Sitges Haloween Guided Tour
Start Date: October 26, 2012
End Date: October 27, 2012
Time: 10:00 pm
Location: Carrer Angel Vidal, 17 08870 Sitges
Claim Ownership
Description
Dia Internacional Cancer de mama Sitges
INFORMATION STALLS IN CAP DE VILA
over 3 days
Local board of Sitges (AECC) Information Desks (Junta Local de Sitges- AECC)
Set out in ‘Cap de la Vila’ Sitges (center of Sitges village) to convey & teach the importance of preventive actions in the fight with Cancer.
Focused at the female population & combating Breast Cancer
- Thursday, October 18th: 6pm to 8pm : 18 – 20hrs
- Friday, October 19th : 6pm to 8pm : 18 – 20hrs
- Saturday, October 20th : 10am to 8pm : 10 – 20 hrs
Contacts
- Local Board of Sitges-AECC
Carrer de Rafael Llompart, 27, pis 1r. : 1st floor: Tel: 93.894.56.54 - L’Associació Marinada VNG
(self-help group for women with breast cancer)
Passeig Marítim, 73 de Vilanova i la Geltrú. Tel 93 815.43.07
Wednesdays from 18-19hrs.
Breast Cancer Advice Document
CATALAN here : ENGLISH (Google Translation) BELOW
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Barcelona city : Breast cancer and early detection:
what to know
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1. Information about breast cancer
2. What is an early detection program for breast cancer
3. What women can not be included in a screening program?
4. Mammography: what you need to know
5. What tests are diagnostic confirmation
6. Benefits and problems associated with population screening
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1. Information about breast cancer
What kind of diseases are in the breast?
Risk factors for breast cancer
Breast cancer is really a very frequent disease?
What survival and mortality which is breast cancer?
What types of treatment are available?
Side effects of surgery: lymphoedema
What types of radiation are there?
Side effects of hormone therapy
Other therapies: therapy directed
Other important aspects: emotional factors
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1. Information about breast cancer
What is breast cancer?
It is a disease that affects the mammary gland and, as in
other types of cancer occurs when cells begin to divide or
reproduce more than necessary and in an uncontrolled manner, thus creating a
mass of tissue called tumor. might appear in different parts of these-
ta mammary gland.
The main function of the mammary gland is producing milk after
delivery. It is located in the front of the chest, in front of the muscle
ing chest. It consists of glandular tissue forming a distributed cumulative
mules are called lobules and ducts are connected to each other by
galactòfors or breast, which are the leading milk to the nipple
during breastfeeding.
The blood circulation is through the blood vessels (veins and arteries),
but there are also other conduits called lymphatic vessels that the
circulating fluid, lymph, yellowish containing cells that defense
without the body of harmful substances.
Cancer occurs when there is a disorderly growth of cells
tissue , in this case, the mammary gland. Breast cancer is the tumor more
frequent in women in Catalonia, representing 30% of all tumors. In
women aged 50 to 65 is where the greatest number of cases of the disease.
Breast cancer is hereditary?
The majority of breast cancers, 70% are sporadic, the
remainder attributed to between 15-20% of cases and familial aggregation between
5-10% are considered hereditary.
Familial aggregation is considered when there are several cases of cancer of ma-
m in the same family without any mutation or less
1. Ribcage
2. Pectoralis
3. Lobes
4. Nipple
5. Halo
6. Uct
7. Adipose tissue
8. Skin
that may have been detected with the techniques available today, these
cases refers to a genetic predisposition weak.
On the other hand, is considered a hereditary cancer that appears in those
people who have a genetic mutation in certain genes (BRCA1 and
BRCA2 ) Which have a high susceptibility to breast cancer.
The presence of a family history of breast cancer is an important risk factor
and as shown, but may be considered secondary to environmental factors
such and / or shared among members of a gene family.Some-
Studies have shown that having a first degree relative, either the mother or
sister with breast cancer can double the risk of a woman
develop breast cancer.This risk is higher if the age of diagnosis
tic is less than 50 years or is a bilateral breast cancer, namely, that
affects both breasts.However, a positive family history of cancer
breast does not necessarily imply a greater predisposition to the disease.
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1. Information about breast cancer
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What kind of diseases are in the breast?
In the breast, like all bodies, there are all kinds of diseases, both benign and
malignant. Within the concept of malignancies accept those tumors
that we believe are invasive and preinvasius, but for their
features require specific treatment.
There are different types of tumors in the place of the breast where they originated and
as well as having the potential invasiveness. We define invasive lesions
those who have the capacity of invasion of surrounding tissue and lymph nodes ,
and can spread to other parts of the body. The preinvasive despite
have atypical cells lack this ability of invasion to other organs.
Preinvasive lesions
Ductal carcinoma “in situ” : Originates in the mammary ducts and tumor
localized, non-invasive but must be treated because it could eventually be-
come invasive.
Lobulillar carcinoma “in situ” : It is a risk marker of develop-
develop a breast cancer. You must make a careful monitoring and control.
Invasive lesions
These lesions can be considered a better prognosis and a
an uncertain prognosis. The classification of these lesions depends on
origin: epithelial , Mesenquimatós (the vessels in fat tissue in
muscle), both sources (phylloides tumor), or lymphatic tissue lesions
metastàssiques to other organs.
The most common are of epithelial origin:
• Ductal . Is the most common.
• Infiltrating carcinoma lobulillar . Sometimes multifocal and / or bilateral.
• Mucinous or colloid carcinoma . The cells produce “mucin,” a
mucus.
• Micropapillary and papillary carcinoma.
Inflammatory breast carcinoma is a type of cancer growth
Fast, aggressive and quite unusual.It is characterized by the appearance of signs
inflammatory breast volume increases, it becomes red,
feeling of warmth, the cancer cells block the lymph vessels in
the skin and acquire the appearance of orange peel.It has a large
potential dissemination.
Risk factors for breast cancer
Among the risk factors for breast cancer include the following:
• Age, because after 50 years is more common.
• Menstruation a very young age, ie, before age 12.
• Menopause late, ie after 50 years.
• Advanced age at the time of the first part (over 30 years) or failing
had children.
• Personal history of breast disease or benign (not
cancerous) breast.
• Mother or sister with breast cancer.
• Treatment with radiation therapy for Hodgkin’s lymphoma earlier directed
chest.
• Hormone treatment after menopause.
• Overconsumption of alcohol.In our environment, we con-
considered that a consumption of alcoholic drinks is equivalent to an intake
approximately 10-12 g. alcohol.In the case of women con-
considers risk from consumption of more than 2 drinks daily
alcoholic beverage is wine, beer or other beverages of higher
graduation.
Recent studies have shown that when the daily consumption of alcohol among
35 to 44 gr., The risk of breast cancer was 1.32 times greater,
or what is the same, a 32% higher risk than people who do not con-
Meixin.In addition, for each unit of alcohol daily over this risk increase was
while at 7%.
• Being overweight, especially if it has been maintained over the years and very particular
tors during menopause.
• Excessive fat, especially animal.
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7
• Recent studies also show possible genetic factors specific
of different races, specifically African American women, which may
increased risk of the disease.
Natural history of disease
As mentioned above, from a healthy cell tissue
breast, and acting on it factors mentioned above, there may be
ir a cellular alterations and abnormal cellular multiplication to de-
sencadenar a malignant lesion.
The breast cancer is the rapid proliferation and reproduction
uncontrolled cells of the glandular epithelium of the ducts of the breast.
Most diseases have a latency period or “window” or more
shorter, which is already present in the body of the person but not yet
Women’s symptoms. If there is a technique to diagnose
disease at this time and, more importantly, start the med-
ment reaching to cure the disease, which can justify screening or
early detection. In the case of breast cancer, there is this period
latency, mammography can warn of the presence of a lesion before
give symptoms and treatment initiated at this time, is more effective and
therefore, increase the likelihood of healing. In other cancers,
Or this window period is very short, and you do not have to present a
technique that allows them to make an early diagnosis, and some types of cancer
even being able to do this early diagnosis, starting treatment in this
does not seem to contribute to improving the outcome of the process.
