Breast cancer - Diagnosis and treatment - Mayo Clinic
Int J Surg. ;8(6) doi: /mephistolessiveur.info Epub Jun Age at diagnosis of breast cancer in Arab nations. Najjar H(1), Easson A. Overall, more cancer research is needed in the Arab world, particularly lung cancer and liver cancer, while breast cancer is most common among females, were excluded as they did not meet the inclusion criteria upon reading the full text. .. While the incidence of cancer increases with age and occurs. cancer in Arab countries occur in women below the age of Women with breast cancer may have advanced disease at diagnosis and data in either abstract form or meeting presentations and some reported in peer-reviewed local or.
Additional objectives were to evaluate the association of a diagnosis of breast cancer with the BI-RADS score, the strong correlation between mammographic findings and breast cancer confirmation is an encouraging finding for our screening program. Mammography screening programs for general population vary across countries, with different recommendations related to the age of starting and the frequency of screening.
Data in literature suggest that screening should be proposed at least every two years from 50 to 70 years of age. For women younger than 49 years, the pathological personal history, breast mammographic density and familial cancer risk should be taken into consideration as their risk of breast cancer may higher. For women with a lifetime risk for breast cancer of more than 25 percent or who are BRCA mutation carriers, screening should begin before 30 years these cases and high risk families refer to high risk breast ovarian clinic in NCCCR [ 6 ].
Moreover, mammography in this young age group showed no evidence that the benefits exceed the risks with the complementary Screening with magnetic resonance imaging may be offered to high-risk women inside approved and audited services or as part of high risk surveillance, since its impact on breast cancer mortality is still uncertain. Finally, breast self-examination is not recommended because it did not show to improve mortality and may increase anxiety [ 7 ].
In the yearfor the first time, a mammographic screening program was launched in Qatar for women aged 40 and older. From toin women agedthe quality of screening has significantly improved over accesses have been registered with an increasing participation, year by year.
Core needle biopsy Core needle biopsy A core needle biopsy uses a long, hollow tube to extract a sample of tissue. Here, a biopsy of a suspicious breast lump is being done. The sample is sent to a laboratory for testing. Your breasts fit into a hollow depression in the table, which contains coils that detect magnetic signals. The table slides into the large opening of the MRI machine. Tests and procedures used to diagnose breast cancer include: Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities.
A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.
Removing a sample of breast cells for testing biopsy. A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area.
Often, a small metal marker is left at the site within your breast so the area can be easily identified on future imaging tests. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous.
A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness grade of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.
Breast magnetic resonance imaging MRI.
Age at diagnosis of breast cancer in Arab nations.
An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images. Other tests and procedures may be used depending on your situation. Research shows that people who are treated for breast cancer at medical centers that treat many cases of breast cancer have better outcomes than do people treated at medical centers that treat breast cancer less frequently.
Staging breast cancer Once your doctor has diagnosed your breast cancer, he or she works to establish the extent stage of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options. Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery.
Tests and procedures used to stage breast cancer may include: Blood tests, such as a complete blood count Mammogram of the other breast to look for signs of cancer Breast MRI Computerized tomography CT scan Positron emission tomography PET scan Not all women will need all of these tests and procedures.
Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.
Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.
Breast cancer staging also takes into account your cancer's grade; the presence of tumor markers, such as receptors for estrogen, progesterone and HER2; and proliferation factors. Mayo Clinic doctors have extensive experience caring for people with breast cancer: More than 9, people seek breast cancer care each year Nearly 1, people undergo breast cancer surgery each year Mayo Clinic uses many cutting-edge treatments, including scalp cooling therapy to reduce chemotherapy-induced hair loss as well as vaccine and immunotherapy, available through clinical trials, to prevent tumor recurrence for patients with high-risk disease.
Other treatment options include proton beam radiation for early and locally advanced breast cancer, and other novel therapies to target triple negative and other subtypes of breast cancer with fewer existing standard therapies. Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones.
Your doctor also considers your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation.
Breast health specialists in the Mayo Clinic Breast Clinic coordinate care for people with breast cancer. These internal medicine doctors who focus solely on caring for people with breast cancer and other breast conditions will meet with you to understand your needs and make arrangements for necessary tests and appointments.
Often, your appointments can be coordinated over a matter of days in one facility. Your breast cancer care team may include internal medicine specialists who focus on breast conditions, breast cancer surgeons, geneticists, medical oncologists, nurses, pathologists, physical therapists, plastic surgeons, psychologists, radiation oncologists and radiologists.
Mayo Clinic offers a truly integrated practice, with a variety of specialists regularly working together and meeting to discuss cases. This ensures that you receive whole-person care that takes into account all of your needs.
Your care team carefully weighs all of your treatment options to create a plan that's personalized for you. There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic.
Talk to other women who have faced the same decision. Breast cancer surgery Mayo Clinic uses many cutting-edge treatments, including intraoperative assessment of margins to ensure that all the cancer is removed during the operation and to decrease risk of re-operation for margin re-excision. Mastectomy Mastectomy During a total simple mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. Other mastectomy procedures may leave some parts of the breast, such as the skin or the nipple.
