Nov.

20, 2021
Cancer Course Empowerment 1400H - 1500H
Via Zoom
– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of Breast MANAGEMENT of
Cancer – Part 1 BREAST CANCER.
Cancer Course Empowerment
– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of Breast MANAGEMENT of
Cancer – Part 1 BREAST CANCER.
Cancer Course Empowerment ROJoson PEP Talk
– objective - for
Fundamentals laypeople to have an I have a Patient
and understanding of the Empowerment
Program in which I
Generalities in FUNDAMENTALS
like to empower the
Medical and GENERALITIES in lay people or
Management the MEDICAL patients to take
of Breast MANAGEMENT of control in the
Cancer – Part 1 BREAST CANCER. management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 My PEP TALK today
Cancer Course Empowerment is entitled:
– Fundamentals and
objective - for
Generalities in
Fundamentals laypeople to have an
Medical
and understanding of the Management of
Generalities in FUNDAMENTALS Breast Cancer, Part
Medical and GENERALITIES in 1. This is part of the
Management the MEDICAL Cancer Course.
of Breast MANAGEMENT of
Cancer – Part 1 BREAST CANCER.
Fundamentals Definition of Terms in Title AND Delimitation of
and Coverage of Talk:
Generalities in
Medical Fundamentals – simplest and essential facts and
Management theories which can serve as a basis or foundation
of Breast and support for advanced information
Cancer
Generalities – general statements of info, not
covering specifics and details

Medical Management – diagnosis and treatment

of breast cancer by physicians
Fundamentals Contents:
and • Screening for breast cancer PART 1
Generalities in • Symptoms that will lead to suspected presence
Medical of breast cancer
Management • Clinical diagnosis of breast cancer
of Breast • Paraclinical diagnostic procedures for breast
Cancer cancer

• Treatment for breast cancer

• Surveillance of breast cancer PART 2
• Prognosis of breast cancer
• Palliative and hospice care for breast cancer
patients
Fundamentals Screening for breast cancer
and
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Screening for breast cancer Usually NO more
and screening in MALES
Generalities in Screening for breast cancer means looking because breast
Medical for a breast cancer that may be present in cancer is rare.
Management apparently healthy and asymptomatic
of Breast persons (particularly females). One principle in
Cancer
medical screening –
Breast cancer is more common in females screen only in high
and uncommon - rare in males. Breast risk situations
cancer may also occur in males (1% and (particularly,
common – high
ratio of 1:100 females)
incidence).
Fundamentals Screening for breast cancer Screening for breast
and cancer means
Generalities in General Screening Methods looking for a breast
Medical • Risk-assessment interview or cancer that may be
Management evaluation present in
of Breast apparently healthy
• Risk-assessment interview and physical
and asymptomatic
Cancer examination persons. [females]
• Risk-assessment interview and physical
examination with use of instrumental
or laboratory diagnostic procedures
Fundamentals Screening for breast cancer Screening for breast
and cancer means
Generalities in General Screening Methods looking for a breast
Medical • Risk-assessment interview or cancer that may be
Management evaluation present in
of Breast apparently healthy
and asymptomatic
Cancer Looking for higher risk for cancer in a persons. [females]
particular patient / person
• Family history of cancer
• Risky lifestyle and behavior (tobacco use;
alcohol use; obese; use of hormones;
exposure to excessive radiation; etc.)
Fundamentals Screening for breast cancer If POSITIVE for
and higher risk, proceed
Generalities in General Screening Methods to symptom-sign
Medical • Risk-assessment interview or evaluation (physical
Management evaluation examination) and if
of Breast indicated, do
instrumental or
Cancer Looking for higher risk for cancer in a laboratory
particular patient / person diagnostic
• Family history of cancer procedures.
• Risky lifestyle and behavior (tobacco use;
alcohol use; obese; use of hormones;
exposure to excessive radiation; etc.)
Fundamentals Screening for breast cancer If NEGATIVE for
and higher risk, MAY
Generalities in General Screening Methods STOP HERE or
Medical • Risk-assessment interview or proceed to
Management evaluation symptom-sign
of Breast evaluation
(interview and
Cancer Looking for higher risk for cancer in a physical
particular patient / person examination) to
• Family history of cancer complete the basic
• Risky lifestyle and behavior (tobacco use; essentials of
alcohol use; obese; use of hormones; screening.
exposure to excessive radiation; etc.)
Fundamentals Screening for breast cancer If POSITIVE for
and higher risk and with
Generalities in General Screening Methods SUSPECTED
Medical • Risk-assessment interview and physical PRESENCE of cancer
Management examination based on symptoms
of Breast and signs, proceed
Cancer to instrumental or
This constitutes the basic essentials of
laboratory
screening. diagnostic
procedures as
indicated.
Fundamentals Screening for breast cancer If NEGATIVE for
and higher risk and with
Generalities in General Screening Methods NO SUSPECTED
Medical • Risk-assessment interview and physical PRESENCE of cancer
Management examination based on symptoms
of Breast and signs, MAY STOP
HERE.
Cancer This constitutes the basic essentials of
screening.
Fundamentals Screening for breast cancer In this era of
and commercialism in
Generalities in General Screening Methods medicine and health
Medical • Risk-assessment interview and physical care,
Management examination with use of instrumental BEWARE of a lot of
of Breast or laboratory diagnostic procedures hospitals and
laboratory clinics
Cancer • DO instrumental or laboratory
peddling screening
diagnostic procedures only if POSITIVE packages for cancer.
FOR HIGHER RISK FOR CANCER or / and Don’t be swayed
IF WITH SUSPECTED PRESENCE OF easily by the
CANCER BASED ON SYMPTOMS AND marketing and
SIGNS. discount offers.
Fundamentals Screening for breast cancer
and
Generalities in PHILIPPINES
Medical
Management Currently, no official nationwide breast cancer
of Breast screening program is available in the Philippines.
Cancer
The Philippines Breast Cancer Control Program
(BCCP) emphasizes the importance of annual CBE
(clinical breast examination) from healthcare
professionals (e.g., nurses, public health Eur J Breast Health
physicians, midwives) and monthly BSE (breast .
self-examination) (6).  2019 Jan; 15(1):
18–25.
Fundamentals Screening for breast cancer
and
Generalities in PHILIPPINES
Medical
Management For breast cancer screening –
of Breast medical societies, hospitals, clinics and individual
Cancer physicians are advocating

