Patient Preparation and Education in Mammography – 2 CE Credits


Patient Preparation and Education in Mammography

Patient Preparation and Education in Mammography

CE Credits
2 Category A
FREE Course Content
Post-Test Price: $5.00
Expiry date: September 1, 2022
Course content
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Approved by the ASRT (American Society of Radiologic Technologists) for 2 Category A CE Credits
Access to the accredited interactive course
License duration: 180 days from purchase date
Meets the CE requirements of the following states: California, Texas, Florida, Kentucky, Massachusetts, and New Mexico
Accepted by the Nuclear Medicine Technology Certification Board (NMTCB®)
Meets ARRT® CE reporting requirements
Refund Policy: Non-Refundable

Objectives

  • Identify the two main types of breast cancer
  • Explain common breast cancer treatment
  • Differentiate between facts and myths of breast cancer detection, risks or treatment – including their impact on breast cancer research and personal choices
  • Know how to obtain pertinent patient information relative to mammographic examinations
  • Communicate effectively with referring physicians and patients
  • Be able to define, identify patient interaction and communications before, during and after the exam

Description

A mammogram is the gold standard in diagnosing breast cancer. Patients coming for a mammogram need to experience care, compassion, reassurance, professionalism, education, and often counseling. A mammography technologist often has to provide all these in addition to performing the mammogram.

Preparing for mammography is a very important step and requires good communication with the technologist who will perform it. Communication will relax the patient and reduce the chance of suboptimal imaging of the pectoral muscles. It will also help in identifying sensitive breasts and the reason behind the sensitivity.

For all these reasons, this course was designed to help you understand how to communicate, prepare, and interact with patients, before, during, and after the examination. It will as well tackle around 20 common myths about breast cancer.

The Patient Preparation and Education in Mammography Screening course consists of 1 module followed by a post-test, and provides you 2 Category A CE credits to fulfill your biennial 24 CE requirements and/or to complete your prescribed continuing education.

Discipline Major content category & subcategories CE Credits provided
BS-2016 Patient Care
Patient Interactions and Management 1.00
MAM-2016 Patient Care
Education and Assessment 1.25
MAM-2020 Patient Care
Patient Interactions and Management 1.25
RA-2017 Patient Care
Patient Interactions and Management 0.75
RA-2018 Patient Care
Patient Management 0.75
BS-2016 Procedures
Pathology 0.25
Surgical/Treatment Changes and Interventional Procedures 0.25
MAM-2016 Procedures
Anatomy, Physiology, and Pathology 0.25
RA-2017 Procedures
Thoracic Section 0.75
RA-2018 Procedures
Thoracic Section 0.75
MAM-2020 Procedures
Anatomy, Physiology, and Pathology 0.25
BS-2021 Patient Care
Patient Interactions and Management 1.00
BS-2021 Procedures
Pathology 0.25
Breast Interventions 0.25

Post-Test & CE Certificate:

Post-Test Price: $5.00

Chapter selection

CHAPTER 1
Types of Breast Cancer

Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer:
  • The ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type
  • The lobular carcinoma starts in parts of the breast, called lobules, that produce milk

Other less common types of breast cancer can start in other areas of the breast. Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. These cancers are called estrogen receptor positive cancers. There are other cancers such as progesterone receptor and HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells, including cancer cells, grow faster.

Symptoms

The symptoms of breast cancer can be early warnings or signs of advanced cancer.

The early warnings are: hard breast lump or lump in the armpit, change in the size, shape, or feel of the breast or nipple, and nipple discharge (bloody, brown, yellow, …). The advance signs are: bone pain or breast pain or discomfort, and skin ulcers or swelling of one arm (next to breast with cancer). Weight loss can also indicate cancer.

Treatments

Breast cancer treatment is based on the type and the stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.

Chemotherapy can be used to kill cancer cells, and radiation therapy can be used to destroy cancerous tissue.

Surgery can also be used to remove cancerous tissue. Surgical techniques can be a lumpectomy to remove the breast lump, or a mastectomy to remove all or a part of the breast and possible nearby structures.

