Breast Complaints Research Articles

Breast Examination Practices among Nursing Students in Warri, Delta State

Objective: To ascertain influencing factors and breast examination practices among student nurses in Warri, Delta state. Design: Cross-sectional survey.Setting: State School of Nursing, Warri, Delta State. Subjects: Two hundred and ninety six student nurses attending the school in 2010 with exclusion of introductory students.Results: Self breast examination was practiced by four-fifths(79.39%) of respondents; of the self breast examination practitioners, 88.52% had a monthly self breast exam. Clinical breast examination had been utilized by one-sixth (17.35%) of respondents. Self perception of proficiency at self breast examination was agreed to by four-fifths(82.35%) of respondents. About a third (21.6%) knew a family member or friend with breast cancer while a fourth (26.71%) had breast complaints in the past requiring Physician consultation. A previous breast procedure was admitted to by a fourth(24.01%) of respondents. There was a strong positive association between self breast examination and previous breast procedure, p

Concerns about inherited risk of breast cancer prior to diagnosis in Japanese patients with breast complaints

The purpose of this study was to reveal characteristics that underlie patients' expressions of concern about their genetic risk of breast cancer at an initial outpatient clinic visit prior to a definitive diagnosis of cancer. A total of 233 women, at their initial outpatient clinic visits, participated in semi-structured and open-ended interviews that surveyed their anxieties, worries, thoughts, and feelings. Each patient completed a self-administered survey comprising questions about her family history of breast cancer and responded to a questionnaire that assessed psychological distress. Patients were divided into those who expressed concerns about inherited risk of breast cancer during the interview (expression group, n=39) and those who did not (non-expression group, n=194). Although patients in the expression group tended to have higher rates of breast cancer in their families, patients without a family history of breast cancer also expressed concerns. We used qualitative content analysis to identify the emotions and thoughts of patients expressing these concerns. Patients with a family history of breast cancer experienced anxiety/worry, risk-reducing behavior, acceptance, objective fact, and denial, whereas patients without a family history of breast cancer experienced anxiety/worry, risk-reducing behavior, surprise/shock, acceptance, objective fact, denial, optimistic thought, regret, and realistic thought. Some patients in the breast clinic had concerns about their inherited risk of cancer, despite lacking a family history of breast cancer. Health care professionals should inquire about family histories and provide appropriate support and counseling to patients as needed, regardless of the patient's genetic risk for the disease.

La galacto-IRM : une nouvelle méthode d’exploration des écoulements mamelonnaires

Nipple discharge is a common breast complaint that justifies an etiologic check-up in order to identify and characterize the underlying intraductal lesion. The low sensitivity and specificity of the existing imaging exams led to the search of new, more efficient ways to explore nipple discharge. MR-Galactography is one of these emerging techniques. Recent literature tends to prove that MR-Galactography could be an interesting technique for localizing and characterizing lesions causing nipple discharge.

Spectrum of Disease in the Male Breast

The purpose of this article is to review the anatomy of the male breast and to describe the imaging findings of a variety of diseases that affect the male breast to better understand and recognize the imaging findings and underlying pathophysiology of diseases and conditions affecting this emerging subset of patients. Understanding the anatomy of the male breast is central to developing a differential diagnosis and delivering optimal care in male patients presenting with breast complaints. Diseases in the male breast can affect the skin and subcutaneous tissues, stroma and glandular elements, and neurovascular and lymphatic structures. Although the most commonly encountered disease entity is gynecomastia, men can develop many other benign and neoplastic diseases, including primary breast cancer. By incorporating clinical presentation with imaging findings on mammography and ultrasound, the breast imager can more effectively establish the correct diagnosis in males.

Management of Senescent Gynecomastia in the Veterans Health Administration

Senescent gynecomastia is common in Veterans Health Administration patients because of clinical characteristics in the population, mainly obesity and the use of numerous etiologic drugs. To assess management of the disease, we studied patients treated between January 1, 2003 and December 31, 2007, in the Veterans Affairs-Tennessee Valley Healthcare System. Four hundred and fifty-four cases of senescent gynecomastia were retrieved from 670 charts addressing breast complaints (positive predictive value = 68%). Average patient age was 68.5 years. Mean body mass index was 29.7. Ninety-two percent of patients were using multiple medications associated with gynecomastia. Medications were considered at least partially etiologic in 79.3% of cases. Medical conditions caused gynecomastia in 13.7%. Over 50% of patients underwent diagnostic imaging studies. One-fifth of patients were tested for etiologic endocrine tumors. Yield on this testing was 1.1% (1/93). Ninety-four percent of patients were managed nonoperatively. Case management in the Tennessee Valley Healthcare System was generally correct, though there was excessive use of imaging, invasive diagnostic procedures, and endocrine assessment. Senescent gynecomastia, a benign disease, can usually be diagnosed by history and physical examination, requires little diagnostic testing, and should be treated nonoperatively.