• Mammogram – starting at age 40 and annually

• Breast self examination
• Clinical breast examination

• Oftentimes, ultrasound of the breasts is added.

Fundamentals Screening for breast cancer
and
Generalities in INTERNATIONAL (American Cancer Society)
Medical •Women aged 40 to 44 should have the choice
Management to start annual breast cancer screening with
of Breast mammograms if they wish to do so.
Cancer •Women aged 45 to 54 should get
mammograms every year.
•Women 55 and older should switch to
mammograms every 2 years, or can continue
yearly screening.
Fundamentals Screening for breast cancer
and
Generalities in INTERNATIONAL (American Cancer Society)
•Screening should continue as long as a woman is
Medical
in good health and is expected to live 10 more
Management
years or longer.
of Breast •All women should be familiar with the known
Cancer benefits, limitations, and potential harms linked
to breast cancer screening. 
Fundamentals Screening for breast cancer
and
Generalities in INTERNATIONAL (American Cancer Society)
Medical
Women should also know how their breasts
Management
normally look and feel and report any breast
of Breast changes to a health care provider right away.
Cancer (BREAST SELF-EXAMINATION)
Fundamentals Screening for breast cancer
and
Generalities in INTERNATIONAL (American Cancer Society)
Medical
For women at average risk of breast cancer,
Management
screening mammography is recommended every
of Breast 1–2 years beginning at age 40 years. If you have
Cancer not started screening in your 40s, you should start
having mammography no later than age 50 years.
Screening should continue until at least age 75
years.
Fundamentals Screening for breast cancer
and
Generalities in INTERNATIONAL (US PSTF and CaTFPHC) USPSTF – US
Preventive Services
Medical Task Force
Management •Mammography every 2 years between age 50 CaTFPHC – Canadian
of Breast and 74 years (2-3 years – Canada) Task Force on
Cancer •For women aged 40-49 years, guidelines Preventive Health
advocate an individualized approach in which Care
clinicians should base decisions on the potential
benefits and harms of mammography, the
woman's preferences, and her breast cancer risk
profile
Fundamentals Screening for breast cancer
and
Generalities in ROJoson Personal Recommendations: Breast specialist-
Medical clinician –
Management • Breast self-examination monthly
in the Philippines,
of Breast starting at age 20 and onwards
Cancer • Clinical examination of the breasts by a usually a board-
breast specialist-clinician every 1-2 certified general
years age 30 and onwards surgeon with
• Mammography, every 2-3 years, from extensive training on
age 50 to 74 breast palpation
Fundamentals Symptoms that will lead to suspected
and presence of breast cancer
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Symptoms that will lead to suspected
and presence of breast cancer
Generalities in
Medical ALERT SYMPTOMS or SYMPTOM-CUES
Management • Breast mass
of Breast • Change in breast contour
Cancer • Nipple retraction
• Nipple-areolar skin erosion
• Nipple discharge – red
• Armpit mass

