Kent Breast and General Surgeon.....
Breast Cancer and Screening
Though breast cancer is the commonest cancer in the UK, affecting over 45,000 women in 2005, the good news is that over the past 20 years there has been a dramatic improvement in survival from breast cancer with more women being successfully treated than ever before. This is due to a combination of earlier diagnosis from screening, increasing specialisation and improvement in the different modalities of treatment including surgery, radiotherapy, chemotherapy and hormone treatment.
The most common symptom is the presence of a painless hard lump. Many cancers are diagnosed in asymptomatic women at routine breast screening. Other suspicious symptoms include a unilateral, bloody or blood-stained nipple discharge, recent nipple retraction, rash or deformity and any unusual deformity of the breast. Pain is not usually a symptom of early breast cancer. It is important therefore that women are aware of how their breasts look and feel at different times and therefore recognise any irregular changes.
The NHS provides free breast screening with mammograms every three years for all women in the UK aged 50 and over. Women aged between 50 and 70 are routinely invited though this is to be extended to between 47 and 73. It is a rolling programme but most women should receive their first invitation before their 53rd birthday (or 50th with the new extended programme). Breast screening saves lives and women are encouraged to avail themselves of the service.
Lifestyle measures like avoiding obesity, reducing alcohol intake and taking regular exercises reduce the risk of developing breast cancer.
Ductal Carcinoma in Situ (DCIS)
This is a pre-cancerous condition in which the cells within the milk ducts have altered but without the ability to spread outside the duct like a true cancer. If untreated however most would develop into an invasive cancer. Most cases are diagnosed in asymptomatic women from a mammogram often as specks of calcium known as microcalcification though not all microcalification is due to DCIS. DCIS can also present as a bloody or blood-stained nipple discharge, a lump or as an usual nipple rash known as Paget’s disease.
Diagnosis is confirmed by biopsy. Treatment depends on the extent of the condition and may be by wide local excision followed by radiotherapy or mastectomy with or without immediate reconstruction.
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