Importance Of Breast Cancer Screening - Mammography

By Author: Indus Health Plus
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Cancer of the breast is the most common cancer in women worldwide, and in many regions it is the most common cause of death from cancer in women. Breast cancer is characterised by a preclinical detectable phase lasting from 1–7 years, depending on the specific disease subtype. Mammography (X-ray examination of the breasts) can detect preclinical cancer, that is, detect the tumour before it is palpable and before it causes symptoms. Tumours detected and treated at an early stage are associated with a better survival rate than those detected symptomatically. Early diagnosis may permit breast-conserving surgery (Stage I disease), reduce the need for adjuvant therapy and decrease complications related to intensive treatment and recurrence.

The Impact of Screening

The incidence of breast cancer worldwide has been on the rise for at least the past half century. Factors such as diminished and delayed childbearing are partly responsible for this increase. Improved diagnostic methods are also generally considered to influence the increase. However, the introduction of screening mammography ...
... occurred several decades after the documented increase in incidence and can account for only a minor part of the increase. On the other hand, the marked increase in the incidence of in situ breast carcinoma appears to be directly related to the availability of mammography, as this form of breast cancer is difficult to detect by clinical methods. In many developed countries mortality rates have been rather stable despite the steady increase in incidence. No clear overall decline in mortality was observed in any place before the late 1980s, when a gradual downturn occurred in Europe, North America and Australia. These decreases in breast cancer mortality have been attributed to a combination of earlier detection and improved treatment, but the relative contribution of each has not been determined..

Protocols for Screening

Breast cancer screening is delivered in a variety of ways, including organised programmes and “opportunistic” activities which involve referral to mammography facilities by clinicians and self-referral by women themselves. Organised programmes are recommended because they include an administrative structure responsible for implementation, quality assurance and evaluation. The population-based approach to programme implementation is recommended because it provides an organisational framework conducive to effective management and continuous improvement of the health screening process, such as through linkage with population and cancer registries for optimisation of invitation to screening and for evaluation of screening performance and impact..

Mammography screening

Mammography screening is performed on large numbers of predominantly asymptomatic women. The potential harm caused by mammography includes the creation of unnecessary anxiety and morbidity, inappropriate economic cost and the use of ionizing radiation. The strongest possible emphasis on quality assurance and physico-technical quality control is required to maintain an appropriate balance between harm and benefit of screening. The evaluation of individual mammograms requires appropriate expertise and performance standardisation. It is also essential to adhere to adequate standards of diagnostic assessment of women with abnormal results of the initial screening evaluation, as well as standards of multidisciplinary management of lesions detected in screening..

There is currently insufficient evidence from studies in high-resource countries to support the efficacy of clinical breast examination or the teaching of self-examination of the breast as a public health strategy to lower the number of breast cancer deaths in the population. These methods are being evaluated for screening in low-resource countries in which most patients currently present for treatment at very late stages. A study aiming to reduce the proportion of newly diagnosed advanced stage breast cancer from 80% to 60% using breast awareness, breast self-examination, clinical breast examination and centralised assessment of abnormalities is currently underway in India.