Nearly 50,000 women in Brazil are afflicted with breast cancer each year. The most effective way to tackle the disease is through early detection. For any woman, discovering a lump can be a terrifying experience and the high statistical probability of being diagnosed with breast cancer justifies such fears: it is the second most common type of cancer in the world and first among women. According to a study performed by the National Cancer Institute (NCI), the expected number of new cases of breast cancer in Brazil in 2011 was 49,240, with an estimated risk of 49 cases per 100,000 women.
The reality in numbers According to the NCI, the expected number of new cases is distributed differently across various geographical regions: in the South East - 71 cases per 100,000 women; in the South – 69 cases per 100,000; in the Midwest – 38 per 100,000, and in the Northeast – 27 per 100,000. The highest incidence is in the Southeast (the most developed region in Brazil) can be interpreted in two ways: on the one hand, the incidence may reflect the effects of urban life in women (stress, sedentary lifestyle, increased consumption of processed foods), on the other, the number of cases can also be a consequence of greater access to diagnostic care; more readily available in industrialized regions.
Getting the word out What can be encouraging in this context is the prognosis of treatment. In the United States over the last ten years, the mortality rate resulting from breast cancer has decreased. This can be attributed primarily to a better understanding of the disease, campaigns for early detection, and more effective diagnostic methods. The challenge in Brazil is certainly related to access to diagnostics and quality healthcare. Still, many women arrive in clinics for treatment already in advanced stages of the disease, greatly reducing the possibility of a cure. Here is where Siemens has played an important role in cooperation with the Brazilian health system.
New techniques Besides the traditional diagnostic methods like mammography and ultrasound, Brazilian radiologists and gynecologists have chosen, magnetic resonance imaging (MRI) scans to study findings in the breasts. One benefit of this method is the possibility of examining both breasts simultaneously in a single session with significantly reduced or no pain and discomfort, detecting whether the breast tissues show changes.
Another feature relevant to MRI in this context is that according to the Brazilian Society of Plastic Surgery, Brazil ranks second in the world for the number of silicone breast implants (either for post-mastectomy or for aesthetic reasons) women receive. José Michel Kalaf, MD, is one of the researchers focusing on this subject in Brazil. "Current protocols and MRI equipment provide high-field and high-contrast resolution and high temporal resolution. This is a technique complementary to the usual methods with high sensitivity for diagnosis of invasive ductal carcinoma. In conjunction with mammography, it provides reports relevant to the diagnosis of ductal carcinoma in situ,” explains Kalaf, director of the Radiology Clinic of Campinas, coordinator of the Breast Course of the São Paulo Radiology Society, and former board member of the São Paulo Radiology Society.
"The MRI technique is highly sensitive; detecting lesions that otherwise would not be identified by conventional methods. A very important application of MRI is associated with the location of nodes for biopsy or surgical procedures, assisting the surgeons in the removal of suspicious lesions and restricting the volume of breast tissue removed," adds Kalaf.
Utilizing the right tools In his clinical practice, Kalaf relies on Siemens equipment to perform the procedures – the MAGNETOM® Verio 3 Tesla MRI scanner. "At present, MRI with contrast has diagnostic significance of large capacity, particularly in the evaluation of implants or prostheses, the resolution of difficult cases of high complexity, the additional assessment of high risk patients with genetic mutations and prone to develop tumors malignant breast."
Another innovative technique for early diagnosis of breast cancer is already in use in Brazil – the VACORA® Biopsy System enables breast biopsy (vacuum biopsy) to be performed under MRI guidance. The clinic Serdil Radiology, located in Porto Alegre, Rio Grande do Sul, was the first in southern Brazil to diagnose a case of occult breast cancer with no palpable lesions using a MAGNETOM® Avanto 1.5 Tesla MRI system in a study. Using this system, it was discovered that lesions that are unable to be imaged using mammography or ultrasound, could be detected and allows for a biopsy of the nodules found. "This is the best alternative to get larger than a core biopsy, for example. This procedure aims to complete a preoperative diagnosis of breast cancer, avoiding unnecessary open surgeries," explains Rogério Dias Duarte, MD, and responsible for this study. "In addition to magnetic resonance equipment, there is a need for advanced computing programs, and most importantly, well trained radiologists, so that the method is efficient in the diagnosis of breast cancer," concludes Kalaf.
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