Breast Screening

Question 1

What is screening in medicine?

Answer 1

Detection of pre-symptomatic disease in apparently healthy individuals.

Question 2

What risk is associated with all health treatments and investigations?

Answer 2

They may cause adverse side effects or fail to achieve benefit.

Question 3

What does “risk aversion” mean in healthcare decision making?

Answer 3

Preference for a certain but smaller benefit rather than an uncertain but larger expected benefit.

Question 4

What are examples of screening tests people commonly receive?

Answer 4

• Obstetric ultrasound
• heel prick tests
• developmental assessments
• dental checks
• Mantoux test
• hepatitis B screening.

Question 5

What ethical conflict exists in public health screening programmes?

Answer 5

Patient-centred care versus best use of limited resources.

Question 6

What is another conflict in screening policy?

Answer 6

Best possible care versus best affordable care.

Question 7

What population trade-off may occur in screening?

Answer 7

Small disadvantages for many individuals versus large benefits for a few.

Question 8

What is the main benefit of breast screening?

Answer 8

Reduced mortality from breast cancer.

Question 9

How can screening affect surgical treatment?

Answer 9

It increases the chance of breast-conserving surgery.

Question 10

How does screening influence chemotherapy use?

Answer 10

Early detection reduces the need for chemotherapy.

Question 11

What psychological benefit can screening provide?

Answer 11

Reassurance.

Question 12

What psychological effect may occur from screening?

Answer 12

Increased anxiety.

Question 13

What practical inconveniences may screening cause?

Answer 13

Time off work and travel costs.

Question 14

What unnecessary procedures may occur due to screening?

Answer 14

False positives leading to additional investigations and biopsies.

Question 15

What is false reassurance in screening?

Answer 15

A negative screening result despite the presence of disease.

Question 16

What report led to the development of the UK breast screening programme?

Answer 16

The Forrest Report (1986).

Question 17

What did the Forrest Report conclude?

Answer 17

Mammography can detect small cancers and improve survival.

Question 18

What attendance rate is targeted in the breast screening programme?

Answer 18

Around 70% of invited women.

Question 19

What mortality reduction was targeted by breast screening?

Answer 19

Around 25%.

Question 20

How many screening centres were initially established in the UK?

Answer 20

104 centres.

Question 21

What age group was first invited for screening?

Answer 21

Women aged 50–64 years.

Question 22

What imaging was used initially in breast screening?

Answer 22

Single-view mammography (mediolateral oblique).

Question 23

What age range is currently invited for breast screening?

Answer 23

Women aged approximately 50–70 years (47–73 trial range).

Question 24

How many views are taken in modern mammography screening?

Answer 24

Two views – craniocaudal and mediolateral oblique.

Question 25

What improvement has occurred with modern screening?

Answer 25

Increased cancer detection rates.

Question 26

What is the breast cancer risk at age 40?

Answer 26

About 1 in 200.

Question 27

What is the breast cancer risk at age 50?

Answer 27

About 1 in 50.

Question 28

What is the lifetime risk of breast cancer?

Answer 28

About 1 in 12 women.

Question 29

What percentage of screening mammograms are normal?

Answer 29

About 95%.

Question 30

What percentage of women are recalled after screening?

Answer 30

About 5%.

Question 31

What tests are performed in assessment clinics after abnormal screening?

Answer 31

- Clinical examination - ultrasound - biopsy.

Question 32

What happens if screening biopsy confirms cancer?

Answer 32

The patient is referred to a surgeon and follows the symptomatic cancer pathway.

Question 33

What is the aim of reconstructive and oncoplastic breast surgery?

Answer 33

To achieve effective cancer treatment with good cosmetic outcomes.

Question 34

What is immediate breast reconstruction?

Answer 34

Reconstruction performed at the time of mastectomy.

Question 35

What are advantages of immediate reconstruction?

Answer 35

Better cosmetic results, lower cost, and psychological benefits.

Question 36

What is delayed breast reconstruction?

Answer 36

Reconstruction performed after cancer treatment is completed.

Question 37

What implant-based reconstruction techniques exist?

Answer 37

Tissue expanders and silicone implants.

Question 38

What flap is commonly used for breast reconstruction from the back?

Answer 38

Latissimus dorsi flap.

Question 39

What abdominal flap procedures are used for breast reconstruction?

Answer 39

TRAM and DIEP flaps.

Question 40

What is a two-stage implant reconstruction?

Answer 40

Tissue expander followed by permanent implant.

Question 41

What is the advantage of implant reconstruction?

Answer 41

No donor site morbidity.

Question 42

What tissue is used in latissimus dorsi flap reconstruction?

Answer 42

Latissimus dorsi muscle with skin and fat.

Question 43

Can latissimus dorsi flaps be combined with implants?

Answer 43

Yes.

Question 44

What tissue is used in TRAM and DIEP flap reconstruction?

Answer 44

Abdominal tissue.

Question 45

What advantage does abdominal flap reconstruction provide?

Answer 45

Creation of a larger breast and “tummy tuck” effect.

Question 46

What is lipomodeling?

Answer 46

Transfer of fat harvested by liposuction into the breast for reconstruction or contour correction.

Question 47

What is the purpose of oncoplastic surgery in breast conservation?

Answer 47

To avoid cosmetic deformity after tumour removal.

Question 48

What percentage of lumpectomy patients may require cosmetic correction?

Answer 48

Up to 30%.

Question 49

What are the two main approaches in oncoplastic breast surgery?

Answer 49

Volume replacement and volume displacement.

Question 50

What is volume replacement in oncoplastic surgery?

Answer 50

Using flaps to replace removed breast tissue.

Question 51

What is volume displacement?

Answer 51

Reshaping the breast using reduction or mastopexy techniques.

Question 52

What tumour characteristic favours breast-conserving surgery?

Answer 52

Small tumour relative to breast size.

Question 53

Why are tumours in the inner breast more difficult to treat with conservation surgery?

Answer 53

Higher risk of cosmetic defects.

Question 54

What is the main goal of breast screening programmes?

Answer 54

Early detection of breast cancer to reduce mortality.

Question 55

What is the main aim of oncoplastic breast surgery?

Answer 55

Achieving effective cancer treatment with optimal cosmetic results.