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October Breast Cancer Consciousness Month
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
ROJoson Breast Wellness ClinicIn support of October Breast Cancer Consciousness Month
AdvisoriesBreast as a Disease
Breast Cancer Risk AssessmentPhysical Examination of the BreastAdvices on Breast Self-Examination
Advices on Breast Wellness Promotion Advices on Need for Other Breast Cancer Screening Tests
Manila Doctors HospitalDSMT Room 301
522-47-13
October Breast Cancer Consciousness Month
Let’s be aware and beware of breast cancer!
Let’s promote and maintain breast wellness!
Beware and Be Aware
of
BREAST CANCERS
Cause UNKNOWN!
NO EFFECTIVE WAY OF PREVENTION!
Presentation and
Progression
Mammographic findings
but without palpable
breast mass
Breast MassDifferent Sizes on Detection
The Smaller The Better
Presentation and Progression
Late Stages
Late Stages
Spread
Spread
Spread
Spread to Lungs Spread to Bone
Spread
Spread to Liver Spread to Brain
Best Chance Against Breast Cancer
EARLY• DETECTION
• DIAGNOSIS
• TREATMENT
OF BREAST LUMP
EARLY DETECTION Strategies
BREAST CANCER AWARENESS!
BREAST SELF-EXAMINATION!
BREAST SPECIALIST EVALUATION!
Promoting Breast Wellness Among Filipino Women
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
ROJ Promoting Breast Wellness Among Filipino Women
Concept of Breast Wellness
A state wherein there is NO breast issue (in the domain of symptoms, diseases, and fear and anxiety even in the
absence of disease)
that affects the physical, mental and social well-being and / or the socioeconomic productivity of a person.
ROJ Promoting Breast Wellness Among Filipino Women
Concept of Breast Wellness
NOT merely absence of breast abnormality or disease!
Patients with breast cancer can still be in a state of breast wellness.
One can be physically ill and yet can feel healthy.
ROJ Promoting Breast Wellness Among Filipino Women
Factors Affecting Breast Wellness
• Breast cancerophobia
• Inadequate knowledge • Myths (unfounded popular beliefs)
• Wrongful interpretation and understanding - read, heard, saw- reports from diagnostic tests
ROJ Promoting Breast Wellness Among Filipino Women
Risks and Causes of Breast Cancer
• All Filipino females are at risk of developing breast cancer.
• Breast cancers are commonly seen in the older female population.
ROJ Promoting Breast Wellness Among Filipino Women
Risks and Causes of Breast Cancer
• The exact cause of breast cancer is not known.
• There is no definite way of preventing breast cancer.
• There is no foolproof (with 100% accuracy) way of predicting who will and who will not develop breast cancer.
ROJ Promoting Breast Wellness Among Filipino Women
Myths on Breast Conditions and Diseases
• A trauma or a bump on the breasts can lead to breast cancer.
• A person with a family history of breast cancer will surely develop a breast cancer in the future.
• Breast cancer is a death sentence.
ROJ Promoting Breast Wellness Among Filipino Women
Myths on Breast Conditions and Diseases
• ALL diagnostic tests, such as mammography and ultrasound, and including the physical examination of the breast specialist, are
100% accurate 100% of the time.
ROJ Promoting Breast Wellness Among Filipino Women
Recommended Strategies on Promoting Breast Wellness and Against Breast Cancer
• Possessing adequate knowledge of breast conditions and diseases
• Performing regular breast self-examination• Seeking regular check-ups and advices from a
breast specialist
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Self-examination
A quality breast self-examination is one that is done completely, accurately, regularly, effectively
can detect breast cancer in its early stage.
ROJ Promoting Breast Wellness Among Filipino Women
Palpation of the Breast
The primary objective of palpation of the breasts,
either by the female person herself or by a breast specialist,
is to look for the so-called “dominant” mass,
which if present, is to be considered a red flag, i.e., one that needs further evaluation.
Lumpy Breast vs Dominant Breast MassOn Palpation
Lumpy breast surface
Fibrocystic changesNormal Breast
Dominant massStood-out, different from surrounding
tissues“Red flag”
Fibroadenoma Fibrocystic Changes
Lumpy breast – no dominant mass
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A fibrocystic breast condition or changes
is due to hormonal changes and therefore,
not considered a disease.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
Breast pain without an accompanying “dominant” mass is usually not due to breast cancer.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A painless “dominant” mass, particularly in female persons 30 years and older,
should not be taken lightly
as this has a higher risk of being cancerous than a painful “dominant” mass.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
Presence of redness on the surface of the breast, particularly with accompanying moderate to severe pain,
is usually due to an inflammatory condition or infection of the breast.
Mastitis
Breast Abscess
Inflammatory breast cancer
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A discharge from the nipple that is not red or reddish in color and that is not accompanied by a “dominant” breast mass
is usually not due to breast cancer.
Nipple discharge due to nonspecific cause or fibrocystic changes
Signs of Malignancy
Carcinoma en cuirasse
Inflammatory carcinoma
Peau d’ orange
Signs of Malignancy
Spread to Lungs Spread to Bone
Signs of Malignancy
Spread to Liver Spread to Brain
ROJ Promoting Breast Wellness Among Filipino Women
Diagnostic Tests
• Not all patients will need a diagnostic test after an interview and a physical examination by a breast specialist.
• All diagnostic tests that can be done on the breasts, such as mammography and ultrasound, have pros (benefits and advantages) and cons (risks and disadvantages) and therefore, must be used judiciously.
