle. The pain may be consistent in nature, burning, sharp or stabbing. Often breast imaging is performed to exclude a mass. Wearing a supportive bra, using pain relief and decreasing intake of caffeine, salt and tobacco may help. Evening primrose oil, vitamin E, Vitamin B complex have also shown benefit in some patients in treating persistent pain. Any masses present should be investigated by a physician.
Breast cysts are very common and are seen as a component of fibrocystic changes. These are fluid filled sac or may be present as several sacs (cysts). They usually disappear in menopause. Most are very small and are not able to be felt. They often change is size depending on the menstrual cycle. Cysts can become quite large and then may become palpable. In this situation they can feel soft or hard and may move on examination. A breast examination and imaging are done to ensure that the cancer is excluded. Most cysts do not require any treatment. Large or painful cysts may be aspirated (fluid removed with a needle under local anesthetic). If cysts have solid components, biopsy of these needs to be performed. Simple cysts do not increase the risk of getting breast cancer.
Fibroadenomas are very common solid breast lesions. They mostly occur in young women, including teenagers. They may be tender to touch or not painful at all. They often feel rubbery. They can vary in size from few millimeters to more then 5cm. Imaging is done to exclude cancer. Often a biopsy is performed to confirm the diagnosis of fibroadenoma that has been suggested on the ultrasound. Treatment of fibroadenomas is required if they are large or are increasing in size.
Nipple discharge is also very common breast condition. Majority of nipple discharge is not associated with malignancy. The discharge may be milky, clear, yellow, green or brown. If nipple discharge is bloody in nature, then examination and imaging are indicated. At times also biopsy is performed to exclude cancer.
Any finding of new breast mass or change in the breast shape should be evaluated by a physician.
DCIS
Ductal Carcinoma in Situ (DCIS) is a NON-invasive breast malignancy. It is present in the milk ducts and it has NOT spread into the surrounding normal breast tissue. DCIS is not life-threatening, but it is associated of higher risk of developing an invasive breast cancer. The rates of DCIS are increasing because people are living longer and because of improved breast screening and imaging.
DCIS usually does not present with any symptoms, but is a finding on a mammogram. A small number of women present with a mass or bloody discharge or nipple changes.
Diagnosis usually involves physical examination of the breasts, imaging (mammogram +/-USS+/-MRI) and core biopsy. If core biopsy is not conclusive, then excisional biopsy is usually necessary.
The pathology report will include the diagnosis of the DCIS, grade of DCIS (grade1-3) and whether any microinvasion is present. In Wellington region the hormonal receptor status on DCIS is not performed.
Standard treatment for DCIS include
“One size fits all” does NOT apply to treatment recommendations of DCIS or invasive breast cancer.
In Wellington region, all cases of DCIS and invasive breast cancer are discussed at the Breast Multidisciplinary Meeting following surgery. Members of this meeting include: breast surgeons, breast radiologist, medical oncologist (chemotherapy specialists), radiation oncologists (radiotherapy specialists), breast pathologists and may include breast physicians. Recommendations of any further treatment following surgery are made at this meeting. If radiation treatment is recommended, then patients are referred to be seen by the Radiation Oncologist for discussion of risks and benefits of radiation treatment.
DCIS usually does not present with any symptoms, but is a finding on a mammogram. A small number of women present with a mass or bloody discharge or nipple changes.
Diagnosis usually involves physical examination of the breasts, imaging (mammogram +/-USS+/-MRI) and core biopsy. If core biopsy is not conclusive, then excisional biopsy is usually necessary.
The pathology report will include the diagnosis of the DCIS, grade of DCIS (grade1-3) and whether any microinvasion is present. In Wellington region the hormonal receptor status on DCIS is not performed.
Standard treatment for DCIS include
- Lumpectomy alone
- Lumpectomy followed by radiation therapy
- Mastectomy with or without breast reconstruction
“One size fits all” does NOT apply to treatment recommendations of DCIS or invasive breast cancer.
In Wellington region, all cases of DCIS and invasive breast cancer are discussed at the Breast Multidisciplinary Meeting following surgery. Members of this meeting include: breast surgeons, breast radiologist, medical oncologist (chemotherapy specialists), radiation oncologists (radiotherapy specialists), breast pathologists and may include breast physicians. Recommendations of any further treatment following surgery are made at this meeting. If radiation treatment is recommended, then patients are referred to be seen by the Radiation Oncologist for discussion of risks and benefits of radiation treatment.
