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Pindara Private Hospital Magazine - Issue Three

Reconstructive Breast Surgery Approximately 800 women under the age of 40 will be diagnosed with breast cancer this year. Due to the prevalence of larger, high-grade tumours and frequency of oestrogen receptor (ER) negative cancers, this group of women experiences a lower rate of disease-free survival. HEALTH & BEAUTY Despite the high rate of diagnosis, this group is also often dismissed as having a benign health problem without further examination. This isn’t enough according to leading Gold Coast Breast Surgeon Dr Daniel De Viana, who advises that any woman who experiences unexplained symptoms deserves an ultrasound of the breast. Ultrasound is the best procedure in determining the benign versus malignant status of a lump. Whilst mammography can be utilised, the denser tissue in this age group limits the sensitivity resulting in a higher false positivity rate in the interpretation of any change. Further examination and management depends on suspicion. Any unexplained symptom should be investigated with a short-term clinical review, followed by an MRI as the gold standard investigation if the patient harbours further concern. The MRI should be timed with the patient’s cycle, ideally coinciding with day 7-10 to reduce the background noise of hormone changes. Unfortunately there is no rebate for MRI of the breast, unless the patient’s family history (three relatives with breast cancer under the age of 50) indicates a strong likelihood. This procedure should be used selectively, as there is a high rate of false positivity particularly in the premenopausal breast, despite its sensitivity. Surgical options for women under 40 are the same as those available to other age groups. Many choose lumpectomy, as this combined with radiation provides the same survival rates as mastectomy. As larger tumours are more common this age group, however, lumpectomy is often not feasible at the initial presentation. There is a growing trend to offer these women neoadjuvant chemotherapy prior to surgery to try to shrink the tumours and allow breast conservation. This approach has proven to be safe with no significant difference in survival compared with surgery up front. In fact, complete pathological remission with no tumour seen in the excision specimen can be pindaramagazine.com.au Pindara Magazine 61


Pindara Private Hospital Magazine - Issue Three
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