Through this program, women with no symptoms attend for routine breast assessment which involves mammography for all women and a clinical examination for some.
All women will be offered a breast cancer 'Risk Assessment' based upon their personal and family history. Women with an elevated risk of breast cancer and women with breasts that appear very 'dense' on the mammogram will be offered a clinical breast examination and additional screening breast ultrasound.
If an abnormality is detected, the need for further investigations is explained and these may be undertaken at once. Each visit includes advice regarding further screening examinations, breast self-examination and information about breast cancer and its detection.
Because screening has been demonstrated to be effective in reducing breast cancer deaths only for women over 40, screening is aimed at that age group. It is our intention to work in close liaison with general practitioners, and all women are encouraged to discuss the result of their visit with their doctor.
Our usual practice is to provide the results of the screening examination to each woman before she leaves the clinic.
Screening is not rebatable through Medicare except for women referred with a personal or family history of breast cancer.
Why have breast screening?
Regular mammograms and breast examination help with early detection of breast cancer, which improves outcomes and quality of life.
What happens at a screening?
We would like your visit to our Breast Clinic to be comfortable, friendly and informative. Please ask questions of any staff member. Our staff are very happy to answer your questions.
When you arrive, your personal details will be checked. You will be asked to confirm a brief personal history to determine whether you are at normal or elevated risk of breast cancer. If it appears you have an elevated risk of breast cancer, you will be offered an interview with a breast care nurse for a more thorough risk assessment. You will then be taken to the patient lounge and be requested to change into a gown.
Depending upon your breast cancer Risk Assessment, or if you have requested to see a breast physician, you may be offered a further interview and clinical breast examination by a doctor.
Shortly after you change, the medical imaging technologist (radiographer or sonographer) will perform your mammogram and/or ultrasound, if one has been requested. She will explain the procedure as she goes and answer any question you might have.
Your images will be read within an hour by two doctors who will decide whether any further investigations are necessary. If the results are normal, you will be given the results verbally and in writing by the breast care nurse or breast physician, and we will recommend the time for your next mammogram. We will send your GP or doctor full details of your results.
If an abnormality is found on the screening images, the breast physician will explain this to you and we will offer further investigations on the same day. If this is not convenient for you at the time, a further appointment can be arranged at a time that suits.
Throughout your visit, staff will explain to you what is being done and why, and will answer your questions. The majority of women who have an abnormality identified during screening do not have breast cancer.
This is a specialised multi-disciplinary service for the diagnosis of all breast disease. Any patient may attend with a referral from their doctor. The diagnostic service also applies to women who have been found to have an abnormality at screening.
- The investigative modalities which may be used include:
- Physical examination by a doctor
- Needle sampling or biopsy of abnormal areas of the breast
- Other specialised imaging techniques , such as breast MRI, which is performed outside the Breast Clinic
A diagnosis is reached by combining the results of these investigations. For patients who undergo a needle biopsy at the Breast Clinic, a pathologist will review the sample within a short period of time and will provide us with a preliminary result. These will be discussed with each woman before she leaves the clinic, and will be confirmed by a telephone call within 1-2 days.
Full details of all results, together with our recommendations for future management, are sent to the referring doctor. For patients with a probable diagnosis of breast cancer, we will contact the referring doctor to discuss their preferred course of action for further treatment.
Magnetic resonance imaging (MRI) is a highly sensitive imaging tool for breast disease The American Cancer Society recommends annual breast MRI for women at high risk of breast cancer from the age of 30. In Australia, Medicare only provides rebates for breast MRI for screening asymptomatic women at high risk of breast cancer between the ages of 40-49.
Breast MRI is also very useful for evaluating and monitoring known breast cancer and for the imaging of breast implants. The Breast Clinic at The Sunshine Coast Private Hospital at Buderim can arrange referral for breast MRI at Sunshine Coast Medical Imaging on the hospital campus, or with another provider elsewhere. Breast MRI performed at SCMI will be integrated with images from the Breast Clinic, with each case reviewed by clinicians highly experienced in mammography, ultrasound imaging and breast MRI.
Breast MRI does not replace mammography or ultrasound, but is a complementary imaging technique. How is a breast MRI procedure performed?
The patient has an intravenous (IV) cannula inserted and then is positioned prone on the MRI table. A series of imaging sequences are acquired to provide information. The images are acquired before and after IV injection of a contrast agent (gadolinium DTPA). The complete examination takes approximately 20-30 minutes. What if a biopsy is required?
If a lesion is identified on MRI requires tissue sampling, it may be possible to locate the lesion using targeted ultrasound or mammography back in the Breast Clinic. If it can be localised in this way fine needle or core biopsy will be performed. If the lesion is only visible on MRI, patient may require MRI guided biopsy. A separate appointment would be required.
What is a hookwire localisation?
Some breast abnormalities requiring surgery cannot be felt by examination of the breast. Your surgeon will then request that the area be localised (marked) using a fine wire called a “hookwire” that guides the surgeon to the area of abnormality.
This procedure is usually done on the day of surgery by a Breast Clinic doctor and radiographer or sonographer.
How is the localisation done?
A needle is inserted into the breast under local anaesthetic using either ultrasound or a mammogram to guide the needle. The needle has a fine wire inside it. When the needle is in place through the area to be excised, the needle is withdrawn leaving the wire behind. The wire has a hook on the tip that hooks into the tissue and will not move.
The wire protruding from the breast is taped to the skin when the procedure is completed. A mammogram is then performed to demonstrate the position of the wire in the breast. The surgeon uses these images in the operating theatre. The discomfort from this mammogram is no more than for a normal mammogram.
The wire is then laid flat to the breast and secured with a dressing. You are able to wear your normal clothes. Most women do not feel any discomfort from the wire.
Is the procedure painful?
The discomfort is usually equivalent to that felt from a fine needle aspiration biopsy. Local anaesthetic is used prior to the insertion of the hookwire needle.
Do you use ultrasound or x-ray (mammogram) for the localisation?
If the abnormal area is visible on ultrasound, we would use ultrasound. This procedure takes approximately 20 – 30 minutes.
Some abnormalities are not seen on ultrasound, in particular microcalcification, and these areas are localised using mammographic (x-ray) guidance. This procedure may take up to one hour.