• Symptoms to look for
• Symptoms to feel for
• How to be breast aware
• Breast awareness 5 point code
• What is the Cobalt Appeal Fund doing?
• Factsheet information
• Risk factors
• How is breast cancer diagnosed
• Picture of a normal breast and breast cancers
• Sentinel node biopsy research
• Donated mobile digital mammography unit

• How is the Cobalt Appeal Fund continuing to support our local breast services?
• Donated mobile digital mammography unit
• MR Imaging of the Breast
• MR Imaging with a High Field Open Scanner
• Image-guided Breast Biopsy
• Cobalt Breast Clinic

• Puckering or dimpling
• Change in the size of either breast
• Changes in the position of the nipple

• Bleeding or discharging from the nipple
• Rashes on or around nipple

• Any lump or thickening in the breast or armpit
• Enlarged glands in the armpit

• Swelling in upper arms
• Changes in sensation, pain or discomfort that is persistent

How to be breast aware

Get to know how your breasts look and feel at different times of the month. Look at your breasts for changes listed above- looking is as important as feeling your breasts.

Checking your breasts should be a natural part of being aware of your whole body and not a routine you perform once a month. By checking randomly you will soon get to know how your breasts feel during normal monthly hormonal changes. Some women have lumpier breasts around the time of a period. If this is the same on both sides, don't worry. If the lumpiness comes and goes with your menstrual cycle, it is nothing to worry about.

Feel all parts of the breast gently but firmly, not squeezing or prodding.

Feel behind the nipple and then up into the armpit, paying particular attention to the upper outer quarter of the breast.

You are looking for a change, something new that was not there the last time you checked.

If you detect a change go and get it checked by your GP. You are not making a fuss and your GP will not feel you are wasting his/her time they know that early detection is vital. Most breast changes are not cancerous but simple cysts or benign lumps. The only way to be certain is to see your doctor promptly. The UK has amongst the highest mortality rate for breast cancer in the world which may be partly due to women delaying reporting changes to their GP. Breast cancer can be successfully treated when detected early.

There is a five point code to help us become breast aware.

1. Know what’s normal for you
2. Look at and feel your breasts
3. Know what changes to look and feel for
4. Report any changes without delay
5. Attend breast screening from the age of 50

What is the Cobalt Appeal Fund doing to help women detect breast cancer early?

The cancer prevention team hold free workshops and talks in the workplace and social clubs to help women become breast aware and recognise what changes to look and feel for as most breast changes are found by women themselves or their partners.

The leaflets below will help you to become breast aware, know what breast changes need to be reported to your doctor and encourage you to go for breast screening when you are invited. When breast cancer is found early there is an excellent chance the treatment will be successful.

• Being over 40 (biggest risk factor is increased age)
• Having a cancer in the other breast
• Family history of the disease (mother, sister, grandmother, aunt who has had breast cancer particularly if they were younger than 50)
• Starting periods early
• Stopping periods late
• Not having children or delaying them until your thirties or forties
• Taking HRT
• Drinking alcohol - limit the amount of alcohol to no more than 1 unit per day

• Mammogram

• Ultrasound scan

• Biopsy or aspiration

Complete breast

Cutaway of breast

Cancer Examples

Ductal carcinoma
(non-invasive / early breast cancer)

Close up of Ductal carcinoma
(non-invasive / early breast cancer)

Invasive carcinoma

Sentinel Node Biopsy - A New Advanced Procedure in Breast Cancer

Sentinel node biopsy is a new technique which can be used in some patients undergoing surgery for breast cancer. Lymph nodes located in the axilla (armpit) on the side of a breast cancer are one of the first places that cancer may spread to. The “sentinel” node is the first in a chain of lymph nodes that drains the breast. A sentinel lymph node biopsy involves the removal of one to three lymph nodes, for assessment by a pathologist. If these sentinel nodes do not contain cancer cells, it may be possible to avoid more extensive surgery.

The sentinel node can be identified using blue dye or a small dose of a low-level radioactive tracer which can be looked for in the nodes. Research has shown that it is best to use both techniques together. Both the blue dye and the radioactive tracer solution, which contains less radiation than a standard x-ray and emits gamma rays, are injected around the nipple area before the operation.