Barriers and opportunities for early detection of breast cancer in Gaza women

A survey of 100 women living inside Gaza (WIG) and 55 Gaza women residing outside Gaza (WOG) was conducted to investigate barriers and opportunities for breast cancer screening, and to better understand possible differences based on residency. The survey found that over 90% of both groups were willing to undergo a diagnostic mammogram for a breast complaint and 86% of WIG and 85% of WOG believed survival was increased with early detection. However, only 27% of WIG and 50% WOG were willing to undergo screening mammography. Religion and culture were not barriers to mammography for over 94% of WIG and 98% of WOG. Limited resources and lack of access to medical facilities were identified as barriers in up to 55% of WIG compared to 15% of WOG. Misconceptions about breast cancer were reported more frequently by WIG, including beliefs that breast cancer is not very common and that breast cancer can be contagious.

Scapulothoracic Bursitis as a Significant Cause of Breast and Chest Wall Pain: Underrecognized and Undertreated

Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4±12.7years, and average BMI was 30.4±7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

Can electronic zoom replace magnification in mammography? A comparative Monte Carlo study

Magnification, which is considered to be a relatively high "dose cost" mammographic technique, is a complementary examination performed on women exhibiting breast complaints or abnormalities. Particular attention is given to the imaging procedure as the primary aim is to confirm the existence of suspected abnormalities, despite the additional dose. The introduction of post-processing capabilities and the widespread use of digital mammography promoted some controversy in the last decades on whether electronic zoom performed on the derived initial screening mammogram can effectively replace this technique. This study used Monte Carlo simulation methods to derive simulated screening mammograms produced under several exposure conditions, aiming to electronically magnify and compare them to the corresponding magnification mammograms. Comparison was based on quantitative measurements of image quality, namely contrast to noise ratio (CNR) and spatial resolution. Results demonstrated that CNR was higher for geometric magnification compared to the case of electronic zooming. The percentage difference was higher for lesions of smaller radius and achieved 29% for 0.10 mm details. Although spatial resolution is maintained high in the zoomed images, when investigating microcalcifications of 0.05 mm radius or less, only with geometric magnification can they be visualised.

Palpable Presentation of Breast Cancer Persists in the Era of Screening Mammography

The aim was to describe cancer detection method and frequency of screening mammography in women undergoing breast cancer surgery in 2000. Patients undergoing breast cancer surgery were identified through an institutional database. Charts were reviewed to determine presentation at time of diagnosis. Presentation was coded "palpable" if the woman presented with a breast complaint or if a new mass was detected on examination versus "screening" if detected on screening mammogram. Five hundred ninety-two breast cancers were identified: 57% presenting by screening and 43% palpable. Cancer was more likely to present as palpable in patients with no previous screening mammography compared with those with previous mammography (67% versus 39%; p = 0.0002). Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years; p < 0.0001). Despite the frequent use of screening mammography, 43% of breast cancers presented as a palpable mass or otherwise symptomatic presentation.

Assessing the Knowledge and Attitudes Regarding Genetic Testing for Breast Cancer Risk in our Region of Southeastern Georgia