Other treatments include hormonal therapy to block certain hormones, for example, Tamoxifen or Aromatase inhibitors, and targeted therapy to interfere with cancer cell growth and function, for example, Herceptin (trastuzumab).

CHAPTER 2
Patient Care

Moving forward, this section called “Patient Care” will cover an introduction, patient education, patient compliance, communication, and medical history documentation.

Introduction

Detecting the breast cancer early offers the best hope for patients, and the mammogram is the gold standard in diagnosing breast cancer.

Patients coming for a mammogram need to experience care. They also need compassion, reassurance, professionalism, education, and often counseling. A mammography technologist often has to provide all these in addition to performing the mammogram.

Patient Education and Compliance

The patient’s waiting room can help in educating the patient by providing patient literature such as brochures, information packets, screening guidelines, and breast examination guides.

Remember that in order to have a successful screening program, the patient has to return for yearly mammograms. Therefore, technologists must ensure the patient’s compliance. This can involve giving the patient a pleasant experience, being understanding, informed, and compassionate. The last thing a patient wants is to encounter an unsympathetic technologist or have a painful experience.

Communication

The technologist must communicate before, during, and after the examination. Before the exam, the communication involves documentation of clinical history. During the exam, the communication could involve a social conversation, or giving the patient step-by-step instructions on positioning. After the exam, the communication means that the patient should not leave the facility without knowing exactly what happens next, including how to get the report, when the report will arrive, and if there will be any follow-up calls.

The communication will relax the patient and reduce the chance of suboptimal imaging of the pectoral muscles. It will as well help identifying sensitive breasts, and the reason behind the sensitivity.

Communication can also determine if the rescheduling of the mammogram may be needed, and it helps to educate the patient, and reveals fears and misconceptions.

The technologist is the link between the patient and the radiologist. It is the technologist who will convey the information, and this information can often help in diagnosis.

Documentation

The most important information that the technologist will convey to the radiologist is the medical history documentation. The technologist should document the signs or symptoms of breast cancer, any abnormalities of the breast, the patient’s hormonal history, surgical history, and medical history.

The documentation must include: changes in the nipple or areola, dimpling or puckering of the skin, swelling, itching or redness of the breast. Other signs to check are the presence of a lump, thickening, pain or nipple discharge.

If there is any nipple discharge, checks should be on the duration, color, bilateral versus unilateral, and spontaneous versus expressed.

The hormone documentation shall include:
  • Early Menarche, before 12 years of age
  • Late Menopause, after age of 55
  • Age of menopause
  • Nulliparity
  • Age of the first pregnancy and the number of births (any pregnancy carried to point of viability)
  • Use of tamoxifen or any similar drugs
Whereas surgical documentation shall include:
  • Core or needle biopsies
  • Surgical biopsies
  • Cyst aspiration
  • Lumpectomy
  • Mastectomy

CHAPTER 3
Breast Cancer Myths

Now let’s move to this new section, “Breast Cancer Myths” where we will cover the early and the modern myths.

The 1990s brought quality mammograms and standardization of mammography imaging in the US with widespread preventative screening, covered by most insurance plans.

Despite the widespread education on breast cancer diagnosis and treatment, there are still a lot of myths and misconceptions about breast cancer. We will now explore some of these and provide the facts.

The first myth is that breast cancer is a new disease. Well, it is not.

The earliest known case of breast cancer was recorded in on a Papyrus dating in the seventeenth century B.C. (1600 B.C.). This document was found in 1862 by an American Egyptologist, Edwin Smith. The papyrus reported a breast tumor, listed as case 45, and even listed the treatment – cauterization of the diseased tissues.

In 1967, an Italian surgeon stopped in front of Rembrandt’s Bathsheba at Her Bath, which was painted in 1654. He noticed an asymmetry to Bathsheba’s left breast; it seemed distended, swollen near the armpit, discolored, and marked with a distinctive pitting. The physician learned that Rembrandt van Rijn (1606-1669) used his mistress as a model for this painting and she later died after a long illness. It was surmised that the cause of her death was almost certainly breast cancer.

