Breast Cancer Awareness Month - ROJoson's Lecture - 16oct22

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: rjoson2001@yahoo.comrojosonmedclinic@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