BREAST CANCER
Breast cancer is the most common cancer in New Zealand. On average 1 in 9 women will develop it at some stage in their lives. It may present as a mass, change in shape of the breast or nipple, skin dimpling or puckering and bloody nipple discharge. Many breast cancers are diagnosed at the Breast Screening before women develop any symptoms. Men can develop breast cancer, approximately 1 of 100 new breast cancer diagnosis are found in men.
Breast cancer develops when breast cancer cells develop abnormally, grow out of control and start invading into surrounding tissue.
Different types of breast cancer behave differently and have different molecular biology. Treatment options depend on cancer behaviour and biology as well as stage at presentation. The stage of breast cancer depends on the size of the cancer, number of lymph nodes involved and whether the cancer has spread (metastasized) to any other tissue apart from lymph nodes.
The treatment of breast cancer usually involves surgery and may also involve radiation and chemotherapy. Depending on the cancer there are different treatment options available to women and this can at times lead to confusion. There should be no rush to make decision or start treatment straight away. With most breast cancers, there is time to think about the options and gather all the information (sometimes may include different imaging or other testing). There is time to get more then one opinion if needed and you can always talk to other women so you can carefully consider all your options.
Surgical treatment options can be lumpectomy (or wide local excision) or mastectomy (with or without reconstruction). If the lump is not palpable then Hookwire may be used to localize the lesion and guide the surgeon to the area that needs to be removed.
Radiotherapy is most often used after lumpectomy (wide local excision or breast conserving surgery). It may also be recommended after mastectomy. Standard radiation therapy is given over 4 weeks (20 treatments), but sometimes other radiation options are available as well. It is always performed after surgical treatment.
Chemotherapy can be given in some cases before surgery (neoadjuvant chemotherapy) or mostly after surgery (adjuvant chemotherapy). It is usually given to tumours that show more aggressive behavior and may have already spread to the lymph node.
If cancer is oestrogen and/or progesterone positive, then endocrine treatment is also recommended. This may consist of tamoxifen or aromatise inhibitors (anastrazole, exemestane or letrozole) medication.
As said before “One size fits all” does NOT apply to treatment recommendations of invasive breast cancer.
In Wellington region, all cases of DCIS and invasive breast cancer are discussed at the Breast multidisciplinary meeting following surgery. Members of this meeting include: breast surgeons, breast radiologist, medical oncologist (chemotherapy specialists), radiation oncologists (radiotherapy specialists), breast pathologists and may include breast physicians. Recommendations of any further treatment are made at this meeting. If radiation treatment or chemotherapy or both are recommended, then patients are referred to be seen by the Radiation Oncologist for discussion of risks and benefits of radiation treatment and to Medical Oncologist for discussion of risks and benefits of chemotherapy.
Breast cancer develops when breast cancer cells develop abnormally, grow out of control and start invading into surrounding tissue.
Different types of breast cancer behave differently and have different molecular biology. Treatment options depend on cancer behaviour and biology as well as stage at presentation. The stage of breast cancer depends on the size of the cancer, number of lymph nodes involved and whether the cancer has spread (metastasized) to any other tissue apart from lymph nodes.
The treatment of breast cancer usually involves surgery and may also involve radiation and chemotherapy. Depending on the cancer there are different treatment options available to women and this can at times lead to confusion. There should be no rush to make decision or start treatment straight away. With most breast cancers, there is time to think about the options and gather all the information (sometimes may include different imaging or other testing). There is time to get more then one opinion if needed and you can always talk to other women so you can carefully consider all your options.
Surgical treatment options can be lumpectomy (or wide local excision) or mastectomy (with or without reconstruction). If the lump is not palpable then Hookwire may be used to localize the lesion and guide the surgeon to the area that needs to be removed.
Radiotherapy is most often used after lumpectomy (wide local excision or breast conserving surgery). It may also be recommended after mastectomy. Standard radiation therapy is given over 4 weeks (20 treatments), but sometimes other radiation options are available as well. It is always performed after surgical treatment.
Chemotherapy can be given in some cases before surgery (neoadjuvant chemotherapy) or mostly after surgery (adjuvant chemotherapy). It is usually given to tumours that show more aggressive behavior and may have already spread to the lymph node.
If cancer is oestrogen and/or progesterone positive, then endocrine treatment is also recommended. This may consist of tamoxifen or aromatise inhibitors (anastrazole, exemestane or letrozole) medication.