Genetic testing for the breast cancer susceptibility genes, BRCA1 and BRCA2, has been available for over a decade. Positive test results carry significant medical, psychological, and social implications. Knowledge of the public's awareness concerning BRCA testing, and perceived benefits and barriers to testing can help refine educational programs and identify subgroups needing additional support. Patients and their acquaintances with a breast complaint attending a surgical clinic or private office were asked to complete a questionnaire about their knowledge of breast cancer genes and their desire to be tested. Demographic information collected included ethnicity, education background, age, income, and personal and family history of breast cancer, knowledge of BRCA genes and testing, and their willingness to participate in genetic counseling. A total of 222 people completed the questionnaire that showed the majority of subjects in southeast Georgia believe breast cancer is inherited 26-50% of the time. Caucasians and those with advanced degrees are the most informed regarding awareness of BRCA genes (p < 0.05); the least informed groups include African Americans and those with no more than a college education. Participants with a family history of breast cancer were significantly more likely to know that genes had been identified that indicate an increased risk of breast cancer (p < 0.05). A history of breast cancer did not impact the degree of awareness (p > 0.05). Subjects aware of genetic testing are more willing to utilize counseling (p < 0.05). Perceptions of breast cancer inheritance, awareness of susceptibility genes, and availability of testing and counseling are not uniform among all population subgroups. In southeast Georgia, educational efforts should focus on the less educated and minority groups.

Breast complaints and cancer: age stratified predictors of risk from a prospective database.

Abstract Abstract #4086 Surgical clinics are presented with a variety of breast complaints. This study looks at major reasons for referral and correlates them to the likelihood of a benign or malignant disease.&amp;#x2028; Data comes from a prospective database of new referrals for surgical assessment. Male patients and presentations of recurrent cancer were excluded. Reasons for presentation were sorted into 7 categories defined as breast asymmetry, palpable mass, non-inflammatory skin changes, inflammatory changes, nipple discharge, nipple changes, pain or abnormal imaging. The dominant complaint was applied. Some patients are included twice if they had another problem in the opposite breast, or a second presentation of a new problem. Patient demographics were recorded and all patients were followed to a benign or malignant diagnosis.&amp;#x2028; Chi-square testing, odds ratios, and confidence intervals were used for the categorical data. Fisher's exact test was employed for categories with a low cell count.&amp;#x2028; Three hundred and ninety of 1050 patients were found to have breast cancer. The most common presentations of malignancy were a palpable mass and abnormal imaging. Less common presentations that also predicted cancer were persistent inflammation, skin changes, and nipple changes. Breast pain (p=0.00001), breast asymmetry (p=0.00001), and nipple discharge (p=0.00001) were significantly correlated with benign disease. The most common diagnosis varied significantly with age. Fibroadenomas were most common in young women, while cysts were frequent in the peri-menopausal group (p=0.0001). A new mass in a woman over 65 years old was malignant 83% of the time (p=0.000001).&amp;#x2028; Reason for referral can be significantly correlated with a benign or malignant diagnosis. Breast asymmetry, pain, and nipple discharge were associated with a benign diagnosis, while a new mass in an older woman was more likely to be malignant than benign. This information can be used to help stratify referrals into high and low risk categories, and identify patients for expedited assessment. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4086.

The use of a mixed reality breast simulator with an innovative touch map feedback system to teach breast history-taking and examination skills.

Abstract Abstract #2105 Introduction: Physical examination remains an important method of breast cancer detection. Unfortunately, many health care professionals express concerns about missing breast lesions and current methods of teaching this essential skill are limited. Through an interdisciplinary collaboration, we created an immersive virtual patient to teach health professions students history-taking and breast examination skills.&amp;#x2028; Methods: Fifteen physician's assistant (PA) and 13 medical students (MS) interacted with a mixed reality human (MRH, a computer avatar with a mannequin-based breast simulator) with a breast complaint (Figure 1).&amp;#x2028; &amp;#x2028; Students spoke to and touched the MRH to take a history and examine a simulated breast with two masses of differing size and consistency. Subjects were surveyed regarding the usefulness of the virtual teaching tool and composed a patient note documenting pertinent history and physical examination findings. Students received feedback regarding the content of their patient note (number of 17 essential content items documented) and on the completeness of their breast examination (percentage area covered) using a color-coded touch map.&amp;#x2028; Results: Student feedback related to the utility of this virtual educational tool was positive. Students only documented a mean of 7.8±2.7 (range=4-15) essential content items in the breast history. The completeness of the breast exam was a mean of 82% (range=62% to 97%) of total breast area examined (Figure 2, green=area examined, red=area missed).&amp;#x2028; &amp;#x2028; More clinically experienced students (MS 3 and 4, N=9) performed better than those with no clinical experience (MS 1 and PA 1, N=19) in both history-taking (58% vs. 40%, p&amp;lt;0.05) and completeness of exam (90% vs. 84%, p&amp;lt;0.05). Fifty percent of students were able to locate at least one mass but only 14% were able to correctly document the location of both lesions.&amp;#x2028; Conclusions: The simulated experience differentiated performance among students with varying levels of clinical experience and identified a need for improved teaching and greater practice among all students. MRH scenarios provide a less anxious learning environment for students to practice breast history-taking and examination. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2105.

