The Importance Of Breast Cancer Screening Essay

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When analysing the program adopted for breast cancer screening the benefits are always weighed against the harm caused by the procedure. The most prominent of these is overdiagnosis. Overdiagnosis occurs when a mammogram finds “cancers and cases of DCIS (ductal carcinoma in situ) that will never cause symptoms or threaten a woman’s life”4 leading to unnecessary treatment that causes adverse effects to the individual involved such as cancer therapy.4 False- positives are another area of concern when assessing mammograms as this means cancerous tumors will be identified where they do not exist. This issue has further implications as unnecessary biopsies are done on patients where there are no cancerous tumors present. These issues have been largely resolved by additional testing such as an ultrasound of diagnostic mammogram, though these procedures incur a cost and time element that would otherwise have been avoided.4 An added consequence of false-positives is avoidable anxiety and physical discomfort. Contrary to the harmful effects presented above, another area of concern is false-negatives. False negatives occur in roughly 20% of mammograms, with the result of unidentified cancer developing The Importance Of Breast Cancer Screening Essay

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Breast cancer is the main cause of tumor deaths in women [1]. Early diagnosis of the disease is widely approved as being essential for effective treatment [2]. Biomedical imaging modalities are the current method of choice for these diagnostics. Hence, this work aims to review and provide detailed information regarding the current state-of-the-art imaging modalities for breast cancer imaging. Rest of the paper will focus on these breast cancer imaging tools with detailed reviews.
1. Mammography

Mammography is a very common and widely accepted breast cancer-screening tool which was developed in the mid-1960s [3]. Several large clinical trials demonstrated that the detection of small tumors using mammography devices at an early stage reduces or delays mortality [4]. An X-ray image of the breast is called a mammogram. The mammogram exam is specifically designed for the identification of certain characteristic masses and/or microcalcifications that might develop to cancer. However, a mammogram can also help in identifying other forms of cysts, calcifications, and tumors within the breast. Mammograms are so far the most efficient screening method for the early detection of breast cancer. As a recommendation by the American Cancer Society, a woman should get her first standard mammogram between the age of 35 and 40. The Importance Of Breast Cancer Screening Essay Two types of mammograms exist, namely; screening and diagnostic. Screening mammograms are done to check for breast cancer in women that present no symptoms whereas diagnostic mammograms are done in the presence of unusual signs or symptoms in the breast. Diagnostic mammogram of the breast gives detailed images using specialized techniques. [5].

For quite some time, screening mammogram has been regarded as a “gold standard” for breast cancer. It consists of two-dimensional X-ray images of each breast. Not only it can provide adequate visualization of soft tissue abnormalities, it can also depict subtle calcifications. The obtained image can either be captured on film (screening-film-mammography) or processed digitally (screening-digital-mammography). The former is very cost effective and relatively easy to perform. However, it has intrinsic limitations related with its sensitivity to substandard film processing conditions, constrained dynamic range, granularity and contrast attributes [6]. Screening digital mammography gives the advantage of digital image communication, manipulation and archival. It uses multiple or single detector assembly to acquire an image the X-rays that pass through the breast which can later be displayed, stored, and communicated electronically [7].The Importance Of Breast Cancer Screening Essay  On the other hand, a diagnostic mammogram is a more detailed X-ray examination of the breast. Diagnostic mammograms are generally used to check for breast cancer after a lump or other symptoms of the disease have been observed. Screening mammography imaging lasts shorter than diagnostic mammography since diagnostic mammography needs more X-rays to obtain views of the breast from several different angles. Clinical investigations comparing screen-film mammography with digital mammography in a chosen population demonstrate similarity for cancer detection, [8], [9], [10], while digital mammography functions better for pre-menopausal women under the age of 50 years with dense breasts [11], [12].