Pain???
Fundamentals Symptoms that will lead to suspected
and presence of breast cancer
Generalities in
ALERT SYMPTOMS or SYMPTOM-CUES for BREAST
Medical
CANCER:
Management • Breast mass
of Breast • Change in breast contour
Cancer • Nipple retraction
• Nipple-areolar skin erosion
• Nipple discharge – red
• Armpit mass
Pain per se without the above associated alert
symptoms is NOT a symptom-cue for breast
cancer.
Fundamentals Symptoms that will lead to suspected
and presence of breast cancer
Generalities in
ALERT SYMPTOMS or SYMPTOM-CUES for
Medical
Management BREAST CANCER:
• Breast mass
of Breast
• Change in breast contour
Cancer • Nipple retraction
• Nipple-areolar skin erosion
• Nipple discharge – red
• Armpit mass
WILL DISCUSS THESE IN CLINICAL
DIAGNOSIS OF BREAST CANCER.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Clinical diagnosis means a conclusion or
Medical decision made by a physician after
Management examining a patient and after evaluation of
of Breast the data on symptoms and signs.
Cancer
Symptoms are what are felt and observed
by the patient or a person on the body.

Signs are findings of a physician after

physical examination of a patient.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Procedures in clinical diagnosis of cancer:
Medical Patient has symptoms.
• Physician evaluates the symptoms to see if
Management
these are alert signals or symptoms-cues for
of Breast cancer or not.
Cancer • Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Processes used in clinical diagnosis of
Medical cancer:
Management
of Breast • Pattern recognition
Cancer • Prevalence
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Processes used in clinical diagnosis of
Medical cancer:
Management
of Breast Pattern recognition process means realization
Cancer that the patient’s presentation conforms to a
previously learned picture or pattern of disease.
Prevalence process means choice of a diagnosis is
based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and system.
Fundamentals Breast cancer is a
Clinical diagnosis of breast cancer
and medical disease when
Generalities in Remember the definition and behavior of some of the breast
breast cancer when looking for pattern cells grow
Medical
uncontrollably with a
Management recognition in the alert symptoms or
potential
of Breast symptom-cues.
Cancer to invade the adjacent
body tissues or organs
and

to spread to distant
tissues or organs.
Fundamentals Breast cancer is a
Clinical diagnosis of breast cancer
and medical disease when
Generalities in Suspect cancer in a breast mass with cues some of the breast
of invasion of adjacent tissues – ILL- cells grow
Medical
uncontrollably with a
Management DEFINED BORDER and FIXATION.
potential
of Breast
Cancer to invade the adjacent
body tissues or organs
and

to spread to distant
tissues or organs.
Fundamentals Breast cancer is a
Clinical diagnosis of breast cancer
and medical disease when
Generalities in Suspect cancer in a breast mass with cues some of the breast
of spread to armpits and distant tissues or cells grow
Medical
uncontrollably with a
Management organs like bone, lung, brain and liver.
potential
of Breast
Cancer to invade the adjacent
body tissues or organs
and

to spread to distant
tissues or organs.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in ALERT SYMPTOMS or SYMPTOM-CUES for
Medical BREAST CANCER:
Management • Breast mass – most common
of Breast
Cancer May have an underlying or associated breast
mass:
• Change in breast contour
• Nipple retraction
• Nipple-areolar skin erosion
• Nipple discharge – red
• Armpit mass
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in BREAST MASS:
Medical Foremost in the physical examination is
Management
of Breast
to look for a dominant mass, the real mass, the
mass which is considered as the red flag, meaning, if
Cancer present, it needs at least more investigation. 