A pilot study to integrate an immersive virtual patient with a breast complaint and breast examination simulator into a surgery clerkship

Background We aimed to determine if an immersive virtual patient (VP) with a breast complaint and a breast mannequin could prepare third-year medical students for history-taking (HT) and clinical breast examination (CBE) on a real patient. Methods After standardized instruction in breast HT and CBE, students (n = 21) were randomized to either an interaction with a VP (experimental) or to no VP interaction (control) before seeing a real patient with a breast complaint. Participants completed baseline and exit surveys to assess confidence regarding their HT and CBE skills. Results Students reported greater confidence in their HT (Δ value = 1.05 ± 1.28, P < .05) and CBE skills (Δ value = 1.14 ± .91, P < .05) and less anxiety when performing a CBE (Δ value = −.76 ± 1.10, P < .05). The VP intervention group had a significantly higher mean HT confidence than the control group at the conclusion of the study (4.27 ± .47 vs 3.50 ± .71, respectively, P < .05). Conclusions A single interaction with a VP with a breast complaint and breast mannequin improves student confidence in breast HT during a surgery clerkship.

Breast Disorders in Children and Adolescents

Although the vast majority of breast disorders in pediatric patients are benign, the presence of any breast complaint frequently raises parental concerns of a potential cancer.1,2 A thorough knowledge of the various breast pathologies, a complete physical examination, and diagnostic evaluation as indicated are needed to reassure the patient and the parents and to avoid missing any rare malignant lesion.3,4

Establishing a Multidisciplinary Breast Unit in a Middle Income Country � Challenges and Successes

The Breast Unit in the University Malaya Medical Centre (UMMC) was set up in 1993 to cater for the increasing number of women presenting with breast complaints. The surgeon plays a central role in the coordination of the multidisciplinary team which consists of the breast surgeon, pathologist, radiologist, oncologist, plastic surgeon, physiotherapist, psychooncologist, as well as the specialist breast care nurse. The unit provides a comprehensive patient care yrogramme, with diagnostic services (triple assessment comprising clinical evaluation, radiological assessment and biopsy), breast screening services (clinical breast examination ana mammography / adjunct ultrasound), oncological services and palliative care services. Throughout the course of the treatment and post-treatment, emphasis is placed on supportive and emotional care of the patient and her relatives. Teaching and training of undergraduate and postgraduate students form part of the functions of this unit, and clinical and basic research is actively carried out. It has been shown that patients treated in a multidisciplinary breast unit have a better overall outcome: however in low and middle income countries, the development of such units are hampered but lack of manpower and resources. In UMMC, with the institution of treatment protocols and guidelines, it is hoped that survival of patients treated in this multidisciplinary unit will progressively improve.Key words : breast cancer, multidisciplinary breast unit, comprehensive breast care

Establishing a Multidisciplinary Breast Unit in a Middle Income Country � Challenges and Successes

The Breast Unit in the University Malaya Medical Centre (UMMC) was set up in 1993 to cater for the increasing number of women presenting with breast complaints. The surgeon plays a central role in the coordination of the multidisciplinary team which consists of the breast surgeon, pathologist, radiologist, oncologist, plastic surgeon, physiotherapist, psychooncologist, as well as the specialist breast care nurse. The unit provides a comprehensive patient care yrogramme, with diagnostic services (triple assessment comprising clinical evaluation, radiological assessment and biopsy), breast screening services (clinical breast examination ana mammography / adjunct ultrasound), oncological services and palliative care services. Throughout the course of the treatment and post-treatment, emphasis is placed on supportive and emotional care of the patient and her relatives. Teaching and training of undergraduate and postgraduate students form part of the functions of this unit, and clinical and basic research is actively carried out. It has been shown that patients treated in a multidisciplinary breast unit have a better overall outcome: however in low and middle income countries, the development of such units are hampered but lack of manpower and resources. In UMMC, with the institution of treatment protocols and guidelines, it is hoped that survival of patients treated in this multidisciplinary unit will progressively improve.Key words : breast cancer, multidisciplinary breast unit, comprehensive breast care

