The International Day of Radiology
The International Day of Radiology (IDoR) is Tuesday, November 8, 2016. This special day marks the 121st anniversary of the discovery of the X-ray by German physicist Wilhelm Röentgen and this year is dedicated to breast imaging and the essential role that radiology plays in the detection, diagnosis and management of diseases of the breast. The Irish Institute of Radiography and Radiation Therapy (IIRRT) is joining more than 100 medical societies around the world in marking this very special day.
Breast Cancer is the most commonly diagnosed cancer among women in Ireland and has the second highest mortality rate. Over 2700 women are diagnosed with breast cancer in Ireland each year and the risk of developing breast cancer increases with age.
Approximately one third of breast cancers will be picked up within screening while two thirds will present to a symptomatic breast clinic. Men are also at risk of developing breast cancer with 23 cancer diagnoses in 2013. In Ireland, a woman has a 1 in 9 lifetime risk at developing breast cancer. Over 75% of all breast cancers diagnosed in Ireland are in women over the age of 50 years.
Breast Screening which uses x-rays as its primary screening tool was rolled out in the East of Ireland in 2000 and it expanded nationally in 2007 for women between the ages of 50-64 years. In late 2015 the screening age extended to include women up to 69 years and this will be fully implemented over 3 screening rounds. The reason breast screening begins at the age of 50 is because of the increased risk of developing the disease. In addition, as we get older the glandular tissue in our breasts begins to disappear and is replaced by fatty tissue. This fatty tissue is much easier to see through on a mammogram (breast X-ray) and it is easier for a radiologist to read the x-rays making cancer detection and diagnosis more effective.
The primary aim of breast screening is to reduce the number of cancer deaths within the eligible population through early detection. Breast cancer is treatable if detected early with a five-year survival of approximately 82%. The screening programme employs highly skilled radiographers who must complete a post-graduate qualification in mammography and work in the specialist area for a minimum of 2 days per week to ensure they are competent in the field of mammography. For approximately 95% of woman the only contact they will have with the screening service is with the radiographer and they will receive a normal result and will be recalled to screening in two years if they are still within the screening age. For women who receive a not normal result they will be recalled to an assessment clinic where the radiographer will carry out additional more specialised x-rays to help the radiologist make a diagnosis. Women who return to the assessment clinic will also have an ultrasound of the breast and where the radiologist cannot rule out an abnormality they will have a biopsy which can be performed under ultrasound or x-ray guidance. Of the 5% of women who are recalled to an assessment clinic 80% will receive a normal result and return to screening while they remain within the screening age and 20% will have a cancer diagnosis. This equates to approximately 1 in 100 women screened will have breast cancer.
Mammography is the most sensitive and specific tool we have in detecting breast cancer among the eligible population however no screening tool is 100% accurate. Some breast cancers will develop in-between 2 screening episodes while a small number of cancers have the same appearance as normal breast tissue on a mammogram and therefore the radiologist is unable to detect any abnormality when they read the x-rays. For this reason, it is important that women check their breasts regularly and know what looks and feels normal for them. If a woman finds any changes it is important that she attends her GP. If the GP evaluates that these changes require additional investigation they will refer the woman to a specialist Symptomatic Breast Clinic in one of the 8 cancer centres around the country. Women younger than 50 years with a symptom or who have a family history of breast cancer can also be referred to a Breast Clinic. All referrals to the clinic are triaged so that the patient attends the most appropriate clinic for their symptoms. For example, if a Dr suspects that the symptom may be a cancer, the patient will attend a one-stop clinic where they will have a mammogram and/or and ultrasound, a clinical examination and a biopsy if necessary on the same day. Whereas, a woman who is referred for family history of breast cancer will initially be seen in a family history clinic. This clinic will assess the increased risk a patient has of developing breast cancer above the general population and depending on their age will recommend appropriate screening using X-ray’s or MRI. A patient will then attend for their imaging at the required intervals and will only meet a radiographer unless an abnormality is detected.
Many people believe that if there is no family history of breast cancer in their family then they are unlikely to develop breast cancer however less than 10% of breast cancers are hereditary (NCRI.ie) therefore it is important to be aware that 90% of breast cancers are spontaneous and the risk increases with age.
If a cancer is detected, then X-rays can play a key role in helping the surgeon remove that cancer. Small cancers are localised in the breast clinic under x-ray guidance using a guide wire and the radiologist will assess the extent of the cancer from the mammography images. These techniques help the surgeon remove the tumour without having to remove the breast. Once the tumour has been removed it is x-rayed immediately and this will help the surgeon assess if the entire tumour has been removed or if additional excision is required.
Depending on the size, type and extent of a tumour some patients will have radiation therapy following surgery.
A patient will return to the Breast clinic annually to have a mammogram and see the surgeon so that any possible recurrence of the tumour can be diagnosed as quickly as possible.