|
A hangsúly
minden szóban jelezve félkövér nyomtatással és aláhúzva
 Jelre kattintva a szöveget hallgathatjuk
Teljes
szöveg 1, 2, 3
4, 5
*
1 *
Screening
mammography is an
X-ray exam of
the breasts designed to detect
breast lumps when they are too small to be detected
by physical examination.
These
small lumps can indicate
early-stage
breast cancer. Size of the cancer
at the time of diagnosis is
one
of the most important
predictors
of outcome.
Screening mammography
can lead to the finding and
treatment
of breast cancer in its earliest
and most curable stage —
nearly one to three years before you
might actually
feel the lump in your breast.
Among
women in the United States,
breast cancer is
the second-leading
cause of death by cancer, behind
lung cancer.
In 2003, an estimated 211,000 new
cases of breast cancer will be diagnosed
and 39,800 women will die of the disease.
Breast cancer
also occurs in men, although
much less frequently.
Breast
tissues affected by cancer
include:
Lobules. These
glandular tissues contain cells that make and
secrete milk. Lobules are organized into
larger clusters called lobes, which
radiate throughout
your breast.
Ducts. These
passageways carry milk from the lobules
to the nipple. Lobules and ducts form your breast's
glandular tissue.
Stroma.
The stroma consists of fatty
tissue and ligaments surrounding the ducts and
lobules, blood vessels and
lymphatic vessels.
Lymphatic vessels.
Similar to veins, they carry lymph, a clear fluid that contains
immune system cells. Most lymphatic
vessels of the breast drain to underarm
(axillary) lymph nodes.
Lymph nodes.
Lymph nodes are solid collections
of immune system cells. The lymphatic
vessels carry lymph to the nodes, where immune
cells mobilize to fight infection.
*
Types of breast cancer
Infiltrating
(invasive) ductal carcinoma,
which represents about 80 percent of invasive
breast cancers, starts in a milk duct,
breaks through the
duct wall.
It also invades the surrounding
breast tissue — fatty tissue, glands, ligaments, and blood
and lymph vessels.
It can spread (metastasize)
to other parts of your body through the lymphatic
system or bloodstream.
Infiltrating
lobular carcinoma, which comprises
about 10 percent of invasive breast cancers,
begins in the milk-producing
glands and can also metastasize.
Less common
are cancers that don't
invade neighboring
tissues.
These cancers are known as
carcinomas
in situ, Latin for "in the natural or normal place."
Ductal carcinoma in situ (DCIS) is the
most common type of non invasive breast
cancer.
DCIS
can present as a lump or
diagnosed after a biopsy
to evaluate
suspicious calcifications
detected on mammograms.
Additional
evaluation, such as a
mammography
with magnification, may be necessary to
determine if the
breast microcalcifications
are from a noncancerous (benign) process or if
they could be associated with
early-stage
breast cancer.
Calcifications in the
breast seen on a mammogram are very common and
fortunately most are benign.
If
there's a
chance the calcifications could be early-stage breast cancer, you'll need a biopsy to know for
sure.
* 2*
=================================
Approximately 80 percent of biopsies
done for calcifications are benign.
Lobular
carcinoma in situ (LCIS) begins
in the lobules. lobjulár,
lobjulsz
Most
breast specialists don't consider
LCIS a true breast cancer but rather
a marker for increased
risk of developing breast cancer later.
LCIS
usually doesn't show up on a mammogram but is
instead
discovered incidentally
when you're having a biopsy for
another abnormality.
Detecting breast cancer: Mammograms
recommended
A
mammogram
is the image — or picture — of your breast that results
from the examination process.
Mammography
refers to the process itself — how the technician
captures the X-ray image of your breast.
"Screening
mammograms — along with
breast health awareness
— are the best means we have today of decreasing
death from breast cancer," says a
breast care specialist at the Mayo Clinic, in Rochester, Minnesota.
"It is therefore prudent that
current
recommendations in this important
area of health care screening are continued."
Your doctor
might order a mammogram to:
Screen for a condition or
Diagnose a condition
A screening
mammogram is used to look for breast changes in women who
have no signs or symptoms of breast cancer.
It usually requires
two views of each breast. A
cranial-caudal view looks at
your breasts from above, and a
mediolateral-oblique
view uses an angle that includes breast tissue
extending to the armpit.
