PREVENTION OF BREAST CARCINOMA IN FAMILY MEDICINE IN THE CONTEXT OF THE GREEN AGENDA OF THE EUROPEAN UNION FOR THE WESTERN BALKANS

Breast cancer is a global public health problem, not only because of the fact that the disease has epidemic proportions, but also because its consequences affect practically all segments of society. About 1.4 million new cases of the disease and over 450,000 deaths with this diagnosis were registered in the world. The epidemic wave of this disease affects both developed and developing countries. That distribution, when it comes to the number of patients, was almost even, while the number of deaths in developing countries was about 40% higher. Opportunity screening is the only option in settings where there is no organized screening program. The goal The aim of this study is to evaluate the outcome and diagnostic performance of ultrasound after analyzing breast mammography in patients with Bi-RADS category 0. Establishing the role of ultrasonography (US) in the detection of breast lesions that are either palpable or detected only by imaging, for the differentiation of cystic and solid lesions, and for guidance procedures. Research methodology This retrospective study followed 438 patients who underwent screening mammography from January 2023 to July 2023; 39 of 438 examinations were classified as BRADS category 0. All screening mammography data collected between January 2023 and July 2023 were reviewed in the institutional database. Results Of the initial 438 patients with a mammogram, 39 were classified as Bi-RADS category 0. The mean age of the patients was 53.3 years (range, 35 to 81). After applying the inclusion and exclusion criteria, 24 patients underwent US, when an adjuvant method was indicated. All lesions or suspicious findings on mammograms in this study were nonpalpable, and the distribution according to the Bi-RADS lexicon was as follows: 6 of 24 (25%) were round or oval lesions; 8 of 24 (33.3%) were round lesions but with indistinct borders; 2 of 24 (8.3%) were mass like asymmetries; 4 out of 24 (16.7%) were focal asymmetries; 1 of 24 (4.2%) cases had multiple round, circumscribed lesions; and the remaining 3 cases had mixed findings (12.5%). Among the 40 Bi RADS category 0 mammograms, 30 (75%) required additional examinations before a final classification was made. Conclusion Breast cancer is the most frequently diagnosed malignancy in women worldwide and is the second leading cause of cancer death in women. Early detection of breast cancer improves outcomes. Although the incidence of breast cancer is almost three times higher in developed than in developing countries, mortality is increasing especially in those regions of the world without early detection programs. Imaging plays a key role in breast cancer screening, classification, and extent definition of breast tumors locally, locoregionally, and at distant sites. Most breast cancers are detected by an X-ray mammogram, usually as part of nationwide screening. Ultrasound (US) examination is routinely used as an essential adjunct to physical examination and mammography in the evaluation of suspicious/ambiguous breast masses. US has also become the modality of choice for guiding percutaneous interventional breast procedures, from core needle biopsy to ablation. Magnetic resonance imaging (MRI) with contrast media plays an important role in identifying mammographically ambiguous breast masses as malignant or benign, as well as in defining the local extent of malignant disease. In addition to radiological imaging (mammography, US, MRI), nuclear medicine imaging techniques increasingly play a complementary role in the diagnostic characterization of breast lesions, especially when devices intended for the breast are used, both for conventional scintimammography and above all for positron emission tomography (PET). Radionuclide procedures play a key role in radio-guided surgery in breast cancer patients, either as radio-guided localization of occult lesions (ROLL) or as radio-guided sentinel lymph node biopsy in the primary treatment phase.