Diagnosing Breast Cancer

Thursday, 09 May, 2019

The busy Breast Imaging Unit in Beaumont Hospital, carries out 15,000 studies annually for patients of the Breast
Care Service. Fortunately in the majority of cases they are able to provide good news. However, for a small number
each year - approx. 400 patients - diagnostic imaging will identify breast cancer. Consultant Radiologist, Jennifer Kerr,
explains, "Nowadays women of all ages are very aware of the need to have any changes in their breasts checked
without delay. In the first instance, they visit their GP and if he/she feels there are breast symptoms that need to be
investigated further, they refer their patient to the Breast Care Service for further assessment."

Following an initial assessment at the clinic by the breast surgical team, patients identified as urgent are sent to the
Breast Imaging Unit on the same day. Women over age 35 have a mammogram first and, if a lump is found or if the
radiologist wishes to investigate further, they will be sent for an ultrasound.

In the vast majority of cases, the mammogram and ultrasound will be normal or identify benign findings. But, if
a lump or other abnormality is identified on the initial imaging, a biopsy is arranged. Most biopsies are performed
straight away. Using ultrasound, the biopsy needle is guided to the area of concern and a sample taken. Some
patients require a biopsy using the mammogram machine for guidance and these procedures, which take longer, may
have to be rescheduled for another day.

Jennifer adds, "Part of our role in diagnosing a patient is to establish the size and extent of the cancer in their breast.
In most cases, we use mammography and ultrasound to achieve a full picture but some patients may also need an

This information is vital to the surgeons in deciding what the best individualised treatment plan will be for each patient.
Smaller cancers can be excised by lumpectomy, but larger tumours may require mastectomy or upfront

Patients identified through the Family History Service as having a high risk of developing breast cancer require close
monitoring. They too come to the Breast Imaging Unit for annual screening. Speaking about the changes that a move to a new building
will bring, Jennifer says, "The current Breast Imaging Unit is very cramped with limited waiting area. It offers little privacy
to women ahead of their scans and much of our scanning equipment needs to be replaced. The Breast Imaging Unit
will be relocated to the ground floor of the new Breast Clinic. We will have two tomosynthesis mammogram rooms,
two ultrasound rooms with capability to perform biopsies and reporting rooms with dedicated breast imaging
workstations to report from. There will also be a dedicated procedure room in which we will be able to perform
biopsies and to remove small breast lesions under local anaesthetic using image guidance. This will mean that
patients will no longer need to go to the operating theatre.

Our patients will be welcomed in to a modern, purpose-built facility where their needs are catered for
solely. They will now wait in well-appointed, comfortable seating areas with adequate changing facilities. And our
colleagues in surgery and other disciplines will be close by on the first floor if we need to consult with them. The
improvements will make an immense difference to the diagnosis and care of all women with breast cancer at
Beaumont Hospital", she concluded

A diagnostic mammogram
is a low-dose x-ray of the breast used to detect breast cancer and other benign breast
conditions. It is the first line test to evaluate a lump or other breast symptom in patients over 35 years. It is also used to
follow patients at risk of breast cancer or who have had a previous breast cancer.

Ultrasound uses high frequency sound waves to characterise lumps in the breast. It can distinguish a solid lump from a cyst
(fluid filled). It is the first line test to evaluate patients under 35 years. It can be used along with diagnostic mammography or
MRI to answer questions about a specific area of the breast. It provides information that is different and often complementary to a mammogram.

Magnetic resonance imaging (MRI) uses magnetic waves to produce hundreds of cross-sectional images of the breast,
(side-to-side, top-to-bottom, front-to-back), which are then read by a radiologist. It shows lesions that take up a dye which
has been injected into the vein.

Tomosynthesis or 3D mammography, is the latest technique for detection of breast cancer. It is particularly useful in
evaluating women with dense breasts, usually younger women. Currently not available in Beaumont Hospital, two
new tomosynthesis mammography machines are planned for the new Breast Imaging Unit in the new clinic.