Screening of Patients with Breast Cancer - Essay Example

? Screening of patients with breast cancer Introduction Screening of patients with breast cancer is key issue in the modern medical context. The riskfactors are considered in every country in its own way. Thus, USPSTF recommend women screening mammography, as well as implement different ways of clinical breast examination (CBE). A special risk group consists of women age 40 years and older. To screen breast cancer is a complex and a challenging activity. Performance of routine breast self examination (BSE) is another key step in the process of breast cancer identification and prevention. It is relevant to speak about gaps in the process of population screening. These gaps are as follows: • Definite identification of benefits proportion obtained in the result of screening before age 50 years, which cannot be made. There are no data concerning costs of screening women younger than 50 years. • It is necessary to cease breast cancer screening appropriate age. Therefore, with respect to research gaps in the field of breast cancer risk identification the main factors, such as age of the patients and family risk factors should be considered. Screening: to be or not to be? In the state of Oregon Breast Cancer Screening was conducted. This screening was conducted in Oregon Evidence-based Practice Center. The benefits of CBE have remained unknown. The magnitude of screening damages still remains unclear. The issue of appropriate screening remains vague. There is a serious screening interval among many age groups. Very often death rate decrease was identified among women age 40-49 years and 70 years and older. It can be claimed that CBE and BSE can be effective in breast cancer screening incidents. To identify breast cancer it is relevant to give general ideas of this disease. Breast cancer is referred to as "a proliferation of malignant cells that arises in the breast tissue, specifically in the terminal ductal-lobular unit. The term “breast cancer” represents a continuum of disease ranging from noninvasive to invasive carcinoma" (Nelson, Tyne, Naik, Bougatsos, Chan, Nygren, Humphrey, 2009). This is a central idea for our further discussion about the importance of breast cancer screening. Screening techniques may identify one of the initial forms of disease entities and benign breast cysts. Noninvasive carcinoma consists of epithelial proliferation which is referred to either the mammary duct, or to the lobule, e. g. lobular carcinoma in situ (LCIS). LCIS is not considered to be a precursor lesion for invasive lobular carcinoma, but very often it is referred to as a marker for increased risk and cancer development in either breast of both invasive ductal or lobular breast forms can occur. Nevertheless, DCIS is often considered to be a precursor lesion to invasive ductal carcinoma. DCIS is composed of a heterogeneous group of lesions which can be characterized by a various clinical behavior and pathologic features. DCIS subtypes can be characterized in the following way: cribriform, comedo, micropapillary, papillary, and solid can be included (Barratt, Les Irwig, Glasziou, 2002). Metastatic potential invasive breast cancers invade the basic membrane into the adjacent stroma. Metastasis can look as the one including adjacent lymph nodes, lung, brain, and bone. In accordance with screening data: "70-80% of invasive breast cancers are invasive or infiltrating ductal carcinoma and approximately 10% are invasive lobular cancers. Some other less common histologic subtypes of invasive breast cancer include apocrine, medullary, metaplastic, mucinous, papillary, and tubular" (Ohnuki, Kuriyama, Shoji 2006). Thus, it is evident that numerous issues should be solved by the modern scientists and researchers in the field of medicine. Screening is an optimal way of breast cancer prevention, but not always medical scientists and researchers can reach a common decision in this field (Barratt, Les Irwig, Glasziou, 2002). Some factors can be directly correlated with breast cancer risk, but for women specific risk factors are sex and age, but many other factors were not properly studied. There are many factors, which are related to family relations. It is evident that family risk factors are very decisive in the potential of disease occurrence. Another famous claim is as follows: those hereditary mutations in tumor suppressor genes BRCA1 and BRCA2 influence of cancer development among women. Screening can be considered as rather risky activity in this field too. This can be explained in the following way: extensive mammographic breast density can be associated with a high degree of breast