As said before “One size fits all” does NOT apply to treatment recommendations of invasive breast cancer.
In Wellington region, all cases of DCIS and invasive breast cancer are discussed at the Breast multidisciplinary meeting following surgery. Members of this meeting include: breast surgeons, breast radiologist, medical oncologist (chemotherapy specialists), radiation oncologists (radiotherapy specialists), breast pathologists and may include breast physicians. Recommendations of any further treatment are made at this meeting. If radiation treatment or chemotherapy or both are recommended, then patients are referred to be seen by the Radiation Oncologist for discussion of risks and benefits of radiation treatment and to Medical Oncologist for discussion of risks and benefits of chemotherapy.
INFORMATION about Breast Surgery
Breast Conserving Surgery or lumpectomy or wide local excision
The palpable cancer or DCIS are removed with a surrounding rim of normal breast tissue. This is usually done as day surgery, but you may stay in overnight. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic.
Hookwire guided excision is used when the lesion or area that needs to be removed is not palpable and therefore difficult to locate at the time of surgery. A guidewire is necessary to mark or locate the correct area that needs to be removed. Hookwire is a very fine wire, around 1mm in diameter. The insertion of the Hookwire is done by radiologist in the morning prior to your surgery. It may be done at Bowen, Boulcott or Wakefield hospital. Mammogram or ultrasound is used to position the wire into the correct area. Your surgery is done under general anaesthetic. The surgeon will remove a piece of the breast tissue around the Hookwire. Whilst you are still under general anaesthetic the specimen with wire in situ will be X-rayed again to check that the correct area has been removed. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. This is usually done as day surgery, but you may stay in overnight.
Mastectomy
It involves removing the whole breast. It is performed when breast conserving surgery is not possible or you choose to have mastectomy. You can expect to be in hospital for 1 night. At the end of the procedure you will have a drain placed. The drain collects any fluid from under your wound. District nurses will come to your place daily to check on the drain. It usually stays in place for 1-2 weeks. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic.
After and before surgery you should start shoulder exercises to prevent shoulder stiffness. Your physiotherapist will show you these while in hospital and it is important that you continue these after the surgery.
Sentinel Node Biopsy
This is performed when lymph nodes in the armpit are not clinically (on ultrasound or palpation) involved by cancer. Sentinel lymph node is defined as the first lymph node that the cancer is likely to spread. During this procedure sentinel lymph node(s) are removed and examined by pathologist to determine whether cancer cells are present there.
A radioactive dye +/- blue dye (Patent Blue) are injected in theatre into the breast. The surgeon finds the radioactive nodes using a probe (Geiger counter) or finds the blue lymph nodes. This is usually done at the same time the primary cancer/DCIS is removed. This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. This is usually done as day surgery, but you may stay in overnight.
Axillary Node Dissection
This is performed when the lymph nodes in the armpit are involved. The number of the lymph nodes removed vary from person to person. All the lymph nodes in the armpit that are below the axillary vein are removed.
This is usually done at the same time the primary cancer/DCIS is removed. This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the procedure you may have a drain placed. The drain collects any fluid from under your armpit. District nurses will come to your place daily to check on the drain. It usually stays in place for 1-2 weeks.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. You are likely to stay in hospital overnight.
Possible Complications of Breast Surgery
Return to work
The average return is 1-3 weeks depending on the type and duration of your surgery. This will also depend on the type of work that you do. Most people start driving within 2 weeks.
Legally you cannot drive, work with heavy machinery, make any important decisions, sign important documents or drink alcohol within 24 hours following general anaesthetic.
The palpable cancer or DCIS are removed with a surrounding rim of normal breast tissue. This is usually done as day surgery, but you may stay in overnight. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic.
Hookwire guided excision is used when the lesion or area that needs to be removed is not palpable and therefore difficult to locate at the time of surgery. A guidewire is necessary to mark or locate the correct area that needs to be removed. Hookwire is a very fine wire, around 1mm in diameter. The insertion of the Hookwire is done by radiologist in the morning prior to your surgery. It may be done at Bowen, Boulcott or Wakefield hospital. Mammogram or ultrasound is used to position the wire into the correct area. Your surgery is done under general anaesthetic. The surgeon will remove a piece of the breast tissue around the Hookwire. Whilst you are still under general anaesthetic the specimen with wire in situ will be X-rayed again to check that the correct area has been removed. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. This is usually done as day surgery, but you may stay in overnight.
