Breast Care Clinic
Fast diagnosis
You have been referred to the Breast Care Clinic for breast examination. This leaflet gives information on what to expect at this out-patient clinic and on the tests that may be carried out.
Symptoms and complaints
You have a complaint concerning one or both breasts. This may be a lump or a swelling; however your complaints could also be secretions from the nipple, an inverted nipple, skin changes, pain or a combination of these symptoms.
It could be that you have no complaint, but that the National Screening Programme for breast cancer has shown up something that requires further investigation.
General
The tests will be carried out by the "Breast Care Team", specialised in examining breast abnormalities and the treatment thereof. The breast care team consists (initially) of a surgeon, a radiologist, a pathologist and two specialised nurses. The breast care nurse has become specialised through a special breast care training, which concentrates on the care and assistance of patients with breast cancer. The oncology nurse is specialised in the care and assistance of cancer patients in general. These nurses are available for questions and problems. The surgeon is in charge of the whole treatment.
For carrying out the various tests the surgeon, the breast care nurse, the radiologist and the pathologist work closely together. This usually makes it possible to give some certainty about the nature of complaint(s) within the one day. You should therefore realize that a visit to the Breast Care Clinic could take up half the day. Depending on the results, extra tests may then be carried out. We try to keep this period of uncertainty as short as possible.
The visit to the Breast Care Clinic
Where to go
On the day of the tests you should report to the General Surgery out-patient clinic (Heelkunde/Chirurgie) on the first floor (Second floor in U.S. English). You should give the staff the letter from the family doctor/G.P. and where relevant the letter from the National Screening Programme.
The tests
Anamnesis and physical examination
At the Breast Care Clinic where the tests take place, you will first have a talk with the breast care nurse and with a doctor from the surgical team.
Among other things they will ask you about the nature of your complaints and about your medical history. This is called the anamnesis.
| If you are on anticoagulant drugs, or could be pregnant possibly, it is important to tell staff this during your first visit to the Breast Care Clinic. |
During the physical examination your breasts, neck and armpits are examined for possible abnormalities. Afterwards, decisions are taken concerning which tests still need to be done to ascertain the nature of the abnormalities.
We try to plan the tests to follow on from each other as much as possible, but it may happen that you have to wait between procedures.
Some of the follow up described below may be necessary:
Mammography (X-ray of the breasts)
This procedure nearly always takes place, even if you have been referred following the National Screening Programme.
The digital mammography takes place in the Radiology department. You should go to the reception desk of that department on the ground floor. For this procedure you need to undress from the waist upwards in the private changing room provided.
During this procedure X-rays are used. These rays are neither visible nor tangible. The amount of X-reays used is so small, that you really do not need to worry about it.
For women under thirty and pregnant women an echo or utrasound is preferable. This is due to the fact that with these women, the gland tissue is so different that the mammography would not be enough for an adequate assessment. It is therefore most important that you tell us, if there is the slightest possibility that you are pregnant.
Usually the technician makes two X-rays of each breast: one in vertical and one in a horizontal position. To give as clear a picture as possible, the breast is pressed flat between two synthetic plates. This pressing of the breast can be painful. If the procedure is very painful, you can tell the technician. Squeezing the breast is not harmful, even if you have a lump.
Extra photos
Together with the technician, the radiologist checks the photos to see whether they are of sufficient technical quality, whether all the tissue is shown and if the photos allow good assessment. Sometimes it is necessary to make more photos.
If you have been referred following a visit to the National Screening Programme, a new mammography is always made. The photos from the National Screening serve as comparison material. A mammography from another hospital will be reassessed.
The mammography can take from 20 to 45 minutes.
Echo (ultrasound)
An echo or ultrasound of the breast is often made following the mammography. This procedure also takes place in the Radiology department.
This procedure makes use of sound waves to examine the breast tissue. The skin of the breast is rubbed with gel, after which the breast is scanned by the radiologist with a small instrument.
The examination method is similar to an echo during pregnancy. An echo does not make use of X-rays and the procedure is not intrusive or painful.
This procedure takes about 10 to 20 minutes.
Fine Needle Aspiration (FNA)
When an abnormality is seen on the mammography and/or the echo, it may be necessary to further investigate the nature of the abnormality. If the abnormality can not be felt, this procedure takes place in the Radiology department with the help of an echo (ultrasound).
If the abnormality can be felt, the pathologist does the FNA in the General Surgery out-patient clinic.
The doctor inserts a thin needle and draws a few cells off. An anaesthetic is not necessary and the procedure takes only about 10 minutes. The cell material is then microscopically examined in the lab by the pathologist for the possible presence of malignant cells. You will be given the results of the puncture by the surgeon.
Biopsy When the previous tests still provide insufficient information to make a firm diagnosis, a tissue biopsy may be necessary. This procedure takes place in the Radiology department.
A biopsy is performed under local anaesthetic, by the radiologist using a needle which is a bit thicker; a small sliver of tissue is removed from the breast. Once the anaesthetic has worn off, this procedure could cause some pain. If necessary you can take 1 to 2 tablets of Paracetamol 500 mg.
This procedure takes about 20 minutes. The results of this test are known within 5 to 7 days.
The results
Every Monday afternoon the results from the Breast Care Clinic are discussed within the Breast Care Team. You will be given an appointment for the following week with the surgeon, who will then discuss the results of the tests with you.
Opening times of the Breast Clinic
The Breast Clinic is available for your questions from 09.00 - 11.30 a.m. and from 14.00 - 15.30 and can be reached at: telephone number 070 - 312 43 59.
Breast Care Nurses: Mrs. P. Keunen.
Telephone number 070 - 312 47 41
Mrs. L. van der Wilden
Telephone number 070 - 312 43 32
Mrs. V. Skinner
Telephone number 070 - 310 58 31
Oncology Nurse, Ms M. Kroon
Monday, Tuesday and Thursday from 08.00 - 16.30 hours
Telephone number 070 - 312 42 16
Edition: September 2010/153