Surgery to create a new breast is optional and can be done at the same time as your mastectomy surgery or it can be done later. Sentinel node biopsy Sentinel node biopsy Sentinel node biopsy identifies the first few lymph nodes into which a tumor drains. The surgeon uses a harmless dye and a weak radioactive solution to locate the sentinel nodes. The nodes are removed and tested for signs of cancer. Radiation therapy Radiation therapy External beam radiation uses high-powered beams of energy to kill cancer cells.
Beams of radiation are precisely aimed at the cancer using a machine that moves around your body. Operations used to treat breast cancer include: Removing the breast cancer lumpectomy.
During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove completely with a lumpectomy procedure.
Removing the entire breast mastectomy. A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola total or simple mastectomy.
Newer surgical techniques may be an option in selected cases in order to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer. Removing a limited number of lymph nodes sentinel node biopsy. To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.
Clinical observation from other Arab countries and comparative age-standardized rates and age-specific standardized incidences show that breast cancer is seen in younger groups. The median age of breast cancer in Lebanon is 52 years, with These rates were significantly higher than those reported in Cypriot The high incidence rates described in Israeli Jews were similar to those described in North American and West European countries, while the lower rates in the other Middle Eastern groups were more similar to rates in Mediterranean Europe, Eastern Europe, and some of Asia and Africa [ 10 ].
Comparisons with SEER data reveal that Pakistan has a younger patient population with larger tumors, higher grades, and more advanced disease stage on presentation than does the United States. Receptor-negative tumors are also more common [ 11 ]. Screening and Early Detection Proper screening necessitates the presence of certain elements which include high-quality screening using mammography, high coverage and participation and effective referral systems for diagnosis and treatment [ 12 ].
It is costly to implement such screening strategies thereby rendering screening unfeasible in low- and middle-income countries LMCs. It is necessary that screening be implemented in LMCs in order to facilitate early detection and avoid advanced stage cancers at presentation.
Age at diagnosis of breast cancer in Arab nations.
However, with mammography being the gold standard of screening in developed countries, it is arguable whether to put it into use in LMCs. Major obstacles involve high cost, lack of health care infrastructure, encouraging women to get screened, and high incidence of breast cancer occurring in younger populations of women aged 40—49 in which no significant benefit of mammography was seen in this age group [ 41314 ].
The guidelines were constituted of four levels of resources which include basic, limited, enhanced, and maximal. The basic-level resources were constituted of basic breast health awareness through education and self-examination and a clinical breast exam CBE.
The limited level includes CBE in addition to diagnostic ultrasound with or without mammography within limited financial means and modest health care systems. The third level involves mammography screening and the maximal level includes population-based mammographic screening [ 15 ].
Using this stepwise-based approach, advancement in LMCs health care systems may be achieved. There is emerging evidence that awareness campaigns in LMCs can improve adherence to screening guidelines. In Lebanon, four national surveys were conducted in collaboration with the National Breast Cancer Awareness Campaigns.
These results reveal an increased tendency to use mammography, however, at a low pace. Guidelines for screening of breast cancer have been established in Lebanon. These include a mammography scan every year starting at the age of 40, women with family history of breast cancer should start screening 10 years prior to the onset of the first case in the family, all women are to have an annual CBE with mammography and one CBE every three years between the age of 20 and 40, all women are to perform breast self-examination BSE once per month starting at the age of 20, two routine views are needed for a valid mammography which include craniocaudal and lateral oblique, and finally ultrasound is not recommended for asymptomatic women [ 17 ].
- The Development of Breast Cancer Screening in Qatar (January 2008-April 2015)
- Journal of Oncology
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With inadequate resources for early detection of breast cancer, the majority of patients from LMCs presents with advanced or metastatic disease. In a recent study done in Pakistan, the clinical presentation of patients was highest in advanced stages III and IV amounting to Both of these values are significantly higher than the Also in Oman the rates are high amounting to Efforts aimed at early detection can decrease stage at diagnosis and potentially improve the probability of survival and cure.
Histologic diagnosis is necessary before initiating treatment. Choosing the type of biopsy whether fine needle aspiration cytology, core needle biopsy, or excisional biopsy depends on the resources available.
Again the BHGI has defined the basic level of diagnosis and pathology to include history, CBE, physical exam, and interpreting specimens from surgical biopsy and fine needle aspiration to include tumor size, lymph node status, histologic type, and tumor grade. The limited level includes mammographic or ultrasound imaging of the breast. Core needle biopsy and image-guided sampling are used in order to determine estrogen receptor and progesterone receptor status as well as margin status.
Also, within this level, resources should be allocated to include evaluation for metastasis with chest X-rays, ultrasound of liver, as well as blood studies.
As for the enhanced level of diagnosis, it includes preoperative needle localization under mammographic or ultrasound guidance, and improved services involve the presence of a cytopathologist. Higher-level resources within this level could include bone scanning for metastatic examination. Adequacy of Management Mastectomy rates in Arab countries are high amounting to