Mastectomy
It involves removing the whole breast. It is performed when breast conserving surgery is not possible or you choose to have mastectomy. You can expect to be in hospital for 1 night. At the end of the procedure you will have a drain placed. The drain collects any fluid from under your wound. District nurses will come to your place daily to check on the drain. It usually stays in place for 1-2 weeks. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic.
After and before surgery you should start shoulder exercises to prevent shoulder stiffness. Your physiotherapist will show you these while in hospital and it is important that you continue these after the surgery.
Sentinel Node Biopsy
This is performed when lymph nodes in the armpit are not clinically (on ultrasound or palpation) involved by cancer. Sentinel lymph node is defined as the first lymph node that the cancer is likely to spread. During this procedure sentinel lymph node(s) are removed and examined by pathologist to determine whether cancer cells are present there.
A radioactive dye +/- blue dye (Patent Blue) are injected in theatre into the breast. The surgeon finds the radioactive nodes using a probe (Geiger counter) or finds the blue lymph nodes. This is usually done at the same time the primary cancer/DCIS is removed. This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. This is usually done as day surgery, but you may stay in overnight.
Axillary Node Dissection
This is performed when the lymph nodes in the armpit are involved. The number of the lymph nodes removed vary from person to person. All the lymph nodes in the armpit that are below the axillary vein are removed.
This is usually done at the same time the primary cancer/DCIS is removed. This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the procedure you may have a drain placed. The drain collects any fluid from under your armpit. District nurses will come to your place daily to check on the drain. It usually stays in place for 1-2 weeks.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound. You can shower as normal. I will see you usually within 2 weeks and remove the dressing in the clinic. You are likely to stay in hospital overnight.
Possible Complications of Breast Surgery
- Bruising – is common and disappears with time
- Haematoma – blood can collect under the skin (haematoma) and cause swelling, discomfort and hardness. It usually resolves, but rarely may need surgery to remove it.
- Wound Infection – this is also unusual. TYhings ot look for are spreading skin redness, discharge from the wound or around the drain, worsening pain in the wound, warm and swollen wound and feeling unwell with flu-like symptoms.
- Change in Sensation – some will occur in the skin because sensory nerves to this area have been affected by the surgery.
- Seroma – fluid will collect in wound in small or larger quantities. If it causes discomfort it may need to be removed using a syringe. This is not a painful procedure.
- Cording – are the tight strands that you may feel in your armpit after the surgery and may impair your shoulder movement. The best prevention is exercise to minimize the scarring in the area.
- Lymphoedema – see the next section
Return to work
The average return is 1-3 weeks depending on the type and duration of your surgery. This will also depend on the type of work that you do. Most people start driving within 2 weeks.
Legally you cannot drive, work with heavy machinery, make any important decisions, sign important documents or drink alcohol within 24 hours following general anaesthetic.
LIFSTYLE
Obesity
Obesity is associated with higher risk of multiple cancers, but especially breast cancer. This seems to be even more so in the postmenopausal women.
Women who are obese and have had a breast cancer are also at 30% higher risk of recurrence and a 50% higher risk of dying from breast cancer.
The relationship of increased risk and recurrence of breast cancer is linked to higher levels of oestrogens and other hormones (insulin). It has been shown that weight loss and weightloss plus exercise decrease oestrogen levels in the body.
Smoking
Smoking does not increase the risk of developing breast cancer, but it does increase the risk of breast cancer recurrence, breast cancer mortality and mortality overall. Women who have had or do smoke were 25% more likely to die of breast cancer. Women who stop smoking can decrease their risk of dying from breast cancer by a third then those women who continue to smoke.
Exercise
Moderate exercise has been shown to decrease the risk of breast cancer by up to 20%. Moderate exercise should be performed for 30 min each day for 5 days in a week. 30 min may be in one session or multiple sessions. Level of moderate exercise is different for different, but is best monitored with heart rate. Any exercise that increases your heart rate to moderate levels is defined as moderate exercise. For moderate-intensity physical activity, a person's target should be 50 to 70 per cent of their maximum heart rate. The maximum rate is based on a person's age. An estimate of a person's maximum heart rate can be calculated as 220 beats per minute (bpm) minus your age.
Diet
Diet is thought to be partly responsible for about 30% to 40% of all cancers. Breast cancer is less common in countries where the typical diet is plant-based and low in total fat (polyunsaturated fat and saturated fat).