2. Breast Magnetic Resonance Imaging (MRI)

Breast MRI scan uses strong magnets and radio frequency pulse to produce very detailed images of the breast. It is a non-invasive technique that produces 3d images without the use of ionizing radiation. In some selected investigations, it requires the use of an agent introduced via the vein to improve tissue contrast [13]. The most useful breast MRI exam for breast imaging uses a contrast agent (gadolinium) that is injected into a vein in the arm through a catheter before or during the exam. This enhances the ability of the MRI to clearly image breast tissue details. Possible uses include [14]:

Evaluation of a woman who has a palpable mass that isn’t visible with mammography.

Evaluation of a lesion in the breast of young women.

Evaluation of a woman who has breast cancer cells in an underarm lymph node.

Determining if a cancer is limited to one area of the breast, or if it is “multicentric” and involves more than one area.

Breast MRI can be limited to the below-listed situations [14]:

• When screening for young women who are prone to breast cancer (gene mutation BRCA1 or BRCA2).The Importance Of Breast Cancer Screening Essay

• Assessment of a woman diagnosed with a lump in an underarm lymph node however who has no indication of tumor on breast self-examination or mammogram.

• Assessment of a woman with lately diagnosed breast cancer and whose mammogram showed a highly dense breast.

Nuclear Medicine Approach

2.1 Scintimammography

Scintimammography is an investigative technique that uses radioactive drugs to give images of an abnormal breast. It is mostly used in women prone to breast cancer yet cannot be screened with MRI. Scintimammography is now regarded as a modality of choice rather than just being contributory due to its non-invasiveness, simplicity, safety, availability and also ability to give the beneficial information required in the proper management of breast lesions [15]. However, scintimammography may not detect very small tumors, such as those less than 1 cm in diameter. Additionally, the scan results may be affected by the activity of visceral organs like the heart or liver. A radioactive tracer known as technetium sestamibi was developed in the 1990s and used to study palpable breast tumors in 1994 [16]. The outcome of the study was 32 episodes of breast cancer, of which 27 were identified by Tc-99m sestamibi, with a specificity of 100%, a sensitivity of 84%, and an accuracy of 87% [16]. In the year 1993, Tl-201 was compared with Tc-99m and the report showed that Tc-99m had a superior sensitivity in detecting breast cancer [17]. Another study which involved more than 2500 patients showed that the specificity and sensitivity of scintimammography in the detecting cancerous breast tumor was about 85% [18], [19]. The Importance Of Breast Cancer Screening Essay For this test, a small intravenous injection of the radiotracer (Tc-99m sestamibi) is injected into the patient’s vein. The patient is then positioned on a comfortable scanning bed. The radiotracer collects in the breast, where its then released as gamma rays. After gamma camera detects this energy, the radiotracer is then analyzed by a computer system which produces images containing both functional and structural information of the tissues and organs (Figure 2.1). Further analysis showed that for tumors whose size is less than 1cm, the sensitivity of scintimammography is only 48% [20].

BREAST CANCER SCREENING DR. DANA MORTEZ ARLECIA PURVIS JULY 17, 2011

Current research shows mammograms are stronger than in the past. In a recent study it has confirmed that mammograms benefit for women in their forties and fifties. Women feel confident about the benefits that are associated with a regular mammograms for finding cancer early. However, mammograms can have their limitations. A mammogram will miss some cancers, and it sometimes can lead to follow up of findings that are not cancer that could include biopsies. Women should be told about the benefits, limitations, and potential harms that are linked with regular breast cancer screening. The Importance Of Breast Cancer Screening Essay Mammograms can miss some cancers. But…show more content…
The purpose of having a screening mammography is to identify small breast cancer. The use of film mammography can be very hard to recognize breast cancer in younger women and women that may have dense breast tissue. This is because the women normal breast tissue have a density of carcinoma. It very difficult to tell which is normal and which could be carcinoma. There is an advantage to the film mammography where the contrast image of the breast can be modified and could allow the differences in the detection of the tissues. According to the case study in the text it states that sixty six percent of all women and fifty one percent of women under age of fifty who has breast cancer will be identified by having a screening test (Fleming, 2008). From my research I found that having a screening mammography is a very valuable tool in the detection of breast cancer especially if it is caught early in the stages to improve the survival rate. For women who get a screening after age the of fifty have a good chance of reducing the risk of death of breast cancer from twenty five to thirty percent and women age forty the data states a very positive chance of detecting breast cancer early and great chances of survival. 2. Are the breast cancer screening patient outcomes between the Case Study data results and the current data results that you identified better or worse? I feel that the case