Once the tracer and dye have reached the nodes, the surgeon scans over the axilla to locate the sentinel nodes with an electric, hand-held gamma ray counter (called a Geiger counter). Once the sentinel node is located by measuring where the radioactivity is the strongest, the surgeon can, through a small incision, look for nodes containing blue dye and remove them for a pathologist to examine and analyse under a microscope.

Several clinical trials have shown that in most cases, if the sentinel node does not contain cancer cells, then the cancer has not spread past the breast. Surgery removing lymph nodes in the axilla may then not be necessary. This can prevent some of the complications of more extensive surgery such as lymphoedema (swelling), cellulites (infection), altered sensation and restricted movement in the arm.

The ultimate goal of sentinel node biopsy is to remove as few lymph nodes as possible in patients with breast cancer suitable for this procedure in order to reduce the complications than can occur when lymph nodes in the axilla are removed.

Consultant Radiologist Professor Iain Lyburn

Donated mobile digital mammography unit

State-of-the-art mobile equipment costing £325,000 to aid the diagnosis of breast cancer has been donated to the Gloucestershire Hospitals NHS Foundation Trust by the Cobalt Appeal Fund thanks to local people and their continued support.The sentinel node can be identified using blue dye or a small dose of a low-level radioactive tracer which can be looked for in the nodes. Research has shown that it is best to use both techniques together. Both the blue dye and the radioactive tracer solution, which contains less radiation than a standard x-ray and emits gamma rays, are injected around the nipple area before the operation.

The Unit has a newly developed digital imaging system giving instant superb quality pictures which will help speed up the service and cut waiting times, it will be used both by the County's NHS Screening and Symptomatic Services.

Consultant Radiologist Prof Iain Lyburn said: “The Gloucestershire Breast Screening Service will be one of the first in the country to be able to offer mobile digital mammography.”

“We are very grateful to the Cobalt Appeal Fund for providing us with the latest technology which will allow us to provide a quicker, more efficient service for our patients.”

MR Imaging of the Breast

MR imaging uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed internal pictures of the body. MR imaging does not use ionizing radiation (as used in x-rays). MR imaging cannot be performed on people with pacemakers and some other ferrous metallic implants.

Usually MR imaging of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool for detecting and staging breast cancer and other breast abnormalities.

MR imaging of the breast is performed to:

• assess multiple tumour locations, especially prior to breast conservation surgery.
• identify early breast cancer not detected through other means, especially in women with dense breast tissue and those at high risk from the disease, including those with a significant family history.
• assess the effect of chemotherapy.
• determine the integrity of breast implants.

MR Imaging with a High Field Open Scanner

Specialist Breast MRI has been performed at The Cobalt Unit since 2001 on 1.5T scanners (the T refers to ‘tesla’ which reflects the strength of the magnet in the machine). We have the UK’s first High Field open scanner. The gantry (casing) in these machines is not as enclosed as in the 1.5T scanners and thus patients who suffer from claustrophobia can be imaged on this piece of equipment. Configuration of the 1.0T open scanner also enables MR image-guided biopsies to be performed. Recently a new breast coil (specialist attachment) has been obtained for our open scanner which enables high resolution imaging of the breast.

Consultant Radiologist Professor Iain Lyburn

Image-guided Breast Biopsy

When clinical and imaging examination demonstrates a breast abnormality, an image-guided biopsy may be performed. A breast biopsy involves removing small pieces of tissue with a small needle under local anaesthesia from the suspicious area in the breast and examining it under a microscope to determine a diagnosis. Image guided biopsies can be performed with stereo tactic mammography, ultrasound or MR imaging. Very few centres have equipment which can perform MR image guided biopsies – shortly The Cheltenham Imaging Centre will be the first unit in the Region to have the facilities for this service.

Consultant Radiologist Professor Iain Lyburn

The new clinic is a joint venture between the Cobalt Appeal Fund and the Gloucestershire Hospitals NHS Foundations Trust.

It aims to be a centre of excellence for breast screening, diagnosis and care of breast cancer patients - bringing these services together under one roof at Thirlestaine Court, Cheltenham. Treatment for breast cancer has seen great improvements in recent years, with more patients living longer. Much of this success is due to earlier diagnosis and improved screening.

We want to give patients the best possible chance of surviving breast cancer. That's why we're joining forces with the Gloucestershire Hospitals NHS Foundations Trust to open the Cobalt Breast Clinic.

to find out how you can help. Each donation will make a difference to thousands of women.