Brief History“Early” breast clinic at founded at GSH

in 1951 (60 years) by Professor Jannie

Louw.

Clinical examinationBiopsySurgical treatment

Real Time On - site Cytology Clinic 1982 “Birth” of on-site, real-time cytology service within the clinic led by Professor D. Dent, Dr A Hacking, Dr G Learmonth

Physical examination.Imaging ( mammogram

and ultrasound)FNA Cytology Histopathology

MissionStatement1. Provide high quality

compassionate care for “breast patients”.

2. Promote awareness in the community.

3. Teach all health care professionals.

4. Perform collaborative research

WHO SHOULD ATTEND THE BREAST CLINIC?

•Anyone with: abnormal mammogram

•with a family history of breast disease

• with lumps that persistent, are painful or not, or that cause concern.

The Team…Includes:NursesCliniciansRadiologyCytologyHistologyOncologySocial workSurgery

And most importantly: The Patients

FNA technique

FNA performed by clinical staff.

Slides stained and prepared in the clinic.

Slides screened on site: an adequacy and provisional assessment is given. Final diagnosis by pathologist

Methods and StatisticsAll patients seen at the GSH Breast clinic presenting with symptoms that warranted an FNA for cytology and if necessary a biopsy for histological correlation.

5 categories used for diagnosis: Inadequate, Benign, Atypical, Suspicious Malignant.

RESULTS 1st 1500 cases 2nd 1500 cases 3rd 1500 cases 1982-1985 2008-2009 2010 -2011

InadequateInadequate 292 (19%)292 (19%) 379 (25%) 379 (25%) 423 (24%)423 (24%)

BenignBenign 700 (47%)700 (47%) 707 (47%) 707 (47%) 692 (46%)692 (46%)

Atyp/Susp.Atyp/Susp. 150 (10%)150 (10%) 85 (6%) 85 (6%) 108 (7%)108 (7%)

MalignantMalignant 358 (24%)358 (24%) 330 (22%) 330 (22%) 277 (18%)277 (18%)

1500 cases in 1500 cases in

32 months32 months

1500 cases in 1500 cases in 1500 cases in 1500 cases in

15 months15 months 12 months12 months

Malignant cytology/ histology correlation 1st 1,500 2nd 1,500 3rd 1,500

Confirmed 349(97%) 330(98%) 272(99%)

No Follow up 9 4 5

Approx 120 Cytology patients

per month.

Approx 21,000 patients have

FNA at the Breast Clinic

Why practice on-site, real-time Cytology?

*Results of benign lumps are given the same day.

Return visits and recalls are facilitated.

Improvement in the triage and flow of patients.

*Resultant reduction of anxiety and reassurance of patient

Huge financial saving.

Impact of the Breast ClinicCLINICAL

•Improved patient care

•Ongoing research using clinic data

EDUCATIONAL:

•Educational workshops taken to seven Cytology centers in• South Africa, and to many centres around the world.

Many visitors to the clinic from around the world.

•International breast clinics have been modeled on the GSH Breast clinic.