One should distinguish dominant mass from

prominent or un-smooth breast tissues which are
usually part of fibrocystic changes, which is
considered normal and does not require surgical
treatment.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Clinical diagnosis of breast cancer
and
Clinical diagnostic algorithm in patients
Generalities in with NO dominant breast mass:
Medical
Management -          NO dominant breast mass found on
of Breast physical examination in patients
Cancer complaining of breast mass and in patients
coming for breast check  – normal or
fibrocystic changes
-          Breast pain with NO dominant
breast mass – fibrocystic changes
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Clinical diagnostic algorithm in patients
Medical with NO dominant breast mass:
Management
of Breast -          Nonsanguinous (not red) nipple
Cancer discharge with NO dominant breast mass
– fibrocystic changes

-          Sanguinous (red) nipple discharge

with NO dominant breast mass –
intraductal papilloma
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in
Medical Clinical diagnostic algorithm in patients
with NO dominant breast mass:
Management
of Breast -          Focal erythema and tenderness
Cancer with NO dominant breast mass -
mastitis
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Clinical diagnosis of breast cancer
and
Diagnostic algorithm in patients with a
Generalities in
dominant breast mass:
Medical
Look for signs of inflammation and
Management
of Breast infection (pus, erythema, tenderness,
Cancer fluctuancy of mass) – if present,
primary diagnosis is inflammatory or
infectious mass – ABSCESS
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Diagnostic algorithm in patients with a
Medical dominant breast mass:
Management If no signs of inflammation and
of Breast
infection, decide whether
Cancer
malignant or benign neoplastic
growth.
Fundamentals Clinical diagnosis of breast cancer
and Diagnostic algorithm in patients with a
Generalities in dominant breast mass:
Medical Look for signs of malignancy (signs of
Management local invasion – ill-defined border,
of Breast
fixation, retraction, ulceration, fungation;
Cancer
signs of spread – axillary lymph nodes) -
if present, suspect MALIGNANT MASS.
Fundamentals Clinical diagnosis of breast cancer
and Diagnostic algorithm in patients with a dominant
Generalities in breast mass:
Medical
Management
If no signs of malignancy – more
of Breast likely, BENIGN MASS (especially
Cancer if mass is CYSTIC - containing
fluid)
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in ALERT SYMPTOMS or SYMPTOM-CUES for
Medical BREAST CANCER:
Management • Breast mass – evaluate the mass
of Breast
Cancer May have an underlying or associated breast mass
(if positive, suspect cancer)
• Change in breast contour
• Nipple retraction
• Nipple-areolar skin erosion
• Nipple discharge – red (cancer if with mass)
• Armpit mass
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Physical examination findings on the breast that
will raise suspicion for breast cancer:
Medical
Management
• Presence of a dominant breast mass
of Breast with telltale (or giveaway) signs of
Cancer malignancy (signs of local invasion of the
breast mass on the adjacent tissues and
signs of spread)

• Presence of sanguinous nipple discharge

with an accompanying dominant mass
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Physical examination findings on the breast that
will raise suspicion for breast cancer:
Medical
Management Signs of local invasion of the breast mass
of Breast on the adjacent tissues
Cancer • Fixation to the adjacent tissues such as the
overlying skin inclusive of the nipple and areola
and the underlying tissues such as chest
muscles and ribs.
• Skin changes over the mass that are suggestive
and indicative of local invasion such as
ulcerations and fungation.
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Physical examination findings on the breast that
will raise suspicion for breast cancer:
Medical
Management Signs of spread
of Breast • presence of palpable ipsilateral axillary
Cancer lymph node and supraclavicular lymph
node.
Fundamentals Example of
Clinical diagnosis of breast cancer
and symptom- and sign-
Generalities in Breast Mass cues and use of
pattern recognition
Medical 30 years old and above and prevalence in
Management Palpable breast mass the clinical diagnosis
of Breast Breast cancer
suspect of breast cancers
Cancer Solid
Breast cancer
Fixed (not movable)
probable

Breast cancer
With armpit lymph node most probable
Fundamentals Example of
Clinical diagnosis of breast cancer
and symptom- and sign-
Generalities in Breast Mass cues and use of
pattern recognition
Medical Any age and prevalence in
Management Palpable breast mass the clinical diagnosis
of Breast NOT breast of breast cancers
Cancer Cystic (containing fluid) cancer suspect
BENIGN

Macrocyst
Hormonal change
Fundamentals Example of
Clinical diagnosis of breast cancer
and symptom- and sign-
Generalities in Breast Mass cues and use of
pattern recognition
Medical Any age and prevalence in
Management Palpable breast mass the clinical diagnosis
of Breast of breast cancers
Cancer With redness, tenderness and possible pus
NOT breast
cancer suspect
BENIGN