Your first
screening mammogram is often called your
baseline mammogram,
which radiologists — doctors who specialize in
interpreting mammograms and other images —
will compare with future mammograms to
look
for changes.
A
diagnostic
mammogram is used to further
investigate
breast changes such as a lump, pain,
nipple thickening or
discharge, or a difference in breast size, shape or
overlying
skin.
It's also used to
evaluate and follow up
on abnormal findings on a screening mammogram
or to evaluate the breasts of
women who have
implants, which can
obscure signs of disease.
obszkjúr
The mammography technician,
often with the help of a radiologist, obtains
additional views
from other angles, gets views
at higher magnification
or focuses in
on areas of concern.
Mammography
exposes women to
low-dose X-rays. But for
women over age 40, the benefits of regular mammography
outweigh the risks posed by this amount
of radiation.
According to the American
Cancer Society (ACS), a woman receives
roughly as much radiation from one mammogram
as from a New York to California jet trip.
Your
doctor
may refer you to a
mammography
facility, or you might be
encouraged
to select another type of
facility — one that's
more convenient for you
— that performs the procedure.
Many hospitals, clinics, doctors' offices, and X-ray or
imaging centers
perform the test. Mobile units
such as vans may offer screening at shopping malls,
community
centers and offices.
* 3
*
Mammography: Just
one part of the equation
Mammography
doesn't eliminate
your need for a breast examination by a
health
care professional nor your need for
promptly
informing your doctor about changes in your
breasts, such as an area of thickening, a lump,
discharge
from your nipple or
dimpling of your skin.
Some breast
changes that indicate cancer
may not be evident
on a
mammogram but may be picked up by touch.
During an examination,
your health care professional will
visually
inspect your breasts for changes in shape,
size or appearance of the overlying skin and
then gently examine your breast tissue and
armpits for lumps or areas of thickening or asymmetry
that may suggest cancer.
Between
the ages of 20 and 39, have your breasts examined
by a doctor, nurse or other health professional
every three years.
Have your breasts examined
every year beginning at age 40. If you're
a
younger woman with
risk factors for breast cancer, such as a
strong family history of the disease or
exposure
to radiation as a child,
consult
your doctor for advice on screening.
It's
possible that your doctor will suggest approaches
such as starting screening mammography at an
earlier age or using other screening methods — such as
ultrasound or
magnetic
resonance imaging (MRI) — in addition to regular mammography.
Also, beginning
at age 20, discuss with your doctor the
benefits and limitations of performing
regular breast
self-examination (BSE).
Although
the routine practice of BSE in screening for breast cancer
is optional, you might find that regular BSE helps you
become
more familiar with your breasts.
Breast familiarity
is key to identifying changes to your breasts
that might need to be checked out by your doctor.
Benefits, risks and limitations of mammograms
One
of the
greatest benefits of mammograms is that they can
identify
cancerous breast tissue in its
earliest stages.
A
small lump
can be removed more easily than a larger lump
— for example through a lumpectomy
procedure — and
the chances are greater that
you'll live disease-free.
A large lump might
require a mastectomy to remove
it, and the risk of the cancer spreading to other parts of
your body increases.
Mammography
is not foolproof. Although mammography
has reduced the number of breast cancer deaths
in women between ages 40 and 69, this method
of screening still has its limitations.
The
accuracy of the procedure depends
in part on the quality of the film and
the experience
and skill of the radiologist.
Other factors —
such as your age and breast density — also can lead to
inaccuracies
in interpretation of the test and
may result
in false-negative or
false-positive mammograms.
For
instance, mammograms of younger women, whose
breasts contain
more glands and ligaments than do those of older women,
can
be more difficult to interpret.
With age,
breast tissue becomes fattier and has fewer
glands, making it easier to interpret the
mammograms to detect abnormal
changes.
Among women
of all ages, 5 percent to 10 percent of
mammograms are abnormal
and require additional testing.
But know that
most abnormal findings aren't cancer — less
than 1 percent of screening mammograms lead to a diagnosis
of cancer.
If you're told that your mammogram is abnormal,
make sure that
the radiologist has reviewed
one of your previous mammograms.
Another
downside to screening mammography is that it
doesn't detect all cancers.
Some cancers that
are picked up by physical examination may not
be seen on the mammogram.
A cancer may be too small or may
be in an area that is difficult to view by mammography,
such as your armpit.
