MRI Screening for Breast Cancer in Genetically High Risk Women
Frenchay Breast Care Centre is a self contained unit directly off the main corridor of Frenchay Hospital, not part of the outpatient department. It is dedicated to diagnosing and treating breast conditions. There are several types of clinic to which you may be referred:
Women who have a breast problem, whether it be a lump, breast pain or a nipple discharge are usually referred by their G.P. and seen in one of these clinics. They are held on Tuesday mornings (Mr. Sahu) and Tuesday afternoons (Mr. Cawthorn) or Monday Afternoons and Thursday Mornings (either consultant)
Breast problems can cause a lot of concern and one stop breast clinics were set up to try and relieve this anxiety. Most of the necessary tests are performed during the clinic and the results are received towards the end of that clinic so that the woman doesn't have to come back on another day for her results. She will be called in again as soon as possible after the results are received and given them by the doctor who saw her earlier and any consequences discussed. There may be some waiting involved in the X-ray department for the mammogram and again back in the clinic for the result of the FNA test, these are technically demanding examinations and have to be reported on by specialist consultants.
Diagnosis is made by examination of the breasts and as necessary by ultrasound examination, mammography and fine needle aspiration cytology.
Ultrasound
This is done by the doctor in the clinic, using a probe, which is moved over the skin and connected to a machine with a TV screen. It uses ultrasonic waves which are completely harmless, but a water based gel has to be put on the skin to conduct the waves through it. A picture is built up on the screen of the breast tissue underneath and can be interpreted by the doctor. Ultrasound Machines
Mammography
A mammogram is an X-Ray of the breasts. The breasts have to squeezed between 2 plates while the pictures are being taken which are usually done from 2 angles in each breast. This can be uncomfortable particularly if the breasts are tender anyway. It is rarely performed on women under the age of 35 unless looking at something specific such as a lump, as the breasts are very dense in younger women and abnormalities don't show up well. Patients have to go to the X-Ray department for this which is about a hundred yards from the clinic.
Fine Needle Aspiration
This test involves taking some cells from an abnormal area of the breast such as a lump using a syringe and needle. The needle is no bigger than the ones used to take blood, but this test can be uncomfortable - local anaesthetic can be used if necessary. The cells are put on a glass slide and immediately taken to the lab to be prepared and examined under the microscope by the consultant histopathologist. Occasionally a larger specimen is needed for diagnosis or further information and a core biopsy is taken which involves a larger needle but which is always done with local anaesthetic.
This is held on Friday mornings with Dr. Shere. If you have a strong family history of breast cancer i.e. 2 or more relatives developed breast cancer or a close relative developed it at a young age, your doctor can refer you to this clinic. Before you come please try and find out as much as you can about your family history - ages of diagnosis of breast cancer, ages now, whether the cancer was in one breast or both, is there any history of ovarian cancer in the family as well etc. We will discuss with you whether you have an increased risk of developing breast cancer and give you an idea of how high that risk is. If you are interested in knowing more detail, we have a computer programme which will work out genetic risks on family trees. If you are at increased risk, as measured by certain criteria, we will offer you screening which usually will mean a mammogram every 18 months. You may also be offered a referral to a clinical geneticist for a more detailed discussion of your family and risks. Women at very high risk may be invited to join a national trial of MRI screening
These are held on Thursday mornings and afternoons although we also see follow up patients in the other clinics on Mondays and Tuesdays. They are for patients whose conditions we are following up, be it after an operation or for a benign condition. We often arrange open appointments for non serious conditions which means that we don't give you a date to come back, but if you are worried about the condition you were referred with or a new breast problem in the following six months, you can ring up and make an appointment directly with us without having to go through your G.P.
This takes place on Monday mornings with Jane Barker or Lin Willoughby, breast care nurses. Lymphoedema is swelling of the arm with fluid which sometimes occurs after surgery and radiotherapy to the breast and armpit. It is important to detect it early on and for this reason you will get an appointment to come to this clinic 6 months after surgery to have detailed measurements made of your arm. If it is detected, massage and arm exercises are usually adequate, only in severe cases will a compression sleeve be needed. Jane will usually see you every 6 months for 2 years.
This takes place on Wednesday mornings with Lin Willoughby, breast care nurse. After a mastectomy you will be fitted with a soft prosthesis to take home from the ward and then Lesley will see you 6 weeks after surgery to fit you with a silicon prosthesis to wear under your bra. You will have a half hour appointment and she can also give you advice on bras and swimwear.