Infection
Abscess
Fundamentals Clinical diagnosis of breast cancer
and
Generalities in Procedures in clinical diagnosis of cancer:
Medical Patient has symptoms.
• Physician evaluates the symptoms to see if
Management
these are alert signals or symptoms-cues for
of Breast cancer or not.
Cancer • Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.
Fundamentals Clinical diagnosis of breast cancer
and The next thing for
Generalities in At end of the clinical examination, the physician to
physician makes a clinical diagnosis: decide is whether to
Medical
do a paraclinical
Management diagnostic
of Breast Possible conclusion or decision: procedure or not –
Cancer • Not cancer
• Cancer suspect instrumental or
• Cancer probable laboratory
• Cancer most probable diagnostic
procedure
Fundamentals Paraclinical diagnostic procedures for
and breast cancer
Generalities in
Medical
Management
of Breast
Cancer
Fundamentals Paraclinical diagnostic procedures for
and breast cancer
Generalities in
Medical The foremost indication for a paraclinical
Management diagnostic procedure can be stated this
of Breast way:
Cancer
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
Fundamentals Paraclinical diagnostic procedures for
and As a rule, there is no need
breast cancer for a paraclinical
Generalities in
To decide on indication of the paraclinical diagnostic procedure if:
Medical
Management diagnostic procedure, • you are quite
of Breast certain of your
the physician uses two processes – primary clinical
Cancer
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for
secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
Fundamentals Paraclinical diagnostic procedures for
and If there is a need for a
breast cancer
Generalities in paraclinical diagnostic
Medical Procedures Benefit Risk Cost Availability procedure, the
(goal – to
Management be more
physician uses the B-
of Breast definite on R-C-A processes.
the
Cancer diagnosis) B – stands for benefit;
R – risk; C – cost; A –
Option1         Availability.
Option2        
Option3        
Fundamentals Paraclinical diagnostic procedures for
and The physician gives or
breast cancer
Generalities in lists the various
Medical Procedures Benefit Risk Cost Availability options of paraclinical
(goal – to
Management be more
diagnostic procedures
of Breast definite on and then gives data
the
Cancer diagnosis) on the BRCA.
With the data given,
Option1         the patient is asked
Option2        
what s/he prefers.
Option3        
Fundamentals Paraclinical diagnostic procedures for Example of BRCA
and breast cancer comparative analysis
Generalities in of paraclinical
Medical diagnostic procedures
Management
of Breast Procedures Benefit (goal – to be Risk Cost (PhP) Availability
more definite on the
Cancer diagnosis)

Option1 accuracy 99% acceptable 4000 available

Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available
Fundamentals Paraclinical diagnostic procedures for
and There are several
breast cancer
Generalities in issues to discuss in the
Issues
Medical selection of
• Using the fad, the popular one without paraclinical diagnostic
Management
comparative analysis (benefit, risk, cost and procedures to be done
of Breast
availability) of other options (usually with no for suspected cancer.
Cancer
considerations for cost-effectiveness and
patient preference)
There are a lot of
• Shotgun approach ordering every possible test
confusion, not to say
just to catch a diagnosis
errors, happening.
• Ordering tests not needed for diagnosis of
cancer NOT recommended
Fundamentals Paraclinical diagnostic procedures for
and There are several
breast cancer
Generalities in issues to discuss in the
Medical Other issues selection of
Management • Primary and secondary indications paraclinical diagnostic
of Breast • procedures to be done
Direct vs indirect investigations of the
Cancer for suspected cancer.
suspected cancer