Needle Aspiration+/- Biopsy
Ultrasound of the Breast
Mammography
ROJ Promoting Breast Wellness Among Filipino Women
Diagnostic Tests
Mammography is usually not done in female patients 30 years or younger
as the breast tissues are too dense to give reliable information and results.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
• A breast specialist who has done physical examination of the breasts of a female person and who has made a need assessment is in the best position to determine whether a diagnostic test should be done or not and, if needed, what should be done.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist BRCA – informed consent - partnership
If a diagnostic test is needed, the choice will be derived at after considering the
benefit (advantages); risk (disadvantages); cost; and availability
by both the breast specialist and the patient.
Problem-solving and Decision-making Process
Options Benefit Risk Cost Availability
1 ++++ ++ +++++ NA
2 ++ + ++ RA
3 +++ ++ +++ RA
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist BRCA – informed consent – partnership
In deciding on treatment, the choice will be derived at after considering the
benefit (advantages); risk (disadvantages); cost; and availability of procedure
by both the breast specialist and the patient.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist BRCA – informed consent - partnership
After treatment for a breast cancer, the choice of surveillance (follow-up) regimen and schedule will be derived at after considering the
benefit (advantages); risk (disadvantages); cost; and availability of procedures
by both the breast specialist and the patient.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist BRCA – informed consent - partnership
Breast cancer surveillance (after primary treatment)Recommendations:
The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed
tomography scans, [18F]fluorodeoxyglucose–positron emission tomography scans, magnetic resonance imaging, and/or tumor
markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is NOT recommended for routine follow-up in an otherwise asymptomatic
patient with no specific findings on clinical examination.
American Society of Clinical Oncology - 2012
Problem-solving and Decision-making Process
Options Benefit Risk Cost Availability
1 ++++ ++ +++++ NA
2 ++ + ++ RA
3 +++ ++ +++ RA
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Check-ups
It is important that there be regular follow-ups and check-ups with a breast specialist to
• catch breast diseases not evident at the time of previous examination;
• recheck initial findings; • review initial evaluation; and • reinforce education and coaching to promote
breast wellness.
ROJ Promoting Breast Wellness Among Filipino Women
Recurrence
• With the exact cause of breast cancer not being known and with treatment directed only against the cancer, there is always a potential for recurrence after treatment.
• After treatment for a breast cancer, recurrence can occur in any part of the body but the more common locations are in the bones and lungs.
ROJ Promoting Breast Wellness Among Filipino Women
Attitude and Practice
• At present, the most practical thing to do in the fight against breast cancer is to detect it early enough and to have it treated as soon as possible.
• With early detection and treatment, there will be reduction in the magnitude of complications and premature deaths that are usually associated with advanced breast diseases.
ROJ Promoting Breast Wellness Among Filipino Women
Attitude and Practice
After doing my best to detect breast cancer early enough, I need to adopt the stance (attitude) of
“hoping for the best at the same time ready to accept the worst”
in order to promote my personal well-being and productivity as a citizen in the community.
Breast Cancer Risk Assessment
ROJoson’s Breast Cancer Risk AssessmentStrong Risk Factors Points
Age25 and younger 126 - 39 240 - 49 350 -70 4More than 70 3
Family History of Breast CancerNegative 1Positive in 2nd degree relatives (any no.) 2Positive in one 1st degree relative 3Positive in more than one 1st degree relatives 4
ROJoson’s Breast Cancer Risk Assessment
Score Level of Risk for Breast Cancer
2 - 4 Low
5 - 6 Intermediate
7 - 8 High
ROJoson’s Breast Cancer Risk Assessment
Family History
Age25 and younger
26 - 39 40 - 49 50 -70 More than 70
Negative 2 3 4 5 4Positive in 2nd degree relatives (any no.)
3 4 5 6 5
Positive in one 1st degree relative
4 5 6 7 6
Positive in more than one 1st degree relatives
5 6 7 8 7
ROJoson’s Breast Cancer Screening Recommendations Based on Risk Assessment, Age, and Family History
Score Level of Risk Breast Self-exam
Breast Specialist Clinical Breast Exam
Mammography
2 - 4 Low √ (monthly) √ (at least once a year)
Χ
5 - 6 Intermediate √ (monthly) √ (at least 2x / year)
√ Once every 2 years but only at age 40 up
7 - 8 High √ (monthly) √ (at least 3x /year)
√ Once a year but only at age 40 up
*Note: At age 40-49, with negative family history for breast cancer, mammography is NOT recommended.
ROJ Promoting Breast Wellness Among Filipino Women
Recommended Strategies on Promoting Breast Wellness and Against Breast Cancer
• Possessing adequate knowledge of breast conditions and diseases
• Performing regular breast self-examination• Seeking regular check-ups and advices from a
breast specialist
ROJ Promoting Breast Wellness Among Filipino Women
Video on How to Do Breast Self-Examination
Reynaldo O. Joson, MD
ROJoson Medical Clinic Manila Doctors Hospital
DSMT (Doctors’ Clinics) Room 301
Tel. No. 522-47-13Tel. No. 558-08-88 Loc. 4100
Cell No.: 09188040304Email: [email protected]@gmail.com
Website:https://sites.google.com/site/rojbreastwellnessclinic
Facebook Pages:https://www.facebook.com/rjoson2001
http://www.facebook.com/ROJosonMedicalClinichttp://www.facebook.com/ROJosonBreastWellnessClinic
Promoting Breast Wellness Among Filipino Women
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg2016