Mammograms can miss about 10 percent to
15 percent of cancers in women. And that number might be
higher in women who have a greater breast density — such as
premenopausal women or women who are on
hormone therapy.
A negative mammogram
shouldn't delay
further evaluation or prevent care for a
finding such as a breast lump, skin change or
spontaneous
nipple discharge.
In addition,
the tumors found by mammography can't all be
cured. Certain types of cancers are aggressive,
grow rapidly and can spread to other parts of your body.
However,
Dr. Lee advises, It's
important to remember
that mammograms are not
performed in a vacuum.
They're ordered
in conjunction with
a clinical
breast examination by
your health care professional.
Along with a
greater emphasis on
self-awareness
of changes to your breasts and
promptly reporting
such findings to your doctor, these exams can lead to early
detection of malignancy and can
decrease the number of deaths from breast
cancer."
*4 *
MaMo2A When should you have a mammogram?
Doctors
don't all agree on the age at which you should
begin to have regular or yearly mammograms.
The breasts of
young women are often too dense to provide
good X-ray images.
If a younger woman has a breast lump, an
ultrasound may be helpful to evaluate
the area of concern.
Fortunately, young women
rarely develop breast cancer.
The American
Cancer Society recommends that
women age 40 and older have a screening mammogram every
year, while the National Cancer Institute recommends
that women age 40 and older have one every one to two years.
MaMo2B
Regardless
of age, women who are
at increased risk of
breast cancer should seek medical advice on
when to begin having mammograms and how often
to be screened.
Risk factors for breast cancer include:
Personal history
of breast cancer
Breast cancer in your mother or sister
Family history
or personal history of
gene abnormalities
related to breast cancer
No pregnancies or first pregnancy after age 35
Early onset of menstruation
Late menopause
History of breast biopsy with
atypical
findings
MaMo2CThe
final decision
about screening should be made by you and your doctor. Here
are some guidelines:
If you're age 20 to 39,
have a clinical breast exam at least every three years. You
don't need screening mammograms yet, but you
might want to
consider regular breast self-exams
to increase your overall breast
familiarity.
If you're age 20 to 39 and at
high risk of
breast cancer, talk to your doctor for an
individualized
program.
Women in this category may benefit from beginning
screening mammograms at a younger age. In addition,
your doctor may recommend other screening
methods, such as
ultrasound or
magnetic
resonance imaging (MRI).
MaMo2D Have a clinical breast exam
every year, and consider performing
regular breast self-exams to increase your
overall breast familiarity.
If you're age 40 or older, have a
clinical breast exam every year. You also need a mammogram
every year or every other year — depending on
the recommendation of your doctor.
This
is true for women both at normal risk and at high risk. In
addition, consider performing
regular breast self-exams to increase
your overall breast familiarity.
If you
choose to perform breast self-exams,
review your technique periodically
with your doctor.
MaMo2EGetting ready for a
mammogram
When
scheduling your mammogram, be
prepared to give
information about your personal or family
history of breast disease.
In addition,
be prepared
to discuss:
Problems with your breasts
Past breast biopsies or surgeries
Whether you have breast implants
Whether you're pregnant or nursing
Whether you're taking hormone therapy or any treatments for
breast disorders
Timing of your menstrual cycle
Whether you've started menopause
MaMo2F
If you're
going to a new facility for your mammogram,
the radiologist
will find it helpful if you
bring prior mammograms along for comparison.
It's important to bring the original
mammogram films, not copies, and
accompanying
reports.
Let staff members know if you're not sure you'll be
able to endure the test.
Because
your breasts will be compressed during mammography,
avoid testing at times when your breasts are
most likely to be tender.
MaMo2GThis often is the week before
and the week during your menstrual period. Your breasts may
be least tender during the week after your period.
You will be
given instructions for
the day of the test.
Don't apply deodorants, antiperspirants,
powders, lotions, creams or perfumes under
your arms or on your breasts.
Metallic
particles in powders and deodorants could be
visible on your mammogram and cause confusion.
If you have
a history of breast pain (mastalgia) or
tenderness, consider taking an
over-the-counter pain medication, such as
aspirin, acetaminophen (Tylenol, others) or
ibuprofen (Advil, Motrin, others) about
an hour before your mammogram.
MaMo2H What happens during a mammogram
At
the
testing facility, you're given a gown and
asked to remove neck jewelry and clothing from
the waist up.
You may be more comfortable if
you wear a two-piece outfit that day.