One of the earliest speculations was that breast cancer was the result of an imbalance of body humors. These were considered blood, phlegm, yellow bile, and black bile.

Breast cancer was also linked to melancholia, and diet or exorcism were used as possible treatments.

Advancement in medical knowledge soon threw out these old myths. However, they have been replaced by other modern myths and misconceptions.

Abortion and Breast Cancer

Myth vs. Fact: will abortion increase breast cancer risk?

It remains uncertain whether elective abortion increases subsequent breast cancer. Terminating an unintended pregnancy sacrifices the protective effect of 9 months of a full-term delivery. It also results in delayed childbearing. The loss of protection creates the net effect of an increased risk.

Age

Myth vs. Fact: after being cancer free for 65 years, you do not need a mammogram.

Although some organizations are now recommending to stop mammograms at the age of 74, this is based on the health of the woman. The reason behind this recommendation is that at 74, if a woman has multiple health issues, these are likely to be more deadly than a cancer that is often slow growing at that age.

Each woman’s breast cancer risk is based on population averages, however, as a woman ages, her risk of getting cancer also increases.

Women younger than 30 years old present breast cancer at 0.3%, which is the lowest percentage. In their 30’s, women record 3.5% of breast cancer cases, and in their 40’s, they record 18% of diagnosed breast cancer. However, the majority of cancers (77%), are reported by women over the age of 50.

Alcohol

Myth vs. Fact: drinking alcohol will increase breast cancer risk.

Alcohol increases the circulation levels of estrogen, and increases the estrogen metabolism, causing cancers to grow.

Moderate alcohol consumption can cause a modest increase in breast cancer risk. Heavy drinking (4 or more drinks a day) doubles the risks. Women who drank 3 to 4 glasses of wine were 34% more likely to have a recurrence of breast cancer. The risks are greater with post-menopausal and overweight women.

Antiperspirants

Myth vs. Fact: antiperspirants can cause breast cancer. They prevent the armpits from purging cancer toxins through sweat. These toxins accumulate in the lymph nodes, and the chemicals in the antiperspirants are absorbed by the skin, causing cancer.

A study by the Journal of the National Cancer Institute conducted in October 2002 found no increased risk link between the use of deodorants or antiperspirants and breast cancer.

Also, toxins are eliminated by the kidneys, not through sweat. Sweat consists mainly of minerals and water. If the antiperspirant is absorbed and stored in the armpit (as toxins), then cancer should develop in the armpit, not in the breast. The lymph drains away from the breast and not to the breast (through one-way valves).

Breast Cancer is an Emergency

Myth vs. Fact: a diagnosis of breast cancer is an emergency and needs immediate surgery.

It may take six to eight years for a breast cancer developing from one cell to grow to the size of one centimeter. By the time a woman feels a lump, the cancer has been present for eight to ten years. So there is certainly the time to get a second opinion, to read, and to fully explore the treatment options.

Dense Breasts

Myth vs. Fact: age and not the density of the breast tissue will determine a woman’s risk of developing breast cancer.

Women with dense breast face a higher risk of missed breast cancer if the mammogram is the only screening tool used.

Recent studies show that the density can be a factor in breast cancer risks in younger women. The breast cancer tends to develop in the dense glandular tissue of the breast. If a woman has dense breast tissue, she would have a higher risk of developing breast cancer than a woman of the same age with fatty breasts.

Breast ultrasonography, digital mammogram, or MRI are more accurate than mammography for assessing the tumor’s size in breasts with a high density.

Personal History of Cancer

Myth vs. Fact: having an ovarian, uterine, or colorectal cancer, increases your risk of developing breast cancer.

Ovarian cancer slightly increases the risk of breast cancer. Uterine (endometrial), or colorectal cancers, double the risks of breast cancer. The risks will increase significantly if the woman also carries the BRCA1 or BRCA2 gene.