There are a lot of

confusion, not to say
errors, happening.
Fundamentals Paraclinical diagnostic procedures for Primary indications
and breast cancer refer to the direct
Generalities in information needed
Medical Primary indications for a paraclinical diagnostic
on the tumor or alert
procedure for cancer:
Management symptom itself where
of Breast - Not quite certain of the clinical diagnosis of cancer is being
Cancer cancer (at the moment, just a suspect or suspected.
probable)
- Need to be very very certain in the diagnosis of
PRIMARY
cancer because an extensive complex
PARACLINICAL
treatment procedure is being planned
DIAGNOSTIC
FIRST priority – must be accomplished first! PROCEDURES
Fundamentals Paraclinical diagnostic procedures for Secondary indications
and breast cancer refer to the other
Generalities in information needed in
Medical Secondary indications for a paraclinical diagnostic
the planning of
procedure for cancer:
Management treatment if there is
of Breast - Need to know before treatment cancer.
Cancer - the extent of the cancer
- other info, such as the specific cancer type SECONDARY
and prognostic exams PARACLINICAL
SECOND priority – if needed to be done, DIAGNOSTIC
should be after the primary indications. PROCEDURES
Fundamentals Paraclinical diagnostic procedures for Both approaches can
and breast cancer be done as dictated by
Generalities in the situation.
Medical Direct vs indirect investigations of the suspected
cancer
Management
- Direct means done on the suspected primary However, as much as
of Breast
cancer lesion itself such as biopsy of the lesion. possible do the direct
Cancer
approach first.
- Indirect means done outside the suspected
primary cancer lesion such that if positive for Do the second
cancer will infer cancer on the primary lesion. approach only if the
direct approach is not
feasible or difficult.
Fundamentals Paraclinical diagnostic procedures for Examples of
and breast cancer physicians’ ordering
Generalities in for paraclinical
Medical Breast cancer suspect with a palpable mass
diagnostic procedures
Management Shotgun approach Targeted and sequential
of Breast • Ultrasound breast with prioritization
Cancer • Mammography approach
• CT Scan • Breast mass
• Tumor Markers examination (eg biopsy
• Bone Scan +/- ultrasound
• Ultrasound if indicated Recommended
abdomen • Extent of cancer tests
• PET scan
Fundamentals Paraclinical diagnostic procedures for Example of BRCA
and breast cancer comparative analysis
Generalities in of paraclinical
Medical diagnostic procedures
Procedures Benefit (goal – Risk Cost Availability
Management to be more in a patient with a
of Breast definite on the dominant breast mass
diagnosis)
Cancer
Biopsy Direct info (4+ Pain  PPP   √
diagnostic
yield)
Ultrasound Indirect (2+) No pain  P   √
Mammogra Indirect (1+) Pain +  PP  
phy Radiation √ CT-scan is usually not
CT scan Indirect (3+) No pain + PPPP
Radiation √ the first or initial test.
Fundamentals Paraclinical diagnostic procedures for Algorithm for
and breast cancer laboratory diagnostic
Generalities in procedures:
Medical (ROJoson Way - based
Management on ROJoson's personal
experiences)
of Breast
Cancer General Indications: 
1) Need to be more definite after an uncertain
clinical diagnosis derived from history and
physical examination (as a rule, if one is quite
certain of the clinical diagnosis - as high of 90%
degree of certainty, no need for laboratory
diagnostic procedure).
Fundamentals Paraclinical diagnostic procedures for Algorithm for
and breast cancer laboratory diagnostic
Generalities in procedures:
Medical (ROJoson Way - based
Management on ROJoson's personal
experiences)
of Breast
Cancer
General Indications: 
2) Need to be more certain - to increase degree of
certainty up to 98-99% on the clinical diagnosis - if
the definitive treatment will be extensive and
mutilating such as mastectomy, chemotherapy,
and radiotherapy.
Fundamentals Paraclinical diagnostic procedures for Algorithm for
and breast cancer laboratory diagnostic
Generalities in procedures:
Specific Indications: (ROJoson Way - based
Medical
• If there is an uncertainty whether a dominant on ROJoson's personal
Management mass is present or not, request for ultrasound.  experiences)
of Breast • If there is an uncertainty whether a dominant
Cancer mass is malignant or not, request for
ultrasound.
• Request for mammography only in patients 40
years old and older who came for a breast
check AND there is no palpable dominant mass
AND the patients are very anxious of possible
malignancy because positive family history.
Fundamentals Contents: Summary
and • Screening for breast cancer Take Away
Generalities in • Symptoms that will lead to suspected presence
Medical of breast cancer
Management • Clinical diagnosis of breast cancer
• Paraclinical diagnostic procedures for breast
PART 1
of Breast
Cancer cancer

• Treatment for breast cancer

• Surveillance of breast cancer PART 2
• Prognosis of breast cancer
• Palliative and hospice care for breast cancer
patients
Fundamentals Be always in touch with reliable medical Take Away in
and information on fundamentals and relation to
Generalities in generalities in medical management of
Medical Patient
breast cancer. Empowerment
Management
of Breast Knowledge is power; it gives power.
Cancer
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of breast cancer.
Cancer Course Empowerment
– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of Breast MANAGEMENT of
Cancer – Part 1 BREAST CANCER.