Accurately and timely diagnosis from the very beginning is the most crucial factor in a patient’s treatment plan. A slow, incomplete, or imprecise diagnosis can end up costing valuable time, and ultimately complicate the treatment. This is why Dr. Kamoltham Pulpinyo, a breast interventional radiologist at Bumrungrad International Hospital, has turned fast and accurate diagnosis into something of a specialty for the sake of her patients.

 

More than just a referral

“When it comes to breast cancer, the patients can generally be divided into two groups. The first group come for checkups without any symptoms, otherwise known as screening test. The second group have come because they noticed something unusual, such as a lump or a pain in the breast area, or a strange secretion from the breast itself. For these patients, a diagnostic test will be performed,” Dr. Kamoltham explains. “First step for either group will be a clinical breast examination by a physician, and after that almost every patient is examined by ultrasound or mammogram, which is done by a radiologist.”
 

Each patient will be categorized according to their risk of breast cancer. “If their risk is low, we will proceed with clinical follow-up and schedule them an ultrasound or mammogram testing over a relatively short time span of, say, about six months. Patients with a medium to high risk will be advised to have a tissue sample taken from their breast (biopsy) for a pathology test to see whether the tissue is malignant.” In the latter case, the radiologist can take the sample right after the examination. The test results will be available within 48 hours. For a very small group of patients, further MRI testing may be required for a proper diagnosis.

 

An indispensable team player

“You could say that, for our patients, we’re the first line of defense against breast cancer. It is our job to obsess over even the most minute clue or possibility that cancer may be present in its earliest stages. The time that we spend doing that is for the patient.” Dr. Kamoltham elaborates, “If the first line of defense does not react quickly enough, the cancer may have advanced to the next stage by the time that a conclusive diagnosis has been made. This could have a profound impact on treatment success. The faster we can pinpoint the nature of the abnormality, the sooner the patient can get treatment. Treatment of early-stage cancer always yields better results than treatment of late-stage cancer.”

 

Calcification vs. Cancer

“Microcalcifications, small calcium deposits that can look rather alarming on a mammogram, do scare many people. There are numerous kinds of calcification that occur in the body, but a very small percentage of those – less than 10% of microcalcifications found in screening – would indicate the beginning of breast cancer,” Dr. Kamoltham said. “If found, we would recommend that a tissue sample be taken for testing.” When asked why a tissue sample is necessary, Dr. Kamoltham gives the following reasons:

1. To conclusively determine whether cancerous cells are present or not. Even if cancer is not found, the test can still yield information as to how much risk of breast cancer there is for the patient, allowing them to personalize their check-up schedule.   
2. If cancer is found, the results will tell us the type, stage, and severity of the cancer. Other details gleaned from the results can also help in forecasting the likeliest outcomes.
3. To provide the physician and the patient with the information to jointly decide on the best treatment plan going forward.

In the second or third instances, an MRI or PET scan might be necessary to determine the stage of the cancer. This will lead to a conclusive diagnosis and a clear treatment plan for the patient.
 

The faster the diagnosis, the better the chances

Radiologists are also indispensable in following-up on the course of treatment prescribed by the oncologists.  Mammogram, ultrasound, MRI and/or PET scans can all be employed to track the disease progression and catch any relapses that may occur. Dr. Kamoltham ends with the following, “as long as the exact causes of breast cancer remain unknown, thorough and methodical screening remains of the utmost importance. Women of all ages should really familiarize themselves with their breasts, and learn how to give themselves breast examinations. If anything unusual is found, a physician should be consulted without delay. Women aged 40 years and above should receive mammogram and ultrasound screenings once a year. Those with a family history of breast cancer, uterine cancer, or ovarian cancer should consult a breast specialist at even younger ages, as their needs might be different.”