Breast cancer is really a very frequent disease?
Breast cancer is the most common among women and accounts for 30% of
all cancers are in women. In Catalonia, the new cases that
appear every year affecting 116 of 100,000 women, or what is the same, a
total of 3,815 new cases. In addition, it is expected that this figure will be increased,
Therefore, although the overall European Union countries, occupies a
intermediate-low, that is, we are the incidents relatively low .
What survival and mortality which is breast cancer?
Being so common, it is still the leading cause of death from can-
cer in women, although in recent years has fallen.
In Barcelona, specifically in women 50 to 69 years, mortality can-
cer breast has decreased progressively, from a mortality
of 71 per 100,000 women in 1985 to 52.3 per 100,000 in 2008.
There are several factors that have made this change, including high-profile
quen diagnostic and therapeutic advances alongside the introduction of
measures for early diagnosis of breast cancer. The survivalof
breast cancer after 5 years of diagnosis has increased
significantly, from 67.6% in women diagnosed between 1985 –
1989, to 76.9% in the period 1990-1994 to 82.5% in diagnosing
nosticades between 1995-1999.
Survival is closely related to prognosis at the time of diagnosis
(Chance of recovery) and treatment options for each case.Basic
cally, all this depends on the following aspects:
• The stage of the cancer, determined by the size of thetumor and its possible
spread to the lymph nodes (especially in the armpit or other body parts) which
are way out of cancer cells to other parts of the body.
• The type of breast cancer.Some cancers are more aggressive than others.
• The concentrations of hormone receptors (estrogen and progesterone)
in tumor cells.
• If the cells have high concentrations of factor receptor growing
Human epidermal growth type 2 (HER2/neu).
• The woman’s age, general health status and menopausal(if the woman
still has menstrual periods ).
• If cancer is diagnosis or recent returns ( recid ).
Currently there is research to determine other factors that
could give more information about the behavior of each
injuries.
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1. Information about breast cancer
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The prognosis of breast cancer, as mentioned above, depends on the extent
time of diagnosis in the early stages of healing is high, but few
cases of disseminated disease with prolonged survival. Hence the in-
interest to get a diagnosis and treatment as soon as possible, plea
which have been implemented worldwide programs for early detection
disease, as in the case of Barcelona which runs from the end of 1995.
What types of treatment are available?
Currently, treatment options are many, varied and many
combinations. The choice of one or another type of therapy is determined
the size, location and characteristics of each tumor.
Thus, broadly speaking, different types of treatment include: surgery
chemotherapy, radiotherapy, hormone treatment and therapy aimed at “day-
ple therapy. ”
Surgery: what?
The aim of this surgery must be radical, effective, ie it must achieve
follow the removal of the local disease, and the result should be aesthetically pleasing. The disseminated-
nation of breast cancer most commonly via lymphatic (lymph), not
Blood. Therefore it is necessary to have information about the involvement of lymph nodes or not.
Usually the cancer cells if they leave the breast, follow the road
no lymph nodes of the armpit, for this reason, the study of lymph
axillary is so important. Recently, the study of sentinel lymph node is
in some cases may prevent the removal of lymph nodes in the armpit, thus avoiding the
patient discomfort and problems secondary to this surgery.
In the surgical treatment of breast cancer is not necessarily the only, or
should not necessarily be the first choice.
For many years accepted that the removal of the breast and lymph nodes
axillary surgery are suitable for the treatment of breast cancer. But
Advances in methods of diagnosis and treatment have led to other
protocols for the preservation of the breast.
In 1972 accepted as breast conserving surgery suitable for treat-
ment of this type of cancer.In recent years has been guided surgery
not only in the conservative treatment of breast cancer, but also lymph
axillary. In cases be required mastectomy (breast removal)
increasingly valued over its reconstruction, immediate or delayed.
The decision will depend on the type of surgery and clinical assessment methods
of diagnostic imaging (mammography, ultrasound, MRI).
Surgery as the first treatment will be made in cases where
feasible to remove the injury to the breast and the lymph nodes in the armpit and
that there is disseminated disease in the body.In other cases it is done
first semester of medical treatment to reduce local disease.
The surgery on the breast are:
• Conservative. Removed the tumor and a bit of healthy tissue around.
Sometimes, depending on the size of the tumor to be removed as a quadrant
(1/4 of the breast), it’s called “quadrantectomia.”
Or • Radical mastectomy. It is the removal of all breast tissue, including
skin around the aureole and nipple and.Mastectomy is currently the most used
the “modified radical mastectomy” that keeps the muscle
latura chest and blood vessels and nerves important not to lose
good mobility of the arm.In some cases, depending on the age of the pa-
cient and the prognosis can be assessed whether or not to
a radiotherapy after surgery. Currently, in some cases,
The patient is offered the possibility of an immediate reconstruction.The cy-
rurgia always be done by a reconstructive plastic surgeon, whether im-
mediately as if it is after a while.
In those cases, because there are some lymph nodes affected
needed further axillary surgery, which can also be:
• Conservative or SLNB. The first is the removal / s node / s
affected nodes / s in the case of dissemination of malignant cells from
breast cancer.At the time of surgery is the location for medium-
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1. Information about breast cancer
9
means of a radiotracer (radioactive substance) is injected in the ma-
ma few hours before surgery. The most common location of
sentinel lymph nodes in the armpit, but there are other locations pos-
sible (internal mammary chain in the region of the sternum, in the ma-
breast tissue, …). This is achieved not have to remove all the tissue
lymphadenectomy. If the sentinel node is affected, it is necessary to remove all
the axillary nodes.
• Radical or lymphadenectomy. It is the removal of fatty tissue of the axilla
that are distributed in the axillary nodes.
Recently, in some cases before surgery is a period of treatment
mind in order to reduce tumor size in this way can
avoid radical surgery (mastectomy) and make it more conservative.
Whenever you make a conservative treatment of breast cancer will be
radiotherapy later use. Radiotherapy in other areas-
Pendra the level of involvement of the lymph nodes at the end of surgery.
Following are the results of the surgery, the oncologist assessed in each case
necessary medical treatment: chemotherapy, hormone therapy or treatment
mind with therapeutic (chemotherapy treatments are not).
Side effects of surgery: lymphoedema
Complications of surgery for breast cancer and more problems
cause of women are those arising from the removal of lymph
axillary. The most common and appears immediately after surgery
is the alteration of the sensitivity of the axilla and inner arm (feeling
burning), which secondarily leads to a difficulty in mobilizing
and above the elevation of the arm.
By late complications can arise as much from surgery
radiotherapy: shrinkage, swelling of the arm (lymphedema), which has been
the removal of lymph nodes. This will result if there is a good report
tion on the care of the limb, a worsening of physical problems
(Can reach a sore shoulder and limit the mobility of the limb)
consequently also psychological and aesthetic.It will therefore be necessary
good prevention Lymphoedema and possible complications of shoulder
have a good quality of life.
So importance should be given a clear and accurate healthcare education
tary.Must perform the exercises appropriate for each moment of the treaty
ment for cancer, which offer a specialized physiotherapist.It is also
important to take care of the arm, avoiding lead weights with that arm, pro-
Ginter it from extreme temperatures, the blood samples, measuring the
pressure, wear tight jewelry or watches, etc..
To minimize secondary complications to the axillary lymph node removal,
is done “sentinel node technique.” It should be noted that
the technique of sentinel lymph node can not totally avoid the appearance
of Lymphedema of the arm.
Chemotherapy: what?
It involves the administration of drugs, usually via intra-
vein, with the goal of eliminating cancer cells that may ro-
Mandre active and can spread through the organism.The drug administra-
administer the dose and frequency depend on factors such as: size
injury, location of nodal involvement, risk factors, age
patient, etc..
