文／台兒醫研部主任 歐妮雅
During pregnancy, women are going through multiple physiological changes, and in addition to that, some pathological processes can occur or some existing ones can be aggravated. The diagnostics can be challenging and requires a solid knowledge of anatomy and specific diseases. It is crucial to distinguish normal processes from pathological. Physiological changes in breast density and architecture make it difficult to evaluate the imaging and palpation exam of breasts. Despite the challenges, breast ultrasound is the method of choice for use in pregnant women with reportedly higher sensitivity and without the risk of ionizing radiation compared to the mammography. It allows diagnosing multiple conditions, such as mastitis, fibroadenoma, and pregnancy-associated breast cancer.
Breast cancer is a global health issue, especially tangible in developed countries. Taiwan as a country with a high socio-demographic index sees a dramatic increase in the number of cases during recent years. In 2016, breast cancer with 12 672 patients accounted for about 12% of all malignant tumors and 5% of all deaths from malignancies in Taiwan, and these numbers are steadily increasing. Due to this, there was implemented a cancer prevention strategy following WHO standards. Since November 2009, the government implemented mammography for women aged 45-69, and further expanded this preventive service in January 2010 for women aged 40-44 with a family history of breast cancer. Despite the active promotion of the preventive measures, the mammography screening rate among 45-69-year-old women in 2015-2016 was 39.3%, relatively low compared to other developed countries. In Taiwan, breast cancer is affecting women at a relatively young age. Even though breast cancer is not as common among pregnant women, there is a chance of pregnancy-associated cancer. Nowadays, there is a tendency of conceiving at a later age, so it is a suitable timing for an ultrasound screening.
As was shown in a previous study conducted in Taiwan, the main barriers for women in utilizing breast cancer screening were lack of time, or perceived conception that they do not need to get screened. We believe that ultrasound breast screening during pregnancy can be a good starting point in promoting breast cancer screening among Taiwanese women. The majority of the women attend prenatal care facilities during their pregnancy and are concerned about their health. A short briefing about the importance of screening during breast ultrasound can educate women about the risk factors, screening, and prevention methods. Such measures might help to decrease the rates of breast cancer, increase the detection rate of benign or malignant processes during pregnancy. According to the survey conducted in the Taiji clinic among 53 pregnant women having breast ultrasound screening, most of women are satisfied with breast ultrasound screening and feel comfortable (Figure 1 (a) and (b)).
In conclusion, we recommend ultrasound breast screening for all women during pregnancy at an early gestational age. Such a measure can help women stay healthy and promote mammography and other preventive measures for fighting breast cancer in Taiwan.