Sleep
Adequate sleep is necessary for well-being, for most people this is 7-9 hours per day. Research on sleep duration and breast cancer risk isn’t conclusive, but we know that getting less than 6 hours per night can lead to trouble. Much of the repair of the everyday wear and tear of living happens during the night. Sleep deprivation can cause low grade inflammation, which is linked to almost all types of cancer and heart disease. Too much light at night has been linked to higher breast cancer risk — which may be due to lower melatonin levels. Melatonin is the sleep hormone that comes out in darkness. It appears to have an important role in regulating normal cell growth.
Meditation
Meditation seems to help breast cancer patients better manage symptoms of fatigue, anxiety, fear of recurrence and hot flushes. It just makes you feel a bit better in many aspects of your life. Meditation can be guided or non-guided. It can be done in groups or alone. Some people use smartphone/tablet apps like headspace or Calm.
Obesity is associated with higher risk of multiple cancers, but especially breast cancer. This seems to be even more so in the postmenopausal women.
Women who are obese and have had a breast cancer are also at 30% higher risk of recurrence and a 50% higher risk of dying from breast cancer.
The relationship of increased risk and recurrence of breast cancer is linked to higher levels of oestrogens and other hormones (insulin). It has been shown that weight loss and weightloss plus exercise decrease oestrogen levels in the body.
Smoking
Smoking does not increase the risk of developing breast cancer, but it does increase the risk of breast cancer recurrence, breast cancer mortality and mortality overall. Women who have had or do smoke were 25% more likely to die of breast cancer. Women who stop smoking can decrease their risk of dying from breast cancer by a third then those women who continue to smoke.
Exercise
Moderate exercise has been shown to decrease the risk of breast cancer by up to 20%. Moderate exercise should be performed for 30 min each day for 5 days in a week. 30 min may be in one session or multiple sessions. Level of moderate exercise is different for different, but is best monitored with heart rate. Any exercise that increases your heart rate to moderate levels is defined as moderate exercise. For moderate-intensity physical activity, a person's target should be 50 to 70 per cent of their maximum heart rate. The maximum rate is based on a person's age. An estimate of a person's maximum heart rate can be calculated as 220 beats per minute (bpm) minus your age.
Diet
Diet is thought to be partly responsible for about 30% to 40% of all cancers. Breast cancer is less common in countries where the typical diet is plant-based and low in total fat (polyunsaturated fat and saturated fat).
- High fat diet - an European study suggests that a diet high in fat, particularly saturated fat, is linked to a greater risk of hormone-receptor-positive breast cancer, as well as breast cancer that is HER2-negative.
- Alcohol - Research consistently shows that drinking alcoholic beverages -- beer, wine, and liquor -- increases a woman's risk of hormone-receptor-positive breast cancer. Alcohol can increase levels of estrogen and other hormones associated with hormone-receptor-positive breast cancer. Among women, light drinkers have a 4% increase in breast cancer risk. Moderate drinkers have a 23% percent increase in risk. Heavy drinkers who consume more than eight drinks per day have a 63% increase in risk.
- Diet high in Vegetables, fruit and whole grains – decreases rates of cancers.
- Decrease amount of animal protein and mix it with vegetable protein (quinoa, beans, lentils etc) and eggs.
Sleep
Adequate sleep is necessary for well-being, for most people this is 7-9 hours per day. Research on sleep duration and breast cancer risk isn’t conclusive, but we know that getting less than 6 hours per night can lead to trouble. Much of the repair of the everyday wear and tear of living happens during the night. Sleep deprivation can cause low grade inflammation, which is linked to almost all types of cancer and heart disease. Too much light at night has been linked to higher breast cancer risk — which may be due to lower melatonin levels. Melatonin is the sleep hormone that comes out in darkness. It appears to have an important role in regulating normal cell growth.
Meditation
Meditation seems to help breast cancer patients better manage symptoms of fatigue, anxiety, fear of recurrence and hot flushes. It just makes you feel a bit better in many aspects of your life. Meditation can be guided or non-guided. It can be done in groups or alone. Some people use smartphone/tablet apps like headspace or Calm.
Lymphoedema
Lymphoedema is swelling caused when lymph fluid accumulates in the surrounding tissue due to impaired function of lymphatic vessels. Throughout our body there is a network of lymph nodes and vessels that carry lymph fluid, similar to blood.
Destruction of lymphatic vessels and nodes by cancer, axillary surgery (sentinel node biopsy or axillary dissection), axillary radiotherapy, and infection are all known causes of lymphedema in patients with breast cancer. Obesity also increases the risk of lymphedema.