Caffeine Intake

Myth vs. Fact: caffeine in coffee will increase symptoms of fibrocystic disease, therefore, breast cancer.

Fibrocystic breast is not a disease. However, the density associated with fibrocystic changes can make breast cancer more difficult to detect with mammography. Caffeine has no effect on breast cancer.

Exercise & Breast Cancer

Myth vs. Fact: exercise will substantially lower the risk of breast cancer.

Girls and young women who exercise regularly between the ages of 12 and 35, have substantially lower risks of breast cancer before menopause compared to those who are less active. The benefit is not linked to the intensity of the exercise, but to the total activity.

This conclusion was the result of a study conducted by Washington University School of Medicine in St. Louis and Harvard University in Boston. It is published in the Journal of the National Cancer Institute-2009.

Family History

Myth vs. Fact: if breast cancer is not in your family, you will not get it.

80% of the women who get breast cancer have no known family history of the disease. Age – normal wear and tear on the body – is the biggest risk factor for breast cancer.

Myth vs. Fact: only your mothers’ family history of breast cancer can affect your risk.

A half of your genes comes from your mother and the other half comes from your father. Therefore, both parents will influence your cancer risk. However, a man with an abnormal breast cancer gene is less likely to develop breast cancer than a woman with the similar gene.

Genetic Link

Myth vs. Fact: having the BRCA1 or BRCA2 gene means you will get breast cancer.

Only 5 to 10% of breast cancer cases are associated with the abnormal genes. 20 to 60% of patients with these genes will never get breast cancer. And, 80% of the women who get breast cancer have no identifiable risk factors.

Gender

Myth vs. Fact: males will not get breast cancer.

Only about 1,600 males get diagnosed with breast cancer each year. However, the incidence of breast cancer in males has increased by 25% in the past 20 years, and breast cancer kills 25% of men who develop it.

High-Fat Foods

Myth vs. Fact: high-fat foods increase breast cancer risk.

Healthy food choice is a good habit. There is no definitive link between fatty foods and breast cancer. However, excess body weight means extra fat, which increases estrogen outside of the ovaries. A high percentage of breast cancer is estrogen receptor positive, and needs estrogen to grow. This means that postmenopausal obesity, and having fat stored in the waist line are linked to increased breast cancer risks.

Hormone Therapy (HT)

Myth vs. Fact: Hormone Therapy (HT) causes breast cancer.

Hormone Therapy (HT) is a combination of estrogen and progestin. If taken for 5 years, it doubles your risks. Estrogen-only therapy carries a lower risk of breast cancer, but increases risks of endometrial cancer. The HT-associated risk returns to normal within 2 years after stopping HT.

The Women’s Health Initiative study (WHI) conducted on women over 60 advises low doses for the shortest possible time.

Injury to the Breast

Myth vs. Fact: trauma or injury of the breast can cause cancer.

Trauma or injury can cause a hematoma or fat necrosis, and the signs and symptoms can be mistaken for a lump or an abnormal scarring. When the body attempts to repair the damaged breast tissue, the affected area may sometimes be replaced with a firm scar tissue. Also, a cancer can be found after the injury, but the two events are not related.

Lumps & Breast Cancer

Myth vs. Fact: all lumps are cancerous.

The majority of breast lumps are benign. Lumps can be a sign of breast cancer, but the aim is to find the cancerous tumor before it gets large enough to be felt as a palpable lump. In addition, please keep in mind that breast cancer can be present without any symptoms.

Magnetic Field Exposure

Myth vs. Fact: electromagnetic fields can cause breast cancer.

Electro-magnetic fields (EMFs) are emitted from devices that produce, transmit, or use electric power. Some sources of EMFs are power lines, transmitters, and household electronics like televisions, microwave ovens, and electric blankets.

Over the past 15 years, there have been several studies evaluating children’s and adults’ residential exposures to electric and magnetic fields in relation to risks of brain cancer, leukemias, lymphomas, and breast cancer. Most findings have been inconclusive.

To limit exposures to EMFs, the National Institute of Environmental Health Sciences recommends increasing the space between devices that emit EMFs and yourself, and discouraging children from playing near power lines.

