Dilemma of false negative mammograms in breast cancer patients

Breast cancer is the most common cancer in women and the second cause of mortality after lung cancer. Mammography is an effective tool in detecting both clinically occult and palpable breast cancers. However, a good number of breast carcinomas may not appear on the mammogram. The false negative rate for conventional mammography worldwide is 10% - 30%1. There are very few studies addressing the results of mammography in Bahrain. To estimate the incidence of false negative mammograms and the possible causes of false negative results in our group of breast cancer patients. Salmaniya Medical Complex [SMC]. Retrospective study. One hundred forty-six mammograms for breast cancer patients were reviewed from January 2000 to May 2011. The mammograms were divided into three groups according to the mammographic report, into malignant, suspicious and benign. Both malignant and suspicious [BIRADS 4, 5, and 6] reports were considered positive mammograms and were excluded from the study. The eleven mammograms, which were reported as benign [BIRADS 1, 2, and 3] and considered negative, were included in the study. The false negative mammograms were 11 [7.5%]. The incidence of false negative mammograms in this study is lower than international figures. False negative mammograms are more common in small sized tumors, located in upper outer quadrant, big breasts, single or un-experienced mammography reader and mostly in conventional than digital mammography

Early breast cancer detection is higher compared to advanced cancer

Breast cancer is the most common cancer in women. It has become possible to diagnose breast cancer early due to effective screening and patient education which became a worldwide practice. National breast cancer screening program in Bahrain was implemented in 2005. To determine the incidence of early, locally advanced and systemically advanced breast cancer patients. Department of Surgery, Salmaniya Medical Complex, Bahrain. Retrospective study. One hundred and sixty-one patients seen between January 2000 and August 2011 were included in the study. One hundred fifteen [71.4%] patients had early breast cancer. Twenty-six [16.2%] patients had locally advanced cancer and twenty [12.4%] had systemically advanced breast cancer. Patients were divided into two groups: group A, [below 50 years] were 87 [54%] and group B [50 years and above] were 74 [46%] patients. Early stage was diagnosed in 68 [78.2%] patients less than 50 years and 47 [63.5%] patients in 50 years or older. There was no significant relation between the stage and the duration of symptoms, marital status, presence or absence of child birth or family history of breast cancer. The incidence of early breast cancer detection in Bahrain is higher than advanced stage. These results might have been secondary to the implementation of the National Breast Cancer Screening Program, as well as the growing health awareness of the general population in regular breast self-examination and early presentation to specialized breast surgeons

Malignant phyllodes tumor of the breast metastasizing to the peritoneal cavity

A fifty-three year old Bahraini female presented with painless rapidly growing mass in the right breast of 3 months duration; no nipple discharge was found. Family history was positive for breast carcinoma in situ in her sister. Lumpectomy was performed. Histopathology proved to be phyllodes tumor; therefore, mastectomy was performed to avoid local recurrence. The patient received local radiation to the mastectomy scar. Four months after the initial surgery, she developed a nodule in the mastectomy scar, left breast lump in the upper outer quadrant and intra-abdominal mass. A fine needle aspiration of the mass in the left breast showed spindle cells with focal atypia and a necrotic background. True-cut biopsy of the intra-abdominal mass showed the metastatic stromal component of the malignant phyllodes tumor with malignant spindle cells. The patient condition worsened, developed bilateral pleural effusions. Adriamycin chemotherapy was planned, but the disease was aggressive enough to end her life within weeks

Giant paraovarian cyst in a young female

A thirty-two year old woman presented with painless, gradually increasing, abdominal distension of eight months duration. Ultrasound and CT scan of the abdomen and pelvis were suggestive of an ovarian cyst. At laparoscopy a huge right broad ligament [paraovarian] cyst was found and cystectomy was performed

Small bowel perforation secondary to fish bone ingestion

Two cases of small bowel perforation due to fish bone injury were seen in the last 10 years in the department of surgery, the first was in 2004 and a further one in 2010. The first case was a sixty-two year old Bahraini male who presented to the Emergency Department with acute lower abdominal pain of four hours duration. Abdominal examination revealed, generalized tenderness and distension. There was no guarding or rebound tenderness. Bowel sounds were audible. Abdominal CT scan was not helpful in diagnosis. Conservative treatment failed and the patient needed surgical intervention. The second case was a seventy-five year old Bahraini male, known to have diabetes, hypertension and senile hypertrophy of the prostate. The patient was admitted with acute generalized abdominal pain of one day duration. Abdominal examination showed generalized abdominal tenderness and guarding with absent bowel sounds. CT scan of the abdomen showed free gas under the diaphragm and free fluid but did not show the site of perforation. Both cases needed urgent laparotomy, identification of the bowel perforation, removal of the fish bone, and simple closure of the perforation. The aim of this report is to increase the awareness of fish bone as a possible cause of small bowel perforation particularly in Bahrain, and to advise early surgical intervention and simple closure of the perforation after foreign body removal

Breast cancer risk factors and stage at presentation

Breast cancer is the most common cancer in females all over the world. In American females, it is accounting for 32% of all cancers. It is well-known that there are major risk factors for cancer of the breast, such as, advanced age, positive family history and history of cancer in the same or other breast. Minor factors have been associated with breast cancer, such as, mammogram abnormalities, biopsy confirmed a typical hyperplasia, early menarche and late menopause etc' etc. Not enough studies have concentrated on reviewing the risk factors in Bahrain; therefore, we have embarked on this study 1,2. To review and assess the staging and risk factors of breast cancer. Surgery Department, Salmaniya Medical Complex. Retrospective/Prospective study. It is a retrospective/prospective clinical review involving 52 breast cancer patients operated upon by the senior author over five years period [1999-2005]. Presentation, diagnostic approach, and management were evaluated. Age at presentation, age of menarche and menopause were recorded. The risk factors, such as age at first delivery if any, lactation, hormonal therapy and if there were any past history or family history of breast or other related cancers. The stage of the disease at presentation was reviewed. Mortality and morbidity were recorded. All patients were females. Age at diagnosis was below 30 years in 2 patients [3.8%], between 30-39 years in 12 patients [23.1%], between 40-49 years in 21 patients [40.4%], 50 years or more in 17 patients [32.7%]. The mean age at menarche was 12 years of age. Sixteen patients [30.8%] were at menopause. The mean age at menopause was 48 years. Thirty-seven patients had child birth [71.2%], unmarried or nuliparous were 10 patients [19.2%]. Age at first delivery was ranging between 16 and 40 years of age. Number before percentage 59.6% of the patients breast fed their infants. Only 11 patients [22%] were using oral contraceptive pills [OCP]. One patient was on hormonal replacement therapy. Family history of breast cancer was positive in 18 patients [34.6%]. Two patients had history of breast cancer of the other breast. Thirty-seven patients [71.2%] had early breast cancer [T1, T2, N0, N1, M0] and 15 patients [28.8%] had advanced breast cancer [T3, T4, N1, N2, M0 -1]. There was no local recurrence, and three mortalities to date. More than half of our patients [67.3%] were below 50 years at presentation whereas internationally it is prevalent above fifty years [85%]. There was a significant high incidence of positive family history [35.3%] in comparison to international studies [5-15%]. In this study, breast cancer was still diagnosed late. In this study, locally-advanced breast cancer was 28.8%, which may improve as breast screening program is being implemented