BREAST IMAGING USING 3D ELECTRICAL IMPEDENCE TOMOGRAPHY

To determine the diagnostic efficiency of 3D Eletrical Impedance Tomography (EIT) compared to Mammography (MG) and Ultrasonography (USG) in imaging the breast. A group of 88 patients presenting with various breast complaints was examined using combined Mammography and Ultrasonography (MG & USG) or either of these modalities alone. The same patients were then examined using the 3D EIT imaging system "MEIK". The findings were then compared. The sensitivity of these modalities for this group of patients were later determined and statistically analysed. Of the total of 88 patients, 59 findings were "suspicious" by any of the 3 modalities alone or by their combination. EIT had a sensitivity of 77.8 % compared to MG with a sensitivity of 83.3 % and USG with a sensitivity of 94.4 % regarding cases of fibrocystic mastitis. For cases involving cysts, EIT had 100 % sensitivity which was the same as that for USG compared to MG with a sensitivity of only 81 %. Among cases of fibroadenoma, EIT had a sensitivity of just 68.8 % compared to MG with a sensitivity of 87.5 % and USG with a sensitivity of 75 %. Finally among cases of carcinoma, EIT had a sensitivity of 75 % compared to the sensitivity of 100 % of MG and USG in our group of patients. The study revealed that there was no overall significant difference in sensitivity between MG-USG (p = 0.219) and MG-EIT (p = 0.779) and USG-EIT (p = 0.169). However, in regard to identifying cysts there was significant difference in the sensitivity of MG compared to USG & EIT suggesting that EIT has a role in these cases. Electrical impedance could be used as an adjunct to Mammography and Ultrasonography for breast cancer detection. However, the differentiation of malignant from benign lesions based on impedance measurements needs further investigation. Multifrequency electrical impedance imaging appears the most promising for detecting breast malignancies but methodological improvements need to be made to realise its potential.

Monte Carlo studies on the influence of focal spot size and intensity distribution on spatial resolution in magnification mammography

Magnification is a special technique applied in mammography in cases where breast complaints have already been noticed, aiming to examine a specific area of the breast. Small-sized focal spots are essential in such techniques in order to reduce the resultant geometrical unsharpness. The x-ray intensity distribution of the focal spot is another crucial parameter for such a technique as it affects the mammographic resolution. In this study a Monte Carlo simulation model is utilized, in order to examine the effect of a wide range of focal spot sizes and three representative intensity distributions on spatial resolution under magnification. A thick sharp edge consisting of lead, non-transparent to x-rays was imaged under various conditions for this purpose, and the corresponding spatial resolution was calculated through the modulation transfer function (MTF). Results demonstrate that focal spots larger than 0.10 mm can mainly be used for low degrees of magnification, especially when combined with double peak Gaussian intensity distribution of the focal spot (sum of two single peak Gaussian distributions with different centers), as the resultant spatial resolution is not as high as the corresponding from smaller foci or uniform and single peak Gaussian distributions. Moreover, for the degrees of magnification usually utilized in clinical practice they do not reach the acceptable limit of 12 lp mm−1. The replacement of the x-ray tube when the focal spot starts being destroyed is very crucial as the possible alteration of single peak Gaussian distribution to double peak Gaussian results in the degradation of spatial resolution. A focal spot of 0.10 mm or smaller, combined with single peak Gaussian intensity distribution, can be considered appropriate even for higher degrees of magnification and its use can contribute in the effort to optimize the magnification views in mammography.

Breast problems presenting in the emergency room

A variety of breast complaints may present in the emergency setting. Therefore, the radiologist in the emergency department must be familiar with the pathology encountered and the associated imaging findings. While mammography is the most commonly and frequently used modality for breast imaging, in the emergency setting, ultrasound may be more readily available and better tolerated by the patient. This pictorial essay describes the spectrum of breast complaints encountered in the acute setting and the associated mammographic and sonographic findings.

358 POSTER Role of combined ultrasonography and mammography in the detection of breast cancer in patients with breast complaints

358 POSTER Role of combined ultrasonography and mammography in the detection of breast cancer in patients with breast complaints