The combination of different treatment options are varied and depend
these same factors. Sometimes it is only that-
chemotherapy or radiotherapy or surgery.Other combinations are
according to therapeutic indication.
Side effects of chemotherapy
The side effects that can occur depend on a treatment
essence of the drug and its dose.But not all effects influencing
All the patients nor with the same intensity.
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The most common are:
• The Alopecia is hair loss and usually appears in the first sessions
chemotherapy and is usually a quick process from the first drop-
mere hair. After finishing the treatment, the hair grows back after
time of the last session.
• Alterations in the blood that sometimes entails a decrease
defense and the need to start treatment with antibiotics is
prophylactic. In this case, often postponed a chemotherapy session
days until recovery of blood parameters.
• digestive disorders such as diarrhea, vomiting, constipation, loss of taste,
mouth sores etc.. Although the occurrence of one or more of these symptoms
considered normal, you should always discuss with the doctor in charge
or the nurse who administers the treatment. There are currently medi-
tions specific to that cause these symptoms and treatment
its side effects are better tolerated.
Changes in menstruation that once the treatment in many
Sometimes it becomes a regular. In cases where such alterations as-
carry a risk of infertility, advised young women who have no children
and you want to have it, contemplate the possibility of obtaining a sample
ovarian tissue for later fertilization if necessary.
Radiotherapy: what?
Involves the use of ionized radiation that nullifies the ability-
child cells to grow and reproduce. This is achieved by the damage that is pro-
Decrease in the cell nucleus through different levels, physiochemical and biological. At injured
· lulaperdlacapacitatdedividir-cal-neelmaterialgenèticnuclearlacèl seimorirà.
The healthy cells are less sensitive to the effects of radiation, since
divide more slowly than the diseased cells and, moreover, are capa-
ces to recover from the damage caused by radiation.
Thus, the goal of radiation therapy is to destroy cancer cells down-
holy minor damage to healthy tissue that may embolten the tumor.
When given radiotherapy?
Radiotherapy for breast cancer plays a well-defined and established
within the multidisciplinary treatment, one of the three fundamental pillars that
While his treatment with surgery and systemic treatment
(Chemotherapy, hormone treatments antidiana).
Numerous studies support their use, both in the conservative treatment
gold (after surgery that has survived breast), and after
mastectomy (removal of the breast), as does that reduce relapse
and thus increase survival.In the case of radiotherapy com-
While, it is usually radiation therapy is initiated once
treatment with chemotherapy.
In locally advanced tumors where surgery is done before Quim
oteràpia order to reduce tumor size sometimes attained-
tion with radiation therapy in order to increase the effect of the treatment.
Subsequently, it is surgery.
What types of radiation are there?
In breast cancer radiotherapy is used both external and the internal,
although the most common is external.Essentially, it is a treatment pro-
vidualitzat, each person will have their treatment.
External radiotherapy, which is generated by an external source to
patient. Today is through electron linear accelerator
emit a type of radiation preferable to that obtained through the pumps
cobalt used until recently because they have a greater penetration
and irradiation is distributed more evenly across the area in which
applied, moreover, is not as aggressive with the skin, thus reduc-
eixen side effects.
Administered in daily sessions over a few minutes time
which can range from one to five weeks.
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Currently there are studies that show the effectiveness of radiotherapy manage-
therapy at the time of surgery when the tumor is removed, enabling
locate the best area to radiate and better protect healthy tissues is
must radiate. It also has the advantage that the treatment can be reduced to
a single dose.
The internal radiotherapy or brachytherapy is another type of treatment
implanted radioactive energy sources directly inside the tumor or
While in space occupied if this has already been removed. Their objective
tive is to provide a high dose of radiation in a small volume of tissue
respecting the neighboring organs.
Can be administered after external radiotherapy and, in ac-
Tea surgical excision of the tumor is left implanted in the
the conduit through which the load subsequently administered ra-
dioactiva.
Side effects of radiotherapy
In general, treatment with radiotherapy for breast cancer is well
tolerated. In some cases there are minimal effects, but others are
more defendants to be given medical treatment for its control.
These effects are difficult to predict accurately because it depends on
multiple factors such as the extent of the radiation field, the dose, the fraction-
Onam and each person’s individual susceptibility. Know that these
effects are temporary and will recover within a few weeks finalizing
treatment. They are mainly:
• Effects of the skin is the most important adverse effects for the individual and
more frequent. It is located in the area where the treatment is administered
and is characterized by redness, itching, increased pigmentation, decentralized
tion … and a later a degree of fibrosis.
• Tiredness (fatigue) in the treatment of breast cancer is not a can-
ously very sharp and in any case less than that can occur du-
ing treatment with chemotherapy.
Hormone treatment: what?
His goal, like all other treatments is to reduce the relapse
increase survival.The mammary gland is an organ-hormonode
penent, ie, the growth of cells depends on their hormones
women. The hormone, is to prevent the growth cel-
phone.In breast cancer tumors are hormonodepenents (60-70%
cases) and others not.Hormone treatment is a crucial maneuver
cial in the case of tumors hormonodepenents.
It begins at the end of chemotherapy, but there are some cases that can
was the only treatment, ie, begins shortly after surgery because there
no chemotherapy.According to recent studies should be considered
also administered in some cases of carcinoma in situ.
The type of treatment depends on the hormonal status of the patient: is different
rent if the woman is menopausal or not, but recent studies looking
benefit in combining the two types of treatment.
Side effects of hormone therapy
Side effects vary with the type of treatment, the most common
is weight gain, sofocacions, joint pain, osteoporosis, as
as often happens in the process associated with menopause.
Other therapies: therapy directed
There are also other types of so-called biological therapies, which ac-
Tuen only on the cancer cell on one of the signal paths
with cells to grow and multiply. These types of therapies
produce fewer side effects and enable a better quality of life
the patients.
Treatment depends on the characteristics of the tumor cells.
On the surface of cells in 25% of cases found receiver
(HER2), which is associated with a worse prognosis.The Herceptin
®
is anantibody
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12
antibody has antitumor activity in this receptor. Its main
Cardiac toxicity is wood.
Other biological treatments inhibitors of intracellular signaling pathways,
Lapatinib as
®
(Also effective in cases of HER2) and Bavacizumab
®
have
demonstrated benefit in advanced disease, but more studies are still
evaluate its benefit in initial illness.
In general, the treatment of a disease like that in the intervening
many professionals, many techniques, long processing time, and many
perceptions, psychological and emotional factor is vital to minimize
the most side effects appear throughout the process. It should
note that the medical team attending the patient can facilitate or gesture
cal support this but it is important that you ask the patient herself or
family to that channel properly.
A resource is easy and convenient to have an agenda on part of back-
registrations data visits and treatments, also spelled all
doubts and worries and everything that appears when we are not in the hospital.
And in visits and treatment sessions when phone in hand and before
appropriate person and make them these questions.
Other important aspects: emotional factors
Cancer is a disease caused by a higher degree of anxiety-
Shah, among other reasons because it is related to the death. This an-
Goshen can generate other types of organic disorders that hinder and De-
Liten energy and emotional well-being necessary to overcome the disease
and treatment process. Psychological intervention can break this
negative circle.
To recognize the feelings generated as a result of illness (fear, anxiety,
fear, anxiety, sadness, anger) and express them, helps build strength, psi
Psychological need to work on the recovery of health. In addition to
disease itself, a woman has to face a process of change that
affect their femininity: Chest loss, hair loss, loss of
menstruation, weight gain with hormonal …
The mental representation of femininity is identified with the chest as this
expresses sexuality, narcissistic and relational sociology of women.When
Mom has a disease, women today claim, rightly, the right to know,
understand and discuss the modalities and consequences of treatment
be affected to a greater or lesser degree identity.
From the psychological aspect, we would say that the relationship with the patient
Your body is unique and special, so too is the only way to get sick,
interpret and position themselves against the disease.Ultimately, each patient has
its peculiar form to get sick.This is precisely what makes talk
person of a disease and therefore a therapy person.