Mammography Accuracy

Myth vs. Fact: mammography is 100% accurate.

Mammography is the most accurate screening tool for breast cancer. It detects 85 to 90% of all breast cancers. However, the accuracy is helped by: BSE and CBE, regular comparison studies, regular mammograms, using adjunctive imaging therapy, and the skills of the radiologists and the technologists.

If a patient has a lump or other change, and the mammogram is “negative” (interpreted as not suspicious or cancerous), the patient should still pursue that finding with her physician.

Mammography Value

Myth vs. Fact: mammograms are worthless for younger patients and will not lower a woman’s risk of dying from breast cancer.

The sensitivity of the mammogram varies with the breast tissue type and with age. Studies on regular screening of younger women are often inconclusive because of the density of the younger breast.

Other factors to consider are: the ability of the radiologist, the utilization of additional imaging, adjunctive modalities, and comparison studies.

Nipple Discharge

Myth vs. Fact: nipple discharge is always cancerous.

Most nipple discharges do not indicate a cancerous condition. Up to 60% of women experience nipple discharge during breast self-examination. Only 10% of all nipple discharges are abnormal.

Clear, milky, yellow, and green discharges, are mostly normal. Bloody, brown, or brackish discharges, are mostly abnormal but can be associated with non-cancerous papillomas.

20% of women experience nipple discharge during self-examination. Most bloody discharges are due to non-cancerous papillomas. Women should report any worrisome nipple discharge to their physician for clinical examination.

Nipple discharge may be a concern if it is:

  • Bloody or watery (serous) with a red, pink, or brown color
  • Sticky or brown to black (opalescent)
  • Appears spontaneously without squeezing the nipple
  • Persistent
  • Persistent

Oral Contraceptive

Myth vs. Fact: the birth control pill increases breast cancer risk.

Older birth control pills were associated with a slight increased risk. The modern birth control pill is not associated with any cancer risk, even after prolonged use. The exception is for women carrying the BRCA1 gene. In such case, the pill can increase breast cancer risk. Also, women younger than 21 can have an increased risk if the pill is taken over 10 years.

Women at a high risk for breast cancer should discuss any concerns about oral contraceptives with their physicians.

Mastectomy

Myth vs. Fact: a mastectomy guarantees that the cancer will not recur at the site of the mastectomy.

Mastectomy (removal of the affected breast) does not guarantee that the breast cancer will not recur.

Many women who have a modified radical mastectomy also undergo axillary lymph node dissection (removal of the underarm lymph nodes) to ensure that the cancer has not spread beyond the breast.

8 to 10 percent of women will have a recurrence in the scar after a mastectomy, and there is also a possibility that the cancer has spread to the lymph nodes, or other areas of the body.

Menarche

Myth vs. Fact: early menarche, with onset of menstruation before the age of 12 increases breast cancer risk.

An early onset of menstruation means a longer lifetime exposure to estrogen, which could increase your risk of breast cancer.

Menopause

Myth vs. Fact: late menopause increases your breast cancer risk.

Breast cancer risk rises by about 3 percent for each year of delayed menopause. “Delayed” means onset after the age of 51, which is the average age of menopause for women in the United States.

Painful Breast Lump

Myth vs. Fact: a painful breast lump is always benign.

Bilateral breast pain is less likely to be associated with breast cancer than unilateral breast pain. However, 10% of invasive breast cancers are associated with pain. On the other hand, pain may accompany a breast lump. Therefore, breast pain must be investigated because it can be caused by a variety of conditions.

Pollutants

Myth vs. Fact: pollutants such as chemicals can cause breast cancer.

Powerful evidence indicates that there is a connection between chemicals and breast cancer. However, there have been no definitive answers from the studies to date.

Pregnancy

Myth vs. Fact: women who have had a breast cancer should not become pregnant, because the high estrogen levels during pregnancy will cause cancers to grow.