Breast cancer: prevention and control


Breast cancer control

WHO promotes breast cancer control within the context of comprehensive national cancer control programmes that are integrated to noncommunicable diseases and other related problems. Comprehensive cancer control involves prevention, early detection, diagnosis and treatment, rehabilitation and palliative care.The Importance Of Breast Cancer Screening Essay

Raising general public awareness on the breast cancer problem and the mechanisms to control as well as advocating for appropriate policies and programmes are key strategies of population-based breast cancer control. Many low- and middle-income countries face now a double burden of breast and cervical cancer which represent top cancer killers in women over 30 years old. These countries need to implement combined strategies that address both public health problems in an effective and efficient way.

Prevention

Control of specific modifiable breast cancer risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake, overweight and obesity, could eventually have an impact in reducing the incidence of breast cancer in the long term.The Importance Of Breast Cancer Screening Essay

Early detection

Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries. Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control (Anderson et al., 2008).

There are two early detection methods:

  • early diagnosis or awareness of early signs and symptoms in symptomatic populations in order to facilitate diagnosis and early treatment, and
  • screening that is the systematic application of a screening test in a presumably asymptomatic population. It aims to identify individuals with an abnormality suggestive of cancer.The Importance Of Breast Cancer Screening Essay

A screening programme is a far more complex undertaking that an early diagnosis programme. (WHO, 2007).

Irrespective of the early detection method used, central to the success of population based early detection are careful planning and a well organized and sustainable programme that targets the right population group and ensures coordination, continuity and quality of actions across the whole continuum of care. Targeting the wrong age group, such as, younger women with low risk of breast cancer, could cause a lower number of breast cancers found per woman screened and therefore reduce its cost-effectiveness. In addition, targeting younger women would lead to more evaluation of benign tumours, which causes unnecessary overload of health care facilities due to the use of addition diagnostic resources (Yip et al., 2008).The Importance Of Breast Cancer Screening Essay

Early diagnosis

Early diagnosis remains an important early detection strategy, particularly in low- and middle-income countries where the diseases is diagnosed in late stages and resources are very limited. There is some evidence that this strategy can produce “down staging” (increasing in proportion of breast cancers detected at an early stage) of the disease to stages that are more amenable to curative treatment (Yip et al., 2008).The Importance Of Breast Cancer Screening Essay

Mammography screening

Mammography screening is the only screening method that has proven to be effective. Although there is evidence that organized population-based mammography screening programmes can reduce breast cancer mortality by around 20% in the screened group versus the unscreened group across all age groups, in general there appears to be a narrow balance of benefits compared with harms, particularly in younger and older women. There is uncertainty about the magnitude of the harms – particularly overdiagnosis and overtreatment. Mammography screening is very complex and resource intensive and no research of its effectiveness has been conducted in low resource settings.The Importance Of Breast Cancer Screening Essay

Breast self examination (BSE)

There is no evidence on the effect of screening through breast self-examination (BSE). However, the practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommend for raising awareness among women at risk rather than as a screening method.

Clinical Breast Examination (CBE)

Research is underway to evaluate CBE as a low-cost approach to breast cancer screening that can work in less affluent countries. Promising preliminary results show that the age-standardized incidence rate for advanced-stage breast cancer is lower in the screened group compared to the unscreened group (Sankaranarayanan, 2011). The Importance Of Breast Cancer Screening Essay

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