Previously it has been recommended for women to avoid having blood pressure checks on that arm, blood tests or intravenous lines, to avoid air travel and heavy lifting. But recent studies have shown that these are not associated with increased risk of lymphedema. The only factor that increased the rate of lymphedema is infections on that limb.
I recommend that all patients slowly resume normal activities and exercise as tolerated. If immediate reconstruction has been performed, then the exercise regimen should be discussed with plastic surgeon. I would also recommend stretching and light yoga both before and after surgery.
Lymphoedema presents a serious problem for many breast cancer survivors, with documented rates of 6 up to 40%. Since the advent of sentinel node biopsy the rates of lymphoedema have decreased to 7-22%. Average time to lymphedema development is 7 months, but can develop years after the operation/treatment.
Treatment may consist of:
Destruction of lymphatic vessels and nodes by cancer, axillary surgery (sentinel node biopsy or axillary dissection), axillary radiotherapy, and infection are all known causes of lymphedema in patients with breast cancer. Obesity also increases the risk of lymphedema.
Previously it has been recommended for women to avoid having blood pressure checks on that arm, blood tests or intravenous lines, to avoid air travel and heavy lifting. But recent studies have shown that these are not associated with increased risk of lymphedema. The only factor that increased the rate of lymphedema is infections on that limb.
I recommend that all patients slowly resume normal activities and exercise as tolerated. If immediate reconstruction has been performed, then the exercise regimen should be discussed with plastic surgeon. I would also recommend stretching and light yoga both before and after surgery.
Lymphoedema presents a serious problem for many breast cancer survivors, with documented rates of 6 up to 40%. Since the advent of sentinel node biopsy the rates of lymphoedema have decreased to 7-22%. Average time to lymphedema development is 7 months, but can develop years after the operation/treatment.
Treatment may consist of:
- Manual Lymphatic drainage/massage – performed by certified treatment providers
- Compression bandaging/garments - performed by certified treatment providers
- Exercise
- Skin and Nail Hygiene
- Low Level Laser Therapy (LLLT) - Low level Laser therapy is also used for treatment of scars and contractures as well as muscle injuries. Some practitioners also use it to minimize post-operative pain related to muscle tightness. There are no reported complications from LLLT.
BREAST CANCER GENETICS
Breast Cancer Genetics
Majority of breast cancer do not have a hereditary component and for most women, their only risk is that they are of female gender.
Around 10% of all breast cancers are thought to be hereditary, meaning abnormal genes are passed from parent to a child. Angelina Jolie has put the hereditary cancer into spotlight and people are now talking more and asking more questions about this risk, which is a good thing.
The common gene abnormalities associated with breast cancer are: BRCA1 and BRCA2, PTEN gene (causing Cowden syndrome), CDH1 gene (hereditary diffuse gastric cancer), p53 (Li-Fraumeni syndrome), STK11 gene, PALB2, ATM, ChEK2 and likely many others.
In Wellington region we use EviQ system to calculate person’s risk of breast cancer. We also send a referral to Genetics team for calculation of the hereditary breast cancer risk and discussion whether or not genetic testing should be performed. Genetic counselling is also performed by them and testing arranged.
All women who have family history of breast cancer and/or associated cancers should be referred either directly to genetic services by their general practitioners or to breast surgeons for assessment and genetic assessment.
Majority of breast cancer do not have a hereditary component and for most women, their only risk is that they are of female gender.
Around 10% of all breast cancers are thought to be hereditary, meaning abnormal genes are passed from parent to a child. Angelina Jolie has put the hereditary cancer into spotlight and people are now talking more and asking more questions about this risk, which is a good thing.
The common gene abnormalities associated with breast cancer are: BRCA1 and BRCA2, PTEN gene (causing Cowden syndrome), CDH1 gene (hereditary diffuse gastric cancer), p53 (Li-Fraumeni syndrome), STK11 gene, PALB2, ATM, ChEK2 and likely many others.
In Wellington region we use EviQ system to calculate person’s risk of breast cancer. We also send a referral to Genetics team for calculation of the hereditary breast cancer risk and discussion whether or not genetic testing should be performed. Genetic counselling is also performed by them and testing arranged.
All women who have family history of breast cancer and/or associated cancers should be referred either directly to genetic services by their general practitioners or to breast surgeons for assessment and genetic assessment.
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Video on shoulder movement after breast surgery
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