cancer (Carter, Castro, Kessler, 2005). An increased risk can be associated with endogenous estrogen exposure. Moreover, such drastic consequences as early menarche, late menopause, nulliparity, and obesity can be identified. Environmental risks are other decisive factors, which can increase risk too. In the modern medical paradigm magnitude of risk occurrence can be explained in different terms. Daily consumption of alcohol can also lead to risk cancer. Even 1-2 drinks a day can be an additional hazard of risk occurrence. Nevertheless, age and family risk factors are considered as the most hazardous potential of cancer occurrence. Screening To identify an asymptomatic phase of breast cancer mammography is used. There is a high level of sensitivity of mammography screening (77-95%), an evident specific basis (94-97%), and the most women can be subjected to mammography. There is a difference between screening mammography practices in America and Britain. These suggestions can be made on the foundation of the Breast Cancer Surveillance Consortium (BCSC) and the National Breast and Cervical Cancer Early Detection Program, and the United Kingdom, applying information from the National Health Service Breast Screening Program. The results of the studies conducted by these organizations show that “open surgical biopsy rates were twice as high in the United States while cancer detection rates were similar” (Kauhava, Immonen-Raiha, Parvinen, 2006). These can be explained by differences in health protection systems in these two countries. In accordance with recent data: "Mammography is mediated by plain film or digital technologies though the main emphasis is made on digital technologies. An evaluation of the cost-effectiveness of a quality controlled mammographic screening program compared to an opportunistic screening program used cancer registry and clinical data from Switzerland. Results showed that the discounted incremental cost-effectiveness ratio comparing quality controlled mammographic screening programs verses established opportunistic screening programs ranged from $73,018 ($61,545.8 USD) at age 40 years to $118,193 ($99,623.2 USD) at age 70 years per life-year gained" (Nelson Tyne, Naik, Bougatsos, Chan, Nygren, Humphrey 2009). The United States and Canada provide high rates of accuracy of digital and film mammography. The main emphasis is made on digital mammography. Magnetic resonance imaging (MRI) has been previously considered as an optimal evaluation method. In accordance with recent data: "MRI and mammography in high-risk women without cancer, sensitivities of MRI ranged between 71-100%, and specificities between 81-97%" (Nelson Tyne, Naik, Bougatsos, Chan, Nygren, Humphrey 2009). CBE is effective and it is a great option to prevent cancer mortality. CBE relates to no intervention but it is appropriate to compare it with mammography. A level of sensitivity of CBE is measured from 40-69%, a level of specificity is identified from 88-99% (Nelson Tyne, Naik, Bougatsos, Chan, Nygren, Humphrey 2009). BSE factor identifies that there is an evident level of breast mortality decrease (Barratt, Les Irwig, Glasziou 2002). It is difficult to identify BSE specificity. In case a woman has abnormal mammographic results it is relevant to gain implement biopsy. There are the following options in the process of breast cancer identification: "magnification, spot compression, and additional angles), a targeted breast ultrasound, or breast MRI. These additional imaging studies may help classify the lesion identified on screening as a benign or suspicious finding in order to determine the need for tissue sampling" (Nelson Tyne, Naik, Bougatsos, Chan, Nygren, Humphrey 2009). Conclusion There is a suggestion that the ACS recommends that women age 20-39 years is subjected to CBE every 3 years. It is claimed that every year women after 40.48 should be subjected to screening of breasts. The American College of Obstetricians and Gynecologists (ACOG) make an emphasis on physical examination. In terms of conditions provided by the World Health Organization (WHO) screening by CBE is not necessary, but CBE should provide a reliable basis for guaranteeing of women's health. It is evident that there is a global shift in approaches to breast cancer identification. The ACS has changed its policy after 2001 and now BSE is an optional screening method. The NCI underlines that providing more public information ensures women's protection from a potential breast cancer. The WHO underlines that it is important to promote national cancer control programs, but BSE screening is not the primary concern. On the basis of reliable data obtained from