The evolution of the disease is a dynamic process and the feelings of the wife
also following an evolutionary process according to the disease.Thus, the fact
know the diagnosis for the patient is a very important energy cost
Therefore, due to the increase of their anguish and anxiety, which can lead to
mental disorganization that affects all areas of action.
The impact of the diagnosis can lead women to develop an attitude
deniers, such comments as, “That’s nothing,” or “has no im-
tance “with manifestations of euphoria that do not correspond to seriously
sity of diagnosis.This mechanism of denial may, in a first moment
mind, helping women to go away emotionally adapting to the news.
Other mechanisms that may appear in this stage may be the omni-
power: “I do not pass anything,” “I can however” or else, the impo-
tence: “this will end with me,” “I do not go out” and sometimes the position is
melancholy: “I always get the worst happens”, “why do you need the treatment
total mind if … “and depressive attitudes, such as neglecting the care
its appearance, not wanting to be social, apathy …A follow-psi
Psychological can help in this process step toward the acceptance of the disease.
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At the time of discharge, should differentiate what is discharged from the
psychic.
The generated high expectations, both in the patient and in the family environment,
liar and friendship, to incorporate into everyday life, work, social, etc., which
were for a time suspended.
It is at this stage when the woman some questions arise. For a
banda is no longer in the medical field, which contained and reassured by
On the other hand calls friends began to distance themselves, family life remakes
Everyday there is a “appearance” of getting back all right, but then when
The patient begins to confront the feeling of life and death itself.
We must help women to walk the path of illness and recovery. She
has become a body that has suffered a loss, and it should be noted that not installed
chronic emotional pain, insufficiently developed. If this pain is
Endless can manifest as apathy, depression, anxiety, and fear was
the background that prevents the development of a full life.
After an ill situation occurs attitude back to the world and this
is a process that takes time.
To help women suffering from breast cancer, still exists in Barcelona
xen some associations that support all levels, both those
sufferers and their families.These associations provide information
of all kinds, emotional support, lectures on various subjects, activities
and ultimately support and therapy and support.Some oferei-
xen recovery activities are physical therapy, yoga, sophrology
among others, Gami also specializes in the prevention and rehabilitation
of lymphedema. These associations are:
• Agate
• Gami
• Spanish Association Against Cancer
• Foundation to help cancer Catalan league Barcelona
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2. What is an early detection program for breast cancer
What are the purposes of the program?
Who is the program (target population)?
There are other methods or tests?
Every few years to do the mammogram?
How do I do to participate in the program?
By inviting women without symptoms?
What should women do not have the age of the target population?
What to do if symptoms in the interval of 2 years?
Who is Responsible for the early detection of breast cancer in Barcelona?
Date of implementation of the program
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2. What is an early detection program for breast cancer
What does the screening?
Does not diagnose a disease before symptoms given. Of these,
ta way can improve the prognosis and / or outcome. In addition, diagnosed
expensive cancer in the early stages treatment can be administered less
leaving less aggressive and physical and psychological in women.
It also improves survival, as if the tumor is diagnosed before
invasive is the cure are higher than 98%.
What is a screening program?
Screening Program (or screening), is the realization of all
the set of things to do this early diagnosis is
ie find the disease before symptoms not give. Therefore, a program
form of screening for a disease proposes testing concrete
apparently healthy people without symptoms.
This course can only be done with certain diseases, as for
to be screened:
1. A disease that is sufficiently severe, significant and / or frequent.
2. This disease must have biological characteristics, which allow
sation to this early diagnosis.
3. Must have proof which enables the early detection and
both diagnosed before the disease gives symptoms.
4. Must deal with a disease that was diagnosed early, can be cured
in most cases.
Breast cancer meets all these conditions, it is a dis-
Aunt serious and in cancers, the most common in women. It has characterized
tics that allow the biological proper diagnosis and
There is a simple test and make it effective, which is the mammogram.Finally
mind, the treatment applied in early stages, can be cured in most
cases.Therefore then, that screening programs for breast cancer
are population, that is offered to all women with an age
that breast cancer is more common.
What are the purposes of the program?
The main objective from the point of view of public health, which is contributing to
reducing mortality from breast cancer among women in Barcelona.
To achieve this, we need the vast majority of women in the population
tion program aimed to benefit from the advantages of screening
early.Therefore, it is important to know the program, the benefits and risks
of screening and participate in a properly informed.
Studies show that breast cancer mortality is reduced
35% in women 50 to 69 years old participating in a program
Screening for breast cancer.
The fact that early detection of the disease also means that treatment
be less aggressive, less mutilating surgery, allowing preserve the breast,
and minor side effects.
To achieve these goals is essential to achieve the one hand,
high participation of people called the program and the other, a
quality of the diagnostic tests used.
Who is the program (target population)?
The population of breast cancer screening program are all
women living and / or registered in Barcelona from 50 to
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2. What is an early detection program for breast cancer
16
69 years. Program not covered by the women of this age group
have a special risk, such as family history or other.
It is this age group and not another, because studies conducted all over the world
and the experience of screening during the years 60 and 70 were
launched in Europe and North America, show that from
50 years is very important when it increases the risk of
breast cancer and therefore, when the screening is more effective.
Which screening test used?
The program uses mammography as a screening test because it has been
proved to be the most effective test for the detection of breast cancer.
It consists of an x-ray of the chest and is comfortable and easy to do. In the mo-
mind to realize it is a pressure on the chest but it is annoying
tolerable. This pressure is important in order to achieve a better qualitative
Diagnostic and mind to reduce the radiation dose. It’s pretty harmless, although
it is not entirely because playing small doses of radiation.
At present many are now digital mammography, which increases with
the accuracy of results in dense breasts, the radiation dose is lower and
much more organic, not having to disclose the mammogram and the radiologist can
read directly from the screen of a computer connected to mammography.
There are other methods or tests?
No other recommended methods for screening. The low sensitivity and speci-
autopalpació the deficit does not allow its use as a mass screening test.
The autopalpació be seen as a way, apart from the observation
Visible changes in the breast, so that the woman is alert during the pe-
ríode between mammography and mammography to detect any possible
anomaly, but never as a screening test.
About Breast ultrasound is a test using ultrasound-
allows determine the nature (liquid or solid) lesions previously identified
decades with mammography.It is a good tool to detect microcalcifi-
tions and considering that between 20 and 30% of breast cancer
manifested as microcalcifications, for then that ultrasound is not
a good screening test to do.
Every few years to do the mammogram?
The pre-screen mammographic offered every two years.Way it recommends different
institutions such as the International Agency for Research on Cancer (IARC) and
the European Guidelines for breast cancer screening.
This recommendation is more widespread and more cost-effective, although there
Some programs that perform mammograms even every 3 years.
In any case, no country for mammograms annually and are becoming the most
two years, since the reduction of mortality and does not vary substantially
decrease costs and possible side effects is significant.
It should be remembered however, that when a woman has certain types of
lesions in the opinion of the radiologist responsible for the program may be called
before age 2.This is what is known as the year advanced control.
How do I do to participate in the program?
With data from the municipal register of inhabitants of the city and through
central registry of insured together all the people who have
ever happened to the medical services of the city, the women identified
those between 50 and 69 years who live in the city.
From this information, they will receive a letter at home that were women-
ra day and time to take the mammogram.Depending on where they live will
summoned to take the mammography or the Hospital del Mar, the spe-
ça, the Clinic, St. Paul’s Vall d’Hebron.
In two weeks, they will receive a letter home with the results.If
necessary to do some other tests in addition to mammography in the
call you on the phone (the process is explained later).
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2. What is an early detection program for breast cancer
17
If a woman does not receive the letter summoning you can get in touch with
program by phone as below. These tele-
background, appearing on posters, leaflets and other information material distributed
empty in the town shops and pharmacies and of course in schools
primary care.