For the procedure
itself, you stand in front of an X-ray machine
designed for mammography.
The mammography
technician places one of your breasts on a
platform that holds the X-ray film and raises or lowers the
platform to match your height.
The technician
helps you position your head, arms and torso
to allow an unobstructed view
of your
breast.
Your breast
is gradually pressed against the platform by a
clear plastic plate.
MaMo2I
Pressure is applied for a
few seconds to spread out the breast tissue. The pressure
isn't harmful, but you may find it uncomfortable
or even painful. If you have
too much discomfort,
inform the technician.
Your breast
must be compressed to even out its thickness
and permit the X-rays to penetrate and separate tissues that
might hide an abnormality.
The pressure also
holds your breast still — thereby decreasing
blurring from movement — and
decreases the
dose of radiation needed.
*
5 *
MaMo2J
During X-ray exposure,
you'll be asked to stand still and
hold your breath.
After
pictures are taken of both your breasts, you may be asked to
wait while the technician checks the quality
of the film.
If the views are inadequate for
technical reasons, you may have to
repeat part
of the test.
The entire procedure
usually takes less than 30 minutes.
Afterward, you may dress
and resume normal activity.
MaMo2K How the
results
are relayed
Mammography produces
black-and-white images of your breast tissue on large sheets
of film.
The images are
interpreted by a radiologist,
who sends a written report of the findings to
your doctor.
Federal law
requires the mammography facility
to provide you with a letter
in plain language
about the results — either on site or by mail
— within 30 days.
This letter should have the
name of the interpreting doctor and should
advise
you of any necessary follow-up care or testing.
MaMo2L If you don't
get a letter, don't assume that the results
are normal. Contact your doctor or the mammography
facility.
If your results are suspicious
or suggest cancer, you must be notified as
soon as possible, ordinarily
within five
working days.
If you don't
have a doctor or other health care professional,
the facility should send you both the report and the letter.
It should also give you a list of doctors who are
willing to
provide further care, if necessary.
MaMo2M What the mammogram may indicate
The radiologist
examines the films for
evidence of cancer or
benign conditions that may require
further testing, follow-up or treatment. Possible findings
include:
Calcium deposits (calcifications)
in ducts and other tissues
Masses or lumps
Distorted tissues
Dense areas appearing in only one breast
Dense areas that have appeared since your last
mammogram
MaMo2N Calcifications
can be the result of cell secretions, cell
debris, inflammation, trauma,
previous radiation
or foreign bodies.
Tiny,
irregular deposits
called microcalcifications may be
associated
with cancer. Larger, coarser deposits called
macrocalcifications
may be caused by a
benign condition such as fibroadenoma
— a common noncancerous tumor of the female
breast — or by aging or injury.
Most breast
calcifications are benign,
but if calcifications appear
worrisome, the radiologist might order a diagnostic
mammogram with magnification views.
MaMo2O If
the pattern or appearance of the calcifications
is suspicious, a biopsy — such as a
stereotaxic
procedure or
wire-localized needle biopsy —
might be recommended.
It's also possible that
another test, such as an ultrasound,
will be used to evaluate a
suspicious
or indeterminate finding on your mammogram.
Dense areas
may indicate tissue with many glands that make calcifications
and masses more difficult to pick up, or they may represent
cancer.
Distorted areas
may suggest
tumors that have invaded neighboring tissues.
Ultrasound
can further define the borders of a suspicious
area and determine whether the mass is solid or is a benign,
fluid-filled lesion
called a cyst.
MaMo2P Another
X-ray exam — known as galactography — can be
performed to investigate nipple
discharge.
In this procedure, a special
contrast material is injected
into one of your milk ducts before the X-ray
images are taken.
A mammogram
alone can't prove that an area of concern is
breast cancer. To establish the diagnosis,
a biopsy must be performed to obtain tissue or
fluid for examination in a laboratory.
MaMo2Q Types
of biopsies include surgery,
fine-needle aspiration
— in which a very thin needle and syringe are
used to remove fluid from a cyst or cells from
a mass — and core needle biopsy, which uses a larger needle
to remove several small pieces of tissue.
Most
of the time an aspiration isn't needed if a
simple cyst can be confirmed on ultrasound
by an experienced radiologist.
But if a cyst appears complex or
indeterminate, then aspiration
is necessary to exclude cancer.
If cancer is
found, you and your doctor can
discuss your options and
decide
on treatment. |
