Screening of Breast Cancer

Dr. Anjani Jalaj, Professor, Gwalior MC

Contents

1. Epidemiology of breast cancer

2. Anatomy of breast

3. Risk factors

4. Signs and symptoms

5. Clinical presentation

6. Screening protocol:

• Breast Self-Examination (BSE)

• Clinical Breast Examination (CBE)

7. Interpretation of screening

8. Other Diagnosis

9. Prevention
Epidemiology of Breast Cancer

Among women, breast and cervical cancers represent > 40% of the incidence burden in India

Top 5 cancers contribute to

58.5% of new cancer cases
in women

Breast cancer has the highest mortality rate among all cancers in women

Source: GLOBOCAN 2018. India Fact Sheet

Breast Anatomy

• Breast is the tissue overlying the chest muscles

• Women's breasts are made of fatty tissues as well as

glandular tissues that produce milk

• The dark area of skin surrounding the nipple is called

the areola

• Connective tissue and ligaments provide support to

the breast and give it it's shape

• The breast also contains nerves, blood vessels, lymph

vessels, and lymph nodes
Picture: WebMD.com
Risk Factors

• Old age

• Menopausal status (early menarche and late menopause)

• Pregnancy (nulliparity and older age at first full term birth)

• Family history of breast cancer (especially in first- and second-degree relatives)

• Lactation (absence or shorter duration of breast feeding)

• Genetic factors

• Hormonal factors (such as prolonged use of combined hormone replacement therapy after menopause)

• High fat diet (leading to obesity)

• Increased alcohol intake

• Reduced physical activity

Signs & Symptoms

• A breast lump or thickening that feels

different from the surrounding tissue

• Change in the size, shape or appearance of

the breast

• One breast hangs unusually lower

• A newly inverted nipple

Signs & Symptoms

• Changes in the skin over the breast, such as dimpling

• Peeling, scaling, crushing or flaking of the pigmented

area of skin surrounding the nipple (areola) or breast
skin

• Redness or pitting of the skin over the breast, like the

skin of an orange

• Swelling in the upper arm

• Milky or bloody discharge from the nipple or change in

the appearance of the nipple
Clinical Presentation

• The breast presents with many types of benign and malignant growth

• Clinical breast examination is followed by radiological and pathological evaluation

• This finalizes the type of growth in the breast

• Breast lesions could be in the form of:

1. Inflammation
2. Benign lump
3. Malignant growth
Clinical Presentation

1. Inflammatory lesion

• Mastitis

• Tubercular mastitis

• Granulomatous mastitis

• Breast abscess

Image: Shutterstock
Clinical Presentation

2. Benign lumps

• Fibroadenoma

• Fibrocystic disease of breast

• Other hyperplastic lesions

• Atypical hyperplasia (considered as premalignant lesion)

Image: Shutterstock
Clinical Presentation

3. Malignant growth

• Duct carcinoma

• Lobular carcinoma

• Medullary carcinoma

Image: https://www.cancer.gov/news-events/cancer-currents-blog/2015/dcis-low-risk
Screening Protocol

Type of cancer Breast Cancer

Age of beneficiary 30-65 years

Screening method Clinical Breast Examination (CBE)

Screening frequency Once in 5 years at the nearest PHC/CHC/DH

Breast Self-Examination (BSE)

Look

1. Stand in front of a mirror and raise your arms

2. Look at your breasts, for changes in the

shape, skin, nipples and vein patterns

3. Repeat with your hands on your hips

Breast Self-Examination (BSE)

Touch

4. Feel for lumps in the breast area using your

fingers (standing or lying down)

5. Move the fingers in circles, starting with the

armpits moving towards the breast and the
nipples

6. Check the nipples for discharge or bleeding

Clinical Breast Examination (CBE)

Ask the patient to lie down on the examination table

Squeeze the nipple gently to check for discharge

Examine the other breast in the same way

Ask the patient to sit up and raise her arm

Palpate the tail of the breast

Check for enlarged lymph nodes or tenderness

Interpretation of Screening

Normal
No abnormality on visual inspection or palpation

Abnormal
Finding Interpretation

Definite asymmetric finding on either visual

inspection or palpation It could either be malignant or non-malignant

Presence of hard lump in the breast with or

without swellings in the armpits; recent nipple
retraction or distortion, skin dimpling or Categorized as probably malignant
retraction, ulceration, blood stained nipple
discharge

Presence of other lumps in the breast, non-

bloody discharge from the nipple Categorized as probably malignant
Other Diagnosis Methods

1. Mammography/Ultrasound examination

2. Fine Needle Aspiration Cytology -FNAC

(for breast cytological examination)

2 3
3. Tru-cut biopsy (for tissue diagnosis)

Image reference: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy/core-needle-biopsy-of-the-breast.html

Prevention

Adopt a healthy diet Stay free of stress and anxiety

Maintain a healthy weight Do not consume tobacco

Exercise Regularly Do not consume alcohol

LARC - IUCD, Chaya and Antara for

Breastfeeding
contraception
Thank You