1.
October
Breast Cancer Consciousness Month
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

2.
ROJoson Breast Wellness Clinic
In support of October Breast Cancer Consciousness Month
Advisories
Breast as a Disease
Breast Cancer Risk Assessment
Physical Examination of the Breast
Advices on Breast Self-Examination
Advices on Breast Wellness Promotion
Advices on Need for Other Breast Cancer Screening Tests
Manila Doctors Hospital
DSMT Room 301

3.
October
Breast Cancer Consciousness Month
Let’s be aware and beware of breast cancer!
Let’s promote and maintain breast wellness!

4.
Beware and Be Aware
of
BREAST CANCERS

5.
Cause
UNKNOWN!
NO EFFECTIVE WAY OF
PREVENTION!

6.
Presentation
and
Progression

7.
Mammographic
findings
but
without palpable
breast mass

8.
Breast Mass
Different Sizes on Detection
The Smaller The Better

9.
Presentation and Progression

10.
Late Stages

11.
Late Stages

12.
Spread

13.
Spread

14.
Spread
Spread to Lungs Spread to Bone

15.
Spread
Spread to Liver Spread to Brain

16.
Best Chance Against Breast Cancer
EARLY
• DETECTION
• DIAGNOSIS
• TREATMENT
OF BREAST LUMP

17.
EARLY DETECTION
Strategies
BREAST CANCER AWARENESS!
BREAST SELF-EXAMINATION!
BREAST SPECIALIST EVALUATION!

18.
Promoting Breast Wellness
Among Filipino Women
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

19.
ROJ Promoting Breast Wellness Among Filipino Women
Concept of Breast Wellness
A state wherein there is NO breast issue
(in the domain of symptoms, diseases, and fear and anxiety even in the
absence of disease)
that affects the physical, mental and social well-being and / or
the socioeconomic productivity of a person.

20.
ROJ Promoting Breast Wellness Among Filipino Women
Concept of Breast Wellness
NOT merely absence of breast abnormality or
disease!
Patients with breast cancer can still be in a state of
breast wellness.
One can be physically ill and yet can feel healthy.

21.
ROJ Promoting Breast Wellness Among Filipino Women
Factors Affecting Breast Wellness
• Breast cancerophobia
• Inadequate knowledge
• Myths (unfounded popular beliefs)
• Wrongful interpretation and understanding
- read, heard, saw
- reports from diagnostic tests

22.
ROJ Promoting Breast Wellness Among Filipino Women
Risks and Causes of Breast Cancer
• All Filipino females are at risk of developing breast
cancer.
• Breast cancers are commonly seen in the older
female population.

23.
ROJ Promoting Breast Wellness Among Filipino Women
Risks and Causes of Breast Cancer
• The exact cause of breast cancer is not known.
• There is no definite way of preventing breast
cancer.
• There is no foolproof (with 100% accuracy) way of
predicting who will and who will not develop
breast cancer.

24.
ROJ Promoting Breast Wellness Among Filipino Women
Myths on Breast Conditions and Diseases
• A trauma or a bump on the breasts can lead to
breast cancer.
• A person with a family history of breast cancer
will surely develop a breast cancer in the future.
• Breast cancer is a death sentence.

25.
ROJ Promoting Breast Wellness Among Filipino Women
Myths on Breast Conditions and Diseases
• ALL diagnostic tests, such as mammography and
ultrasound, and including the physical
examination of the breast specialist, are
100% accurate 100% of the time.

26.
ROJ Promoting Breast Wellness Among Filipino Women
Recommended Strategies on Promoting Breast Wellness
and Against Breast Cancer
• Possessing adequate knowledge of breast
conditions and diseases
• Performing regular breast self-examination
• Seeking regular check-ups and advices from a
breast specialist

27.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Self-examination
A quality breast self-examination is one that is done
completely,
accurately,
regularly,
effectively
can detect breast cancer in its early stage.

28.
ROJ Promoting Breast Wellness Among Filipino Women
Palpation of the Breast
The primary objective of palpation of the breasts,
either by the female person herself or by a breast
specialist,
is to look for the so-called “dominant” mass,
which if present, is to be considered a red flag,
i.e., one that needs further evaluation.