Criteria for the program
The program for the early detection of breast cancer follows the recommendations
nations established in the European guidelines for quality programs
Screening for breast cancer . Among the recommendations for improving the quality
include:
• The use of digital mammography, as well as conducting systematic
two projections of the image and read by at least two pro-
tions different.
• The periodic review of radiological diagnostic equipment to ensure
smooth operation and reliability of the results.
• Participation in a multidisciplinary program of professional
sional healthcare experience and specific training activities
screening.
• Monitoring of current diagnostic and therapeutic protocols based on
scientific evidence and approved by health institutions.
• The periodic evaluation of the main indicators of process and outcome of pro-
program, such as participation, the number of tests carried-
ized, detection rates, the distribution of cancer cases and treatment
ments carried out. These indicators are compared with the standard
recommended by the scientific community, year after year can conclude
we are within the recommended values.
By inviting women without symptoms?
Because, as mentioned above, is to detect the disease
before symptoms appear. This means that women are apparently
are healthy, and therefore need to find from which all presented
ten anomalies to take mammogram. However, this does not mean that
have breast cancer because mammography is not sufficient to make
diagnosis, other tests needed to confirm whether the abnormality is really
cancer or not.
What should women do not have the age of the target population?
The performance of mammography in women outside the age range of programs
my answer is basically clinical criteria. Detection Program
Early Breast Cancer does not include women outside this age range,
because the effectiveness and predictive value of mammography is low,
In other words, the likelihood of erroneous results is higher.
What to do if symptoms in the interval of 2 years?
Note that mammography is not a vaccine and the fact that a
control results are correct does not mean that women do not have to
attention to any changes or to detect abnormalities in their breasts.
So if you notice something wrong you should not hesitate to consult your doctor
header or gynecologist as soon as possible.
Who is Responsible for the early detection of can-
cer breast Barcelona?
In Barcelona, the Barcelona Health is who is responsible
last and therefore address.
The Public Health Agency of Barcelona is responsible for the coordination
and organization, implementing the Plan of Communication and Information, Evaluation and
Management and Organization.
The major city hospitals are responsible for the management of Pro-
program in their respective areas of reference.Responsible for the quote
women make mammography and, if necessary, diagnostic tests and
case of cancer treatment.
Depending on the district in which the woman lives, the controls will be in a hospi-
pital or another, being established this release:
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2. What is an early detection program for breast cancer
18
• Hospital del Mar: Old City and St. Martin.
• Hospital of Hope: Grace and Sarria Sant Gervasi.
• Hospital Vall d’Hebron: Horta Nou Barris.
• Hospital: Left Eixample, Sants and Les Corts.
• Hospital Sta. Cross and St. Paul: Right Eixample and Sant Andreu Guinardó.
Moreover, the program works in conjunction with network
health centers (CAP), Program Assistance and Sexual Health
Reproductive (passive) and the Office of Community Pharmacy.
The City Council also participates with the complicity and collaboration-
tion of those responsible for city districts.
Date of implementation of the program
In Barcelona, the program began in November 1995, responding to
guidelines set by the Health Plan of the city Department of Health
the Government of Catalonia.
Contacting the Program
Technical Office
Public Health Agency of Barcelona
Pl. Lesseps, 1
08023 Barcelona
Tel.: 93 202 77 80 / Tel.: 93 202 77 81 / Tel.: 93 202 77 87
Hospital del Mar
Passeig Maritim de la Barceloneta, 25-29
08033 Barcelona
Tel.: 93 248 30 78
Hospital of Hope
Avenue Sanctuary of Mount St. Joseph, 12
08024 Barcelona
Tel.: 93 367 43 14
Vall d’Hebron
Passeig Vall d’Hebron 119-129
08035 Barcelona
Tel.: 93 280 02 04
Hospital de la Santa Creu i Sant Pau
San Quentin, 89 F Block level -1
08025 Barcelona
Tel.: 93 556 55 01 / Tel.: 93 556 55 02
Hospital
Valencia, 184
08011 Barcelona
Tel.: 93 227 93 02
Health Responds
Tel.: 902 111 444
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3. What women can not be included in a screening program?
Women with a family history of breast and ovarian
What criteria define a high-risk of breast and / or ovarian cancer hereditary?
What criteria define a moderate risk person?
When should a person derived from one primary care services to a query
risk assessment of breast and / or ovarian cancer?
Women with a history of breast pathology
Special situations that do not exclude the screening program
What drives risk assessment and genetic counseling are in Barcelona?
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20
3. What women can not be included in a screening program?
Women with a family history of breast and ovarian
As mentioned above, a family history of cancer ma-
ma and / or ovarian cancer is a major risk factor to be studied, it may be
occur as a result of environmental and / or genetic. This means
that in cases of family history is important to study genetic
determine if the person is:
• Women at high risk: excluded from the program and will continue to be some controls-
pecífics indicated by the professional.
• Women with moderate risk of less than 50 years will follow anu-
the age of 50 and joined the program with the same criteria
the rest of the general population.
• Women at low risk: follow the same rules as the general population.
To determine the risk that a person may have a family history
cancer would ideally be a complete family history including
documented information on all cases of cancer
ovarian and breast cancer that has been in the family for the last 3
generations.
It is considered first-degree father or mother, brothers and sons. Of
second degree, grandparents, uncles and nephews, cousins and third grade.
What criteria define a high-risk breast cancer
and / or ovarian cancer hereditary?
For men, taking into account the relative degree, and states:
• Three or more first-degree relatives affected by breast and / or ovarian cancer.
• Two cases among first-and second-degree:
Two cases of ovarian cancer.
A case of breast cancer and one ovarian cancer.
A case of breast cancer in men and one breast / ovarian cancer.
Two cases of breast cancer under 50 years of age.
A case of bilateral breast cancer and breast cancer in a woman
less than 50 years.
• Regardless of the relative degree:
Breast and ovarian cancer in one patient.
Bilateral breast cancer diagnosed before age 40.
The high-risk women have a cumulative risk over the life of develop-
ing breast cancer more than 24%.
In these cases, monitoring and control options are diverse and range from
screening and follow-up intervals of between one month to one year, or
Where can recommend a prophylactic mastectomy.In any case,
options should be discussed with the affected person, informing the
the benefits and limitations of each of the strategies, ensuring that
the final decision to take one’s interested.
What criteria define a moderate risk person?
First-degree relatives of people affected by breast cancer fami-
lies with:
• A breast cancer in a person aged between 31 and 50.
• Two first-degree relatives with breast cancer between ages 51 and
59 years.
• A bilateral breast cancer in a person 40 years or older.
They are women who have a cumulative risk to develop life-long
breast cancer that ranges between 15-24%.We recommend adding self-
examination and clinical breast examination, annual mammography between 35 and 50
years, from 50, to join the program of mass screening.
When should a person derived from a primary care service
a query evaluation risk of breast and / or ovarian cancer?
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3. What women can not be included in a screening program?
21
The primary professional advise or lead a person
consult a genetic counseling unit to assess the risk of change
cer breast in the following cases:
• When a person reported having had two or more cancer cases ma-
ma and / or ovarian cancer in the same family line, either the maternal or paternal.
• A family member (both first and second degree) with cancer
breast cancer in young age, ie, before age 50.
• A family member who has had breast cancer and ovarian cancer.
• A case of breast cancer in a man.
• A case of bilateral breast cancer in a young person, that is, less
50 years.
In genetic counseling unit, you will be a family history of cases
breast and ovarian cancer and a risk assessment will define the person
one of these three cases: high risk, moderate or low. Once these-
thy valuation, determine the professional rules to follow.
Women with a history of breast pathology
Excluding program for women with atypical ductal hyperplasia and carcinoembryonic
lobulillar my spot, which require specific monitoring indicated
by the relevant professional.
Special situations that do not exclude the screening program
• Women who have undergone radiation therapy to the chest.
Those women who have been treated with radiation therapy to the chest area
a lymphoma timoma or other diseases have an increased risk
of developing breast cancer. This risk seems particularly
important when the dose received was high and was administered between 10 and
16 years, despite persisting throughout life.
