Screen for cancer (by GERALDINE LING in Mind Your Body of the Straits Times dated 14 october 2010)

The following article by GERALDINE LING is from Mind Your Body of the Straits Times dated 14 october 2010, Thursday.


Sometimes, breast abnormalities cannot be felt. This is when mammograms and ultrasounds are used to scan suspicious areas and biopsies done to check for cancer. GERALDINE LING reports.

Mammogram image of a hookwire that has been inserted into the breast to mark the area of abnormality.

A lump in the breast. Dimpling of the skin. A weepy nipple.

These are some signs that women should not ignore as they could indicate breast cancer.
However, some breast abnormalities cannot be felt. They show up only through scanning methods like mammograms and ultrasounds.

In the scans, breast abnormalities may appear as small white spots or flecks, which could indicate calcium deposits. Cysts, or fluid-filled sacs in the breast, can also show up as shadows.
Thankfully, most abnormalities that show up on mammograms do not indicate breast cancer.

For example, out of 1,000 screening mammograms, 10 per cent needs to be investigated further. Eventually, of the 1,000, fewer than 2 per cent will turn out to be cancer, said Dr See Hui Ti, a senior consultant at Parkway Cancer Centre.

Abnormalities that may indicate malignancy show certain features.

For example, very tiny white calcium deposits found in a very dense cluster can be considered suspicious. A dense cluster of cells may be a sign of cancer as cancer cells divide rapidly.

However, a very large white spot (like a popcorn) is often benign. These larger deposits may be caused by previous injury to the breast tissue, said Dr See.

To determine if such abnormalities are cancerous, one of four types of biopsy methods are typically used.

The doctor will decide which biopsy method to use only after a detailed consultation with the patient, said Dr Wong Seng Weng, medical director of The Cancer Centre.

1: Fine needle biopsy and cytology

This is also known as fine needle aspiration. The abnormality is first located through an ultrasound. Then, a very thin, hollow needle is used to obtain cell samples to be tested.

It is a minimally invasive procedure that takes less than a minute under local anaesthesia, said Dr Tan Yah Yuen, a consultant breast surgeon at Mount Elizabeth Medical Centre.

Usually, no scar is visible and the procedure is similar to taking a blood test, she added.
This is typically used for cysts that can or cannot be felt. Fluid can be completely drained and the cyst disappears, said Dr Tan.

The procedure costs less than $300.

2: Core biopsy

This is performed under local anaesthesia and is similar to fine needle biopsy and cytology. The suspicious area is located through either a mammogram or ultrasound.

However, this procedure uses a slightly bigger needle (Picture 2) because strips of breast tissue are also removed. This allows for a more accurate assessment than a fine needle biopsy and cytology, or cell analysis, said Dr Tan.

The core needle can be inserted several times until the doctor is satisfied that enough tissue has been collected. On average about three to four insertions are made, she added.

The procedure takes about 15 to 30 minutes leaving a scar that is about 2mm long.

It costs between $600 and $1,000.

3: Mammotome biopsy

Again, the doctor uses imaging guidance to locate the suspicious area. A handheld device with a probe (Picture 3, not in this posting) is inserted into a small cut - smaller in diameter than a pea - over the abnormality.

The device is used to vacuum, cut and remove the suspicious area.

Small, benign abnormalities can be fully removed through the mammotome.

It is most useful when the aim is to remove small abnormalities, such as tiny calcium deposits, as completely as possible to improve diagnostic accuracy, said Dr Tan.

Dr Mona Tan, a breast surgeon at Paragon Medical Centre said that abnormalities less than 2cm can be removed through the procedure.

Mount Elizabeth's Dr Tan said the procedure takes about 15 to 30 minutes to complete.

It costs about $2,500 to $3,500. Soreness and swelling may last from a few days to two weeks. The healed scar may be about 2 to 4mm in length.

4: Hookwire localisation biopsy

There are two parts to this procedure.

A hookwire is first inserted, under local anaesthesia, into the breast under imaging guidance. It will mark the area of abnormality.

The patient is then taken to the operating room and given general anaesthesia. The wire is removed together with a surrounding margin of tissue.

One instance when hookwire localisation is used over a mammotome is when a patient has smaller and denser breasts, say a bra cup size below B, said Dr Mona Tan. This is because a mammotome requires enough breast tissue to be compressed to be effective.

One drawback of the hookwire method is that the abnormal area may be missed if the hookwire slips out of position after its insertion, said Dr Tan. However, she added that this rarely happens.
The procedure takes between 20 and 40 minutes and costs between $2,500 and $3,500. The scar will be about 3 to 4cm long, said Mount Elizabeth's Dr Tan.


In 1,000 mammograms, fewer than 2% will show up as cancer cases.

Most biopsies can be completed under 40 minutes