29.
Lumpy Breast vs Dominant Breast Mass
On Palpation
Lumpy breast
surface
Fibrocystic changes
Normal Breast
Dominant mass
Stood-out, different
from surrounding
tissues
“Red flag”

30.
Fibroadenoma Fibrocystic Changes
Lumpy breast – no dominant mass

31.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A fibrocystic breast condition or changes
is due to hormonal changes and therefore,
not considered a disease.

32.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
Breast pain without an accompanying “dominant”
mass is usually not due to breast cancer.

33.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A painless “dominant” mass, particularly in female
persons 30 years and older,
should not be taken lightly
as this has a higher risk of being cancerous than a
painful “dominant” mass.

34.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
Presence of redness on the surface of the breast,
particularly with accompanying moderate to severe
pain,
is usually due to an inflammatory condition or
infection of the breast.

35.
Mastitis

36.
Breast Abscess
Inflammatory
breast cancer

37.
ROJ Promoting Breast Wellness Among Filipino Women
Recognizing Breast Conditions and Diseases
A discharge from the nipple that is not red or
reddish in color and that is not accompanied by a
“dominant” breast mass
is usually not due to breast cancer.

38.
Nipple discharge due to nonspecific cause
or fibrocystic changes

39.
Signs of Malignancy
Carcinoma en cuirasse
Inflammatory carcinoma
Peau d’ orange

40.
Signs of Malignancy
Spread to Lungs Spread to Bone

41.
Signs of Malignancy
Spread to Liver Spread to Brain

42.
ROJ Promoting Breast Wellness Among Filipino Women
Diagnostic Tests
• Not all patients will need a diagnostic test after an interview
and a physical examination by a breast specialist.
• All diagnostic tests that can be done on the breasts, such
as mammography and ultrasound, have pros (benefits and
advantages) and cons (risks and disadvantages) and
therefore, must be used judiciously.

43.
Needle Aspiration+/- Biopsy

44.
Ultrasound of the Breast

45.
Mammography

46.
ROJ Promoting Breast Wellness Among Filipino Women
Diagnostic Tests
Mammography is usually not done in female patients
30 years or younger
as the breast tissues are too dense to give reliable
information and results.

47.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
• A breast specialist who has done physical
examination of the breasts of a female person and
who has made a need assessment is in the best
position to determine whether a diagnostic test
should be done or not and, if needed, what should
be done.

48.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
BRCA – informed consent - partnership
If a diagnostic test is needed, the choice will be
derived at after considering the
benefit (advantages); risk (disadvantages); cost; and
availability
by both the breast specialist and the patient.

49.
Problem-solving and Decision-making Process
Options Benefit Risk Cost Availability
1 ++++ ++ +++++ NA
2 ++ + ++ RA
3 +++ ++ +++ RA

50.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
BRCA – informed consent – partnership
In deciding on treatment, the choice will be derived
at after considering the
benefit (advantages); risk (disadvantages); cost; and
availability of procedure
by both the breast specialist and the patient.

51.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
BRCA – informed consent - partnership
After treatment for a breast cancer,
the choice of surveillance (follow-up) regimen and
schedule will be derived at after considering the
benefit (advantages); risk (disadvantages); cost; and
availability of procedures
by both the breast specialist and the patient.

52.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Breast Specialist
BRCA – informed consent - partnership
Breast cancer surveillance (after primary treatment)
Recommendations:
The use of complete blood counts, chemistry panels, bone scans, chest
radiographs, liver ultrasounds, pelvic ultrasounds, computed
tomography scans, [18F]fluorodeoxyglucose–positron emission
tomography scans, magnetic resonance imaging, and/or tumor
markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is NOT
recommended for routine follow-up in an otherwise asymptomatic
patient with no specific findings on clinical examination.
American Society of Clinical Oncology - 2012

53.
Problem-solving and Decision-making Process
Options Benefit Risk Cost Availability
1 ++++ ++ +++++ NA
2 ++ + ++ RA
3 +++ ++ +++ RA

54.
ROJ Promoting Breast Wellness Among Filipino Women
Importance of Check-ups
It is important that there be regular follow-ups and
check-ups with a breast specialist to
• catch breast diseases not evident at the time of
previous examination;
• recheck initial findings;
• review initial evaluation; and
• reinforce education and coaching to promote
breast wellness.

