CANCER.Breast cancer .Same research has shown that patients with tumor smaller than 1 cm (stage 0) have a survival equal to ten years' 85%. Early diagnosis allows to evaluate the possibility of a less radical surgery, also increases the ability to perform a surgical reconstruction with better aesthetic results.

Breast cancer is the leading cause of death among women aged between 34 and 75 years. Indeed, data of morbidity and mortality for breast cancer are extremely worrying.

. This group of women deserves special attention because in this case the surveillance may significantly increase rates of healing. Among the factors that will certainly increase the risk of developing breast cancer are:

family history of breast cancer, especially in the mother or a sister;

nulliparity or first child after 34 years;

Previous cancer in one breast;

exposure to ionizing radiation, eg radiation therapy for acute postpartum mastitis, skin cancer, keloids, acne;

Mammography showing initial predisposing diseases.

What signs to think of a breast lesion?

Affecting the shape

Abnormal volume

Skin retraction, the presence of dimples in the skin due to retraction of subcutaneous aponeurotic septa is certainly one of the most characteristic semiological breast cancer.

Skin rash, usually due to inflammation erythema is not a specific sign of breast cancer. Although it can sometimes be an expression of a tumor that is invading the skin or, if extended to the whole breast, a carcinomatous mastitis, is a symptom of little importance for early diagnosis.

Skin edema, skin edema even in its characteristic appearance in "orange peel" is not a strictly specific sign of breast cancer could also be due to any cause of obstruction axillary or an inflammatory process in the breast itself.

Skin ulcer, deviation and / or nipple retraction, nipple changes especially if unilateral should always be carefully evaluated. And 'in fact common for small tumors located in the subareolar region or nearby could lead to phenomena of fibrosis, retraction irreducible or a deviation of the nipple.

Epithelial alteration and areola or nipple

Spontaneous secretion of blood

Self-examination

Palpation of a breast lump is the most simple and important for the early detection of breast cancer. This examination can be performed by the patient or doctor. The American Cancer Society and the press does not promote intensive specialized education programs, continually stressing the importance of regular breast dell'autoesame. Consequently, it is hoped that women who are experiencing the presence of breast lumps are requested as soon as the doctor. In fact, over 90 percent of breast lumps was detected by the patient herself. The self-examination with a correct technique should be encouraged to do so the patient because it can exert enormous influence over her. Most women know that early detection increases the chances of healing and self-examination can lead to early diagnosis, but a survey conducted by Gallup with the sponsorship of the American Cancer Society indicates that less than 20 percent women do breast self-examination. Only about half of women surveyed annually undergoing breast examination by a doctor. Moreover, only 35 percent of all women surveyed reported that their physician had raised the issue dell'autoesame breast, and only 25 percent had received instructions to practice the correct method of examination. However, 92 percent of women who received instructions from the doctor sull'autoesame of the breast, then practice it more or less regular.

... To perform self-examination, the patient must first observe Breast placing itself in an upright position in front of a mirror. First put your arms at your sides, then lift, then bends down and finally gets his hands on her hips looking asymmetry, dimples or skin abnormalities of the nipples. So - always standing in front of the mirror - the patient proceeds to palpation of both breasts, starting from the upper outer portion and proceeding medially and downwards. The woman should lie down and then repeat the process of palpation in the supine position. Self-examination requires a very limited amount of time. It should be at the same time each month, about 10 days after the onset of menstruation.

Consideration outpatient

The physician should conduct a systematic examination of the breasts and follow the following clinical diagnostic criteria:

Clinical examination

Mammography

Thermography

Echography

Diaphanoscope

Cytology-biopsy

Palpation of the breast should be performed with the patient supine with both arms behind his head is sitting with their arms up. In both positions the examination must be conducted with both muscles at rest and in contraction and must also involve the more remote areas of the breast, the inframammary fold, axillary extension and be completed by the exploration of the axilla and supraclavicular region. The best technique is the two-hand with fingertips that go through the dial to dial the entire breast with circular movements and gentle even pressure. The palpation is the most significant "isolated nodule" appearance that can occur with extremely varied in consistency, size, relationships with surrounding structures and other features that must be carefully evaluated before expressing an opinion on the possible nature of the injury that has determined. Findings that finds its limits more in the subjectivity of photography and, especially when the dimensions do not exceed one centimeter in the general lack of specific findings.

