Keeping Abreast October 2019
Keeping Abreast is the regular BreastScreen SA publication providing a snap shot of what’s happening at BreastScreen SA and topics relating to breast cancer screening.
Celebrating 30 Years Of Breast Cancer Screening
BreastScreen SA is celebrating 30 years of providing free breast cancer screening for the women of South Australia. Our mission is to find breast cancer at an early stage, before it can be felt, through a program that is designed by the women, for the women.
The impact of our service over the past 30 years has resulted in an increase in the survival rate for breast cancer in South Australia. Research has found that by regularly participating in screening, women are reducing their risk of dying from breast cancer by more than 40%.
BreastScreen SA has performed more than 1.9 million screening mammograms to more than 350,000 local women right across the state. While we’ve also played a role in changing the lives of more than 11,000 women who have been found to have early stage breast cancer, often before they could feel it, BreastScreen SA has given them the best possible chance of successful outcomes thanks to early detection.
On behalf of our program, we would like to thank you for being part of our story, for encouraging women to have a breast screen and supporting women’s health here in South Australia.
Breast Cancer Awareness Month
October is breast cancer awareness month. Please help us to promote free breast cancer screening during this October by creating a display or simply popping a counter top box out for women visiting your practice to choose a small gift. Each year we dispense counter top boxes to practices however this year we are asking you to order yours; simply email us at BSSApromoed@sa.gov.au and we’ll send you out your promo pack.
Abnormal Lymph Nodes Found At Screening: Recommendations For Investigation
Normal and abnormal axillary lymph nodes (both unilateral and bilateral) are commonly seen on mediolateral oblique (MLO) screening mammograms. Normal axillary nodes are more common, and are identified as normal when they are typically small and oval with a lucent centre due to hilar fat.
Abnormal axillary lymph nodes found during screening and/or assessment with BreastScreen SA are the most common presentation of possible systemic disease when no evidence of breast cancer is found. Systemic disease typically presents with bilateral abnormal axillary nodes, whereas unilateral is more concerning for a breast-related cause including breast cancer.
If the findings are unilateral, the patient will be recalled to Assessment Clinic, due to the possibility of underlying breast malignancy. However, if bilateral and potentially secondary to systemic disease, the client’s general practitioner (GP) is best placed to investigate the abnormal lymph nodes.
In the circumstance of bilateral abnormal nodes, the client’s GP is then contacted by phone and a letter is sent from BreastScreen SA advising that while no evidence of breast cancer has been found, abnormal axillary lymphadenopathy has been noted. If there is no known cause, then further investigation is recommended. Sometimes a treating specialist review may be advisable. The client may then contacted by her GP with a letter also being sent to her from BreastScreen SA.
If there is no known pathology, women will usually require at least a clinical examination and complete blood picture, as well as ultrasound and fine needle aspiration biopsy of the abnormal nodes. It is important to remember that although no breast lesion has been seen on the screening mammogram, an occult breast cancer remains a possibility. This is why a clinical breast examination should always be part of the assessment of these women.
A suggested flow chart for investigation of abnormal lymph nodes found at screening mammography is included with the letter from BreastScreen SA to the woman’s GP. The films from BreastScreen SA can be accessed online on request by the radiology firm for where the woman is referred.
For audit and follow-up purposes, BreastScreen SA appreciates feedback from the GP with details of the assessment, investigations and results.
Benign causes of lymphadenopathy include:
- infection, either acute or chronic
- Rheumatoid arthritis and other arthropathies
- connective tissue disorders, such as SLE
- granulomatous diseases, including sarcoidosis
- silicone lymphadenopathy
- tattoo pigment, often calcifications.
Malignant causes include:
- lymphoproliferative disorders (lymphoma, leukaemia)
- metastatic breast cancer
- metastatic melanoma
- lung cancer
- other malignancies, such as stomach, ovarian carcinoma.
During the five year period 2013-2017, pathological lymph nodes without any breast abnormality were detected in approximately 154 cases at BSSA, representing 3.6 women per 10,000 women screened.
Malignancy was diagnosed in 28 of these women (18%). Although in some cases there was known pre-existing malignancy such as Chronic Lymphocytic Leukaemia (CLL), ten of the 28 cases were newly diagnosed as a result of the mammographic finding. In a further six cases, the outcome of the pathology of the lymph node is unknown/not available. There were three cases of invasive breast cancer diagnosed.
It is therefore recommended that all women whose screening mammograms show abnormal lymph nodes with no known cause have further investigation.
Eligibility For Screening – A Flowchart For Decision Making
A common question women often ask is when are they able to access free breast cancer screening. To help, BreastScreen SA has designed a simple flowchart for assisting GPs in having this conversation with their patients. The flowchart is available from the homepage of the BreastScreen SA, or you can download your copy of the Eligibility for screening with BreastScreen SA (PDF 48KB).
Why Should You Recommend BreastScreen SA To Your Patients?
As a fully accredited population based screening program, BreastScreen SA offers an evidence-based service that is reducing the burden of breast cancer on the South Australian community. Read the BreastScreen SA fact sheet (PDF 220KB) on why recommending regular breast cancer screening could save the lives of female patients in your practice.
Where Are The Mobile Screening Units?
Our three mobile screening units visit over 30 country, rural and outer metropolitan South Australian areas. Our units visit each area every two years and are always well attended.
To find out where our mobile screening units are travelling for the remainder of this year and early next year, please see the schedule below, and please remind your clients to make a booking while the unit is in their area, by calling 13 20 50 or by registering online at BreastScreen SA.
For a schedule of mobile clincs, see the Breast Screening Clinics page..
How To Encourage Your Patients To Have A Breast Screen
Building collaborative partnerships with GPs is an important strategy for BSSA. We offer:
- a range of free printed resources, including brochures in 25 languages, posters, pens and promotional boxes
- seminars for health professionals and practice managers – at BSSA or your venue
- personalised contact with GPs via surgery visits
- display materials
- articles for professional magazines/newsletters.
Contact our Medical Officers for more information on 08 8274 7151.
167 Flinders Street
Adelaide SA 5000
Phone: (08) 8274 7151
Fax: (08) 8357 8146