55.
ROJ Promoting Breast Wellness Among Filipino Women
Recurrence
• With the exact cause of breast cancer not being
known and with treatment directed only against
the cancer, there is always a potential for
recurrence after treatment.
• After treatment for a breast cancer, recurrence can
occur in any part of the body but the more
common locations are in the bones and lungs.

56.
ROJ Promoting Breast Wellness Among Filipino Women
Attitude and Practice
• At present, the most practical thing to do in the
fight against breast cancer is to detect it early
enough and to have it treated as soon as possible.
• With early detection and treatment, there will be
reduction in the magnitude of complications and
premature deaths that are usually associated with
advanced breast diseases.

57.
ROJ Promoting Breast Wellness Among Filipino Women
Attitude and Practice
After doing my best to detect breast cancer early
enough,
I need to adopt the stance (attitude) of
“hoping for the best at the same time ready to
accept the worst”
in order to promote my personal well-being and
productivity as a citizen in the community.

58.
Breast Cancer
Risk Assessment

59.
ROJoson’s Breast Cancer Risk Assessment
Strong Risk Factors Points
Age
25 and younger 1
26 - 39 2
40 - 49 3
50 -70 4
More than 70 3
Family History of Breast Cancer
Negative 1
Positive in 2nd degree relatives (any no.) 2
Positive in one 1st degree relative 3
Positive in more than one 1st degree relatives 4

60.
ROJoson’s Breast Cancer Risk Assessment
Score Level of Risk for Breast Cancer
2 - 4 Low
5 - 6 Intermediate
7 - 8 High

61.
ROJoson’s Breast Cancer Risk Assessment
Family History
Age
25 and
younger
26 - 39 40 - 49 50 -70 More
than 70
Negative 2 3 4 5 4
Positive in 2nd
degree relatives
(any no.)
3 4 5 6 5
Positive in one 1st
degree relative
4 5 6 7 6
Positive in more
than one 1st degree
relatives
5 6 7 8 7

62.
ROJoson’s Breast Cancer Screening Recommendations Based on
Risk Assessment, Age, and Family History
Score Level of Risk Breast Self-
exam
Breast
Specialist
Clinical Breast
Exam
Mammography
2 - 4 Low √ (monthly) √ (at least once
a year)
Χ
5 - 6 Intermediate √ (monthly) √ (at least 2x /
year)
√ Once every 2
years but only
at age 40 up
7 - 8 High √ (monthly) √ (at least 3x
/year)
√ Once a year
but only at age
40 up
*Note: At age 40-49, with negative family history for breast cancer, mammography
is NOT recommended.

63.
ROJ Promoting Breast Wellness Among Filipino Women
Recommended Strategies on Promoting Breast Wellness
and Against Breast Cancer
• Possessing adequate knowledge of breast
conditions and diseases
• Performing regular breast self-examination
• Seeking regular check-ups and advices from a
breast specialist

64.
ROJ Promoting Breast Wellness Among Filipino Women
Video on How to Do
Breast Self-Examination
Reynaldo O. Joson, MD

65.
ROJoson Medical Clinic
Manila Doctors Hospital
DSMT (Doctors’ Clinics) Room 301
Tel. No. 522-47-13
Tel. No. 558-08-88 Loc. 4100
Cell No.: 09188040304
Email: rjoson2001@yahoo.com
rojosonmedclinic@gmail.com
Website:
https://sites.google.com/site/rojbreastwellnessclinic
Facebook Pages:
https://www.facebook.com/rjoson2001
http://www.facebook.com/ROJosonMedicalClinic
http://www.facebook.com/ROJosonBreastWellnessClinic

66.
Promoting Breast Wellness
Among Filipino Women
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
2016