Mammography and xeromammografia (when you can run)

The most important diagnostic tool yet developed for the detection of breast cancer before the patient or doctor are aware of the presence of a lesion is xeromammografia. It is based on passing a beam of radiation through the breast, the image is recorded on a plate coated with selenium electropositive, then dusting powder blue electrostatically negative, and then transferred onto paper. This technique has the advantage of allowing the detection of abnormal masses smaller than in I-cm minimum size detectable by physical examination. In addition images can highlight areas xeromammografiche parenchyma with dense connective tissue hyperplasia. Since xeromammografia includes exposure of the patient to radiation at low doses have been expressed about the possibility of then so breast cancer. However, such arguments are now unsustainable.

The accuracy of xeromammografia identifying tumors ranged between 70 and 90 percent in women - on palpation are devoid of mass m morning, there is 40 per cent of positive mammography. In numerous case studies of mammography "suspicious" with breast examination negative in 20-25 percent of cases the biopsy showed the presence of cancer. However, any suspicious lesion should always bioptizzata. In which patients perform a mammogram? In healthy women, aged between 35 and 49 years, no breast symptoms, objective findings of abnormal or risk factors for breast cancer is recommended to perform two basic tests, after at least three years from a ' another. In women over 50 years and not at high risk, the xeromammografia be performed every 12-18 months.

.
. Indications for immediate implementation of xeromammografia not elective or otherwise of a mammogram at any age (and - if necessary - a test year) are:

symptoms of recent onset breast or annoying;

presence of a large mass or other abnormal objective findings;

a family history of breast cancer in mother or sister, or other higher risk factors;

difficulty and uncertainty of the outcome of objective breast - for example in a patient with large breasts, silicone implants or scars, and postoperative deformity;

previous mastectomy for cancer in one breast;

evaluation of a metastatic process to start from a place unknown primary. (In this case, palliative treatment program depends on the identification of a primary breast lesion).

Thermography

This technique allows to obtain a photographic image of the infrared emanations of each breast (Figure 5). In normal breasts, the pattern thermal skin of the breast is symmetrical and constant. The majority of cancers are associated with an increased metabolic rate, thereby increasing the temperature of venous blood from the tumor. In addition, any tumor larger than 3 mm may be accompanied by increased vascularity. This results in an increase in the infrared area of the breast, which is recorded on a special heat-sensitive film. Thermography takes just minutes and does not involve radiation exposure. This review was included in many programs for detecting breast cancer in the population because it has proved useful in highlighting certain early-stage cancer patients with equivocal and xeromammografia examination negative.

Thermography to escape a large number of malignancies clearly identified by xeromammografia; thermographic examination should be additive and not substitute for physical examination and mammography. In addition it has an incidence of false positives by 20 percent and does not offer a good location of the tumor biopsy purposes.

Running a blopsia according to the positive result of thermography alone is not justified. It must first confirm that there is clinical or xeromammografica the presence of an anomaly. However, even in the absence of these data - the patient is considered at risk for the presence of cancer in early stage. It should therefore be kept under tight control until a later thermography does not give a normal result or it is not possible to identify the precise cause of disorder of the first thermography.

Other diagnostic methods

10 per cent of patients with breast cancer has a secretion of fluid from the nipples. In these cases it may be useful to the cytology of the liquid. Since only 25 percent of the blood secretions is due to a tumor, the characteristics of secretion should not be considered definitely diagnostic. Currently are being studied special suction devices, which allow you to extract the liquid from the breasts in patients without secretions, and in this way can be improved Cytological diagnosis of carcinoma

Diagnostic value of mammography

And 'possible to detect neoplastic lesions before they can be detected by patient or doctor can highlight masses smaller than 1 cm. Xeromammografie can highlight abnormal areas of dense parenchyma with connective tissue hyperplasia (index greater risk of subsequent carcinoma). Exposure to low dose radiation appears to be offset by the diagnostic yield. The accuracy of xeromammografia hover around 70-90 percent, but sometimes there are false negatives and false positives. Never postpone the biopsy of a suspicious lesion under the negative result of mammography.
.......

e- mail E-MAIL here

>>>see first page

>>>see also RICERCA