Moreover, the levels of radiation from diagnostic tests
not represent an increased risk large enough to exclude
these women the overall program of screening.
• In the case of transsexuals undergoing estrogen therapy, pain-
welcome there epidemiological evidence of increased cancer risk
breast, some cases have been reported in the medical literature, which
it is expected a higher incidence of breast cancer
this group will increase as you age.Therefore, it is considered
that can benefit from the screening program.However, the offer
the inclusion of female to male transsexuals who have not been mastectomitzats.
• For women with hormone replacement therapy during
menopause, the program does not exclude because no evidence
science that shows that change every two years in the making
bring benefits of mammography for women.It is open to the gynecologist
decide in each case the monitoring to be done to women.
• Women with breast implants, do not present a greater risk of cancer, but
yes more technically difficult to perform correctly mammography,
therefore requires an appropriate experience by the technical specialists
t in radiology (TER).In terms of program, then follow the criteria
biannual mammograms.
What genetic counseling units or risk assessment is to
Barcelona?
Genetic Counselling Unit
Medical Oncology
Hospital de la Santa Creu i Sant Pau
San Quentin, 89-08041 Barcelona
Tel.: 93 556 56 38
Fax: 93 556 57 69
High Risk Unit and Cancer Prevention
Medical Oncology
Hospital Vall d’Hebron, 119-129
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3. What women can not be included in a screening program?
22
Building Maternal and Child
Passeig Vall d’Hebron 119-129 – 08035 Barcelona
Tel.: 93 274 60 85
Fax: 93 274 60 59
Genetic Counselling Unit
Hospital del Mar
Passeig Maritim de la Barceloneta, 25-29 – 08003 Barcelona
Tel.: 248 35 95
Fax: 93 248 33 66
Unit genetic counseling in hereditary cancer
Institute of Oncology Corachán-IDOC Medical Center
C. Gironella 6-8, Level 1 – 08012 Barcelona
Tel.: 93 280 08 55
Fax: 93 280 54 00
Institut Universitari Dexeus
Genetic counseling unit in Hereditary Cancer
C. Sabino de Arana, 5-19 – 08028 Barcelona
Tel.: 93 227 47 00
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4. Mammography: what you need to know
What is the purpose of a mammogram?
What is the personnel involved in performing the test?
What are the results from the test?
What is the waiting time for results and how they receive?
How and when to make the next appointment?
What is the reliability of mammography?
What is the sensitivity of mammography?
What is the specificity of mammography?
What are the predictive values of mammography?
What are the quality controls carried out in and mammography technicians?
There are risks associated with radiation?
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24
4. Mammography: what you need to know
What is a mammogram?
This is a test image, like a picture, specific to breast tissue.
What is the purpose of a mammogram?
Is the test appropriate to carry out the screening and early detection of cancer
breast. Consequently, its purpose is to detect lesions regardless if-
gui development phase in which they are at the level of the breast tissue.
Thus, the main utility of this test is to detect images sustainable
Pitocin injuries that can correspond to very small sizes, and not
could have been detected by clinical examination. This allows the
diagnosis in early stages, allowing less aggressive treatment
an improved prognosis.
What is the personnel involved in performing the test?
The test is performed by technicians with specific training in radiology to
mammograms.
Reading makes radiologists with experience in inter-
tion of mammography screening following the recommendations of the Guidelines
European screening for breast cancer.
How is the test?
First scans without clothes from the waist up while
the right woman with arms raised. In this exploration, we review the existing
tence of symptoms or lesions visible at breast.
Once the scan is necessary to correctly placed in the chest
in order to obtain mammography screenings without proper
repeat the test. Therefore, the technical help women to put corrective
ment for breast mammography tray. Below is compressed
contralateral breast plate.Are two projections of each breast: one
top to bottom (Crane-flow) and side (mediolateral oblique).
A good compression of the breast tissue is important to obtain
highest quality images for diagnosis and to reduce the radiation dose administered
entry.It is also important to incorporate the maximum possible chest.These facts
can cause discomfort or even pain in some women.
How long is the test?
The length is variable, but the process usually takes between 5 and
10 minutes.
What type of reading is done?
Each mammogram is read by two radiologists separately and in case of discrepancies,
ence in the results, along with a third radiologist reach a consensus.
It’s free test?
Mammography screening is free in the context of program detected
ment of early breast cancer, and all studies and tests it
might arise, which are funded through taxes and service provided by
National Health Service.
What are the results from the test?
To define the results is mainly used BIRADS classification
the American College of Radiology
BIRADS 0: Mammography which must be supplemented with other pro-
go, either because there is a questionable image (do not know if it’s
or tissue injury) or better to qualify a lesion detected as
if, for example, is a lesion with liquid means it is a cyst
benign.
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4. Mammography: what you need to know
25
BIRADS 1: Mamas images without abnormal: normal breast, thus
calls women to control 2 years.
BIRADS 2: Mamas clearly benign lesions that do not require being
studied, so the woman will also be summoned to control 2 years.
BIRADS 3: Mamas with probably benign lesions, and although in mol
Sometimes teas do not require additional studies that women can be
advanced control called a year.
BIRADS 4: Mamas with injuries that are from a low to a moderate
suspicion of malignancy. Additional tests are required, mainly dis-
SIVES. Between 15 and 30% of cases will be a malignant lesion or tumor. In
the other, depending on the results of these additional studies
So you may be convened each year as regular checks to pass
2 years.
BIRADS 5: Mamas with lesions suspicious for malignancy. It requires pro-
go further, particularly invasive. Between 70 and 90% of cases
resulted in a diagnosis of cancer. In the other, both may be convened
the woman who as a year to two years.
What is the waiting time for results and how they receive?
The waiting time depends on the results: those mammograms
normal or benign probably have not required additional studies,
tions, the results are sent by post, on average, reach a
period of 15 days. Sent a report but not mammography, however, if
Women want mammograms, it may request.
Those patients with any abnormal mammograms that requerei-
xen tests will be mentioned about a week later,
telephone for making them. When you call the woman as
up appointment after 2-3 days at most. We try not to call, for example,
on Friday so that the woman not too distressed. If the
results of additional studies, both invasive and non-invasive, are
normal women receive the results by mail.
How and when to make the next appointment?
The report is sent to the registered mammographic, indicated when it will
Her call for the next mammogram. In all the letters as
There is a telephone number to answer questions in relation to outcome.
In most cases, women are called back for 2 years, but
certain occasions should repeat the test with less than two
years are called “advanced controls”, to be held from
in the previous mammogram.
What is the reliability of mammography?
The reliability of a test refers to the extent to which the test does not commit
errors and therefore, we can “trust” the results.Reliability, measured by
Two different types of indicators, namely: sensitivity and specificity.This
means, since the absence of errors is almost impossible, at least it
may know to what extent the results of the test are true and to what extent
we may be wrong, ie, to quantify the error.
What is the sensitivity of mammography?
Sensitivity is the proportion of all cancer patients test
mammography detected as suspicious.Its value depends on the age, ie
size also increased with increasing age sensitivity.In women with
50 years or more sensitivity values ranging between 68% and 90% (being
most values about 85%).In women under the age between 40
and 49, the figures fall to the sensitivity of 62-76%.This difference
has much to do with the breast tissue and the changes that occur
age, especially linked to hormonal changes that occur in the body
women around the menopause, ie about 50 years.
What is the specificity of mammography?
The specificity, is arguably the complementary sensitivity, ie
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4. Mammography: what you need to know
26
the proportion of all women without breast cancer test
actually classified as such. Its value is estimated between 82% and 97% in
women 50 to 69 years.
What are the predictive values of mammography?