The hormonal and metabolic changes that occur during pregnancy have not been shown to have any noticeable effects on long-term breast cancer prognosis. Breast cancer survivors should consult their physicians before planning a pregnancy.

Pregnancy & Breast Feeding

Myths vs. Fact: never having children increases your breast cancer risk, and breast feeding decreases it.

Never having children or giving birth at a later age nearly doubles the risk of breast cancer. On the other hand, breastfeeding at any age lowers the risk of breast cancer.

Prophylactic Mastectomy

Myth vs. Fact: a prophylactic mastectomy will prevent breast cancer.

Prophylactic mastectomy is a preventive procedure in which one or both of the breasts are removed in women who are at very high risk for developing breast cancer. Some studies have shown that prophylactic mastectomy can reduce the risk of breast cancer by 90%.

Breast tissue also extends up towards the neck, under the arms, and to the chest wall. A woman is at risk of developing breast cancer as long as the breast tissue remains in the body.

Risk Factor

Myth vs. Fact: having a risk factor for breast cancer means that you will get it for sure.

Even if you have a strong risk factor, risk factors give only the probability of occurrence of the breast cancer, and are not a certainty. Also, 80% of women who get breast cancer have no identifiable risk factors.

Statistic “One in Eight”

Myth vs. Fact: the statistic “one in eight women will develop breast cancer”, means that if eight women are randomly selected, then one of those eight women is guaranteed to get breast cancer.

The one-in-eight-women is calculated over a lifetime to age ninety-five. If researchers were to follow a large group of girls born today and track them until they became ninety-five years old, then one out of every eight of those girls (approximately 12.5%) would develop breast cancer sometime in her lifetime. The one-in-eight risk is a cumulative lifetime risk of developing breast cancer if you live at least to the age of 95.

Stress or Type-A Personality

Myth vs. Fact: stressful events lead to cancer which means that type A personalities are more prone to develop breast cancer.

The National Cancer Institute & British Medical Journal studies found no conclusive correlation between the stress and breast cancer, or even the recurrence of the disease.

Classic type-A personality traits are ambitiousness, competitiveness and aggressiveness.

Race and Breast Cancer

Myth vs. Fact: black women get a more aggressive form of breast cancer.

African-American women die from breast cancer at a higher rate than white women. It was proven that the 5-year survival rate for breast cancer was 71% for African American females, and 86% for white females. Experts attribute the difference to poorer access to health care among the black people, and poor treatment planning because the majority of breast cancer among them is not estrogen receptor positive.

Myth vs. Fact: white women have a higher incidence of breast cancer.

The rate of diagnosis is higher among white women but as a group, white, Hawaiian, and black women have the highest rates of the disease, according to the National Cancer Institute. The lowest rates occur among American-Indian, Vietnamese, and Korean women.

Some researchers and advocates for women with the disease say there’s a correlation between breast cancer incidence and industrial pollutants.

Radiation

Myth vs. Fact: past radiation treatment will increase your breast cancer risk.

Women who have undergone radiation therapy for Hodgkin’s disease, for example, are significantly more likely to develop breast cancer. In fact, some experts recommend early mammography screening after Hodgkin’s. Studies suggest that this could be due to the radiation delivered to the breast tissue during treatment for Hodgkin’s disease.

Multiple scoliosis imaging during the teenage years can also expose the young breast tissue to radiation.

Underwire Bras

Myth vs. Fact: tight bras will constrict the lymphatic system, allowing toxins to accumulate in the breast tissue.

This myth started from a 1995-book titled “Dressed to Kill”, by Sydney Ross Singer and Soma Grismaijer. The authors claimed that tight bras constrict the lymphatic system, causing cancer-promoting toxins to accumulate in the breast tissue. As evidence, they pointed out that breast cancer rates are higher in Western societies, where bra use is more common. Although, experts say “Dressed to kill” does not consider other variables such as diet and environment, age, family history, obesity, and not having children.

No study has been able to prove this theory. Also, the lymph drains away from your breasts through the lymphatic system, and if there is an infection in the system, this means that there would be a higher incidence of lymph node cancer.

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