The positive predictive value of a test is related to the presence of
disease in the population. How much is this disease among people
of a given population are more likely to find people ma-
sickness when doing a screening and it also indicates that people
of that population are more likely to develop the disease
study. It is therefore, the proportion of all women in the mamogra-
present results lend suspects and are called to take other tests,
finally diagnosed with breast cancer. In women who are
mentioned for the first time in the program, predictive values are between
6 and 8%. This means that in only 6-8% of women called to
Additional studies done after doing the mammogram, they eventually di-
Agnostic cancer. In proportion as the years go by and therefore women
have been invited more than once to get the mammogram, the
value increases, ranging between 12 and 14%.
All these values are very important in making the decision of what
The group is suitable for carrying out the screening. As you can see, the fact-
shown that after 50 years the disease is present, add then
the reliability of the test is also higher, while women
young, the same test is more likely to fail. That is why the pro-
screening programs start at age 50, only rarely
from 45 and never before this age.
What are the quality controls carried out in Mammography
and technicians?
We recommend specific quarterly checks mammograms
plan for Radiological Protection Service. In addition, technicians must
to conduct daily tests to ensure the proper functioning of
the processor (if using analog mammography) and periodically and
with the review of a radiologist, the evaluation of image quality
mammographic obtained through a dummy.
As for the training of technicians working in the program
approximately every two years is recommended that the program units
undertake a refresher course, for each radiology technician incor-
Porat Screening Program.
Each year, the program drives evaluate the results and com-
stop with the quality standards set by the European crisis-guide
bone breast cancer, allowing a check that banda
Things are going well and the other where necessary, to improve detection of situations.
There are risks associated with radiation?
Radiation always involve risk, although the radiation emitted in
mammograms are minimal.The number of radiation-induced cancers
is very little, if anything, happens in people who for reasons of
disease or for work reasons, many have undergone radiation and ori-
January very diverse.You can hardly induce breast cancer just because
to become regular checks.Otherwise, is closely related to the age at
it starts to mammograms and how often you will make. So
Also, the risk of breast cancer radioinduït decreases with age and so-
Particularly after menopause.
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5. What tests are diagnostic confirmation
When testing is necessary to confirm diagnosis?
What proportion of women participating in the screening need?
What are the diagnostic tests for confirmation?
Cited as the women who need further studies?
How long does it take to have the results of additional studies?
There is some information and advice for women who would do more research?
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28
5. What tests are diagnostic confirmation
When testing is necessary to confirm diagnosis?
Mamogràfiques certain images may induce doubts and diagnoses
therefore require the completion of other tests to guide the result.
Categories radiographic BIRADS 0, 4 and 5 require such testing.
What proportion of women participating in the screening
need?
Depending on the units mamogràfiques between 5 and 10% of women
which has been in the mammogram will cite some evidence for com-
complementary.
What are the diagnostic tests for confirmation?
Diagnostic confirmation tests are divided into two groups.
1. Noninvasive tests: These tests are not agredei-
xen body of the woman. Typically tests that extend the study of
mammogram from another perspective in order to see more clearly es-
structure of the image.
These tests are: repeating, extension or new screening mammography-
tions, ultrasound and MRI.
2. Invasive tests: As its name suggests,
testing is more aggressive because it is a sample of
breast tissue to analyze it and not just have an image in
the case of the above.
These tests are invasive: a puncture or biopsy. The puncture can be made
with different gauge needles, so talking puncture aspiration
fine needle, hollow and thick or surgical biopsy. As for surgical biopsy
cal, is to extract a greater amount of breast tissue, sometimes even
entire lesion is removed, which means that it requires surgery.
The use of one or other evidence depends, among other factors, the type of injury and
the degree of suspicion of malignancy of the lesion evaluated, as well as characteristic
tics own equipment or radiological history of mammography
patient.In general, the city of Barcelona, again to cite to become pro-
go further to 5 of every 100 women participating in the program and end-
mind of every 100 women reconvocades for additional studies just
diagnosed with breast cancer in 7 women.
Below is a brief description of the tests indicated.
Non-invasive tests
Repeat mammography
For various reasons (such as the appearance of artifacts in the images or that
not observed properly margins mammograms) can be
necessary to repeat the test.Normally, it is at the same time
in which the wife has gone to mammography, previous qualitative
technicians.Sometimes though, again quoting the woman to repeat
same initial projections.
Expansion of mammography
Extended or focused mammograms are used at the request of
radiologists when diagnosing certain images can doubt
minimized through the expansion of the region under study.
Mammography with other screening
Other possible projections that involve the placement of the breast and
different positions of the device may be required in the usual case
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5. What tests are diagnostic confirmation
29
doubtful that any image diagnosis could not be observed
projections used correctly.
Ultrasound
The test most commonly used is complementary ultrasound: it
a test without radiation, which allows using ultrasound identified
expensive nature of the possible nodes, ie, whether they are liquid and therefore
benign, or if they are solid and therefore could be studied with other
tests, such as, invasive. In addition, ultrasound can detect the exis-
existence of underlying breast tissue injuries in questionable mammogram.
However, ultrasound is a useful tool to detect and study-MICROCAL
cificacions and therefore not only serves as a screening technique. Know that
20-30% of breast cancers can be said from the point of view
Radiological as microcalcifications and therefore not seen with ultrasound.
It is possible that certain patients with dense tissue fibro-
glandular breasts to use this technique to evaluate the breast, but not
there are questionable lesions in mammography.
Magnetic Resonance (NMR)
The MR is a little test used in screening for breast cancer.
Involves making cuts using a field sequential image
without radiating magnetic doses. Its use is more common in
confirmation of malignant disease of multiplex or tracking contralateral
the other breast in patients with large volume of breast tissue and diagnosis
cancer known.
Invasive
Fine needle aspiration (FNA-cytology)
It’s a puncture using a fine needle, similar to that used in
the blood test, which requires no anesthesia. Its main utility
is the study of axillary nodes. With evidence of puncture attempts
For cellular tissue which can be subsequently analyzed by Service-gone
Pathological economy.
Thick needle (or Corebiòpsia BAG)
It is a thicker puncture using a needle, using previously
Short-acting local anesthetic. Its main use is in the study
of breast lesions. To perform this test to avoid compliance
tions of bleeding, you should avoid factors such as administrative descoagulants
tion of antiplatelets such as aspirin or Sintrom before and after the test.
Thick needle vacuum-assisted
It’s a puncture using a needle still thicker and assisted
vacuum by applying pre-acting local anesthetic.The amount
tissue obtained is higher than can be obtained with other punctual
tions.Its main use is in the study of breast lesions, principally
ern accompanied by microcalcifications. To make this
test to avoid bleeding complications, you should avoid factors
descoagulants Sintrom or the administration of aspirin before and after
the test.
Surgical biopsy
This extract more amount of breast tissue that can be extracted,
re with other types of biopsies.Sometimes, removed all the injury
So that means it requires surgery and almost
time, as is used to remove the entire lesion.Thus, this intervention
tion in most cases it is healing.
Cited as the women who need further studies?
Hospitals program, use various methods to quote women
can specify tests. In any case, initially
attempting to call any woman to inform her of the
need for implementation of this new evidence.In case of impossibility
phone first attempt by the woman quoted postage
This subpoena or through other means.The person responsible for this
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5. What tests are diagnostic confirmation
30
citation is usually one of the administrative program, which dis-
born result of mammography.
How long does it take to have the results of studies
Additional?
Usually not spend more than 30 days to obtain the information,
da from the tests is returned to the patient.
Hospitals program, using different methods for the return of
information on the results of tests for women. In
Generally, if the tests have ruled out the suspicion, the woman will receive in the home
test results, informing them of when will the next-mamo
graphy within the program.
In the case of invasive, you do within the circuit of each hospi-
capital and, therefore, the delivery of results, follow the procedure in
this case even though the citation is made mostly from the program.
In all hospitals, when you have the results of invasive tests are
calls for women to talk to a professional who explains the results
and guidelines to follow in both cases the result is the absence of disease
as if a tumor has been detected. In the absence of disorder in some
hospital appointment is not personal and it is called part of sending the report re-
date website by the radiologist responsible for the testing and the woman is still integrated into the
program being called at 2 years or, as mentioned above,
the year if the professional necessary. For diagnostic
cancer, women are integrated in the caring of the hospital.
There is some information and advice for women in
Who would do more research?
Each hospital is part of the Cancer Screening Program Ma-
ma Barcelona provides the users of a mobile
contact program where a health professional resolve their dub-
teas. In addition you can also consult your doctor or gynecologist for
for more information.
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6. Benefits and problems associated with population screening
What are the benefits of participating in a population screening program?
………………………………………….. ………………………………….
What risks may involve participation in a population screening program?
As benefits the community we live a population screening program?
………………………………………….. …………………………..
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32
6. Benefits and problems associated with population screening
In developed countries, early detection of breast cancer is a practical
Common policy. Thus, women between 50 and 69 years are offered a ma-
mografia every two years to detect early cancer
breast and to contribute to the reduction of deaths. But
screening, like everything else, has not only benefits but also some risks.
From a population perspective, the early detection of breast cancer
has more benefits than risks, but at the individual level can not talk or a
positive effect (derived from early detection of the disease) or negative (the
Possible side effects of screening are explained below). In
However, the decision to participate in screening should be personal, taking into
consider its pros and cons.
The success of screening programs depends, among other things, what
is a high participation and therefore need to call for a major effort
Cato. However, the information provided to women invited-
December shall be allowed to decide whether or not to participate in the most adequate
da possible, having truthful, complete and understandable.
What are the benefits of participating in a program population
tional screening?
The benefits will occur especially in people in it pos-
sible to detect the disease at the stage that has yet symptoms.
1. Cancer screening and early commencement of treatment, which makes
increase the chances of healing.
2. Most tumors are diagnosed small size, which allows applying a
less aggressive treatment with fewer side effects. Most
cancers detected in the program can be treated with surgery con-
conservative breast (tumerectomia), avoiding mastectomy (removal
around the chest), which reduces the risk of physical disability and have
a better quality of life.
What risks may involve participating in a program population
screening?
1. Overdiagnosis: some cancer precursor lesions and some
in the very early stage cancerous tumors that are detected in the pre-screen-
manage, grow very slowly or not they tend to develop at all.They are
injuries that may never have caused problems that would not have
known of its existence unless the program for the detection of cri-
bone.Unfortunately, you can not know which cancers progress and
and what not, so we must treat them all.
2. Sobretractament: The result of overdiagnosis. All le-
sions are treated and therefore, there are women that have been detected by
Screening is treated an injury that might not have ever said,
with the consequences of receiving some unnecessary treatment
ments that involve a number of risks that are not insignificant.
3. Diagnostic errors: false positives and false negatives: the false positive
occur when the results of a test, in this case the mammography
suggest the presence of disease without actually exists.This forces
to perform additional diagnostic tests that never seri-
in need. False positives can not be avoided but can be
reduced by improving the reading of mammograms by radiologists and
performing double screening.The opposite (false negatives)
more frequent and can occur when the mammogram shows no
sign or suspicion of disease, although women do suffer.
4. False sense of security: early detection is only useful for detecting
cancers that have already appeared, but not prevent them.There is a risk
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6. Benefits and problems associated with population screening
33
after the completion of a mammogram with a normal result, women
mistakenly believe that there is no need to worry more about the making of the
next mammogram within 2 years. Remember that having to rea-
lized recently resulting in normal mammogram should not be
impediment, if a woman detects an alteration in breast con-
Sultan your doctor or gynecologist. In fact, it may in some cases
between mammography program made by the following text and develop a
cancer. This called interval cancers and cancers can not be prevented.
5. Anxiety: it is inevitable that women experience some degree of anxiety
So while waiting for a result as is required when ex-
Additional ploracions to reach definitive result. It is important to
minimize the distress arising from waiting for test results and
This should be reduced to a minimum the time between the completion of the test and
results. Each hospital that performs the program incorporates the mechanisms
mechanisms necessary because, among performing the mammogram and the result
ity, is the minimum time that one of the objectives of quality
established by this program (less than two weeks).
Also remember that a woman in a percentage close to 90% of
participants, the test result is normal and therefore only a small
group of women have suspected breast cancer test results
mammography.
6. Radiation effects: any radiography and, therefore, any ma-
mografia involves radiation. Mammography only required doses
low and also in screening programs is still a proto-
cabbage mammography quality control that makes this potential risk
cial even smaller. Moreover, the risk of cancer radioinduït
decreases with age and is particularly low after menopause.
7. Nuisance test: approximately half of the women con-
fied that the mammography procedure is cumbersome and / or painful. For
achieve a high quality image compression is necessary ma-
ma which can cause discomfort and / or pain.The degree of pain and / or discomfort
associated with anxiety at the time of the menstrual cycle.
As benefits the community we live program population
tional screening?
1. Improved survival and reduced mortality in Dar-
recent years the survival of breast cancer has been increasing.These-
ta improvement is due in part to advances in treatment and the effect
of early detection with mammography, especially in programs
screening population.In addition, several studies have shown that
screening can reduce mortality from breast cancer in a while
ratio lower than initially thought.
2. Reducing inequalities: the cancer screening program
Breast call to all women 50 to 69 years and offer the ma-
disks of the same quality services and helps to reduce inequality
ties for the social or cultural controls mammography and therefore, what
also reduce these inequalities in mortality and morbidity.The
data on the Barcelona show that the program cri-
bone population had a positive role in this regard.
3. Increase the perception of women need to take care:
the fact that there is a population screening program can-
cer breast is heightening social awareness about the disease and
the importance of early detection.
4. Detection of population at risk for breast cancer presented
ing family history: women attending the program were
is a simple questionnaire about personal and family history of cancer.
This allows detection of familial risk cases are referred to the uni-
ties appropriate genetic counseling.
5. Initially, lower cost treatment, especially surgical. A
Also, apply less aggressive treatments, women have better quality
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6. Benefits and problems associated with population screening
34
life and fewer side effects during the treatment period, involve a
This saint is also a benefit for women as costs in general.
Given these facts, the best thing to do is to properly inform
women so they know what the risks and benefits of participating in a
population screening program, and try to quantify po-
der take steps to minimize them.
The most important thing is that women have access to clear and rigorous-
where you can find pink and reduce fear and anxiety both anticipated result
ties as cancer. Both the program and the hospital staff have
qualified women to be informed of everything you want and need to know,
both tests to confirm how improved treatments
that has occurred in recent times. You can also consult your doctor or
nurse of the health center for more information and emotional support.
General Coordination
To quote the report job
Communications Working Group
Detection Program
Early Cancer
Breast Barcelona
Puigpinós Rosa Riera (ASPB)
Working Group on Communication for Early Detection Program
Breast Cancer in Barcelona.
Breast cancer and its early detection: what you need to know.
Barcelona Public Health Agency of Barcelona, 2011.
Public Health Agency of Barcelona (ASPB)
Puigpinós Rosa Riera, Gemma Serral, Rocio Barbero,
Helena Martorell, Manuel Piñeiro, Pilar Ramos, Santi Gomez
Ten Elia, Mariona Pons-beams
Mar Health Park:
Francesc Macia, Immaculate Collet Burón Andrea, Maria Dolores Sabadell
Vall d’Hebron:
Xavi Martinez Miranda Nacho
Hospital Clinic of Barcelona:
Montse Selva, Xavier Bargalló, Farru White, James Guell
Hospital de la Santa Creu i Sant Pau:
Maria Teresa Puig, Maria Jesus Quintana
Programme for Sexual and Reproductive Health (PASSIR)
Anna Zaragoza, Aldo giugno
Institute for Health Studies (IES)
Andres Segura
Analysis Center and Health Programs (CAPS):
Graciela locks
Primary Health Care (PHC)
Manuel Fernando
Agate Group:
Montse Domenech
Barcelona Health Board (CSB)
Mariano Jiménez
College of Pharmacists of Barcelona (COFB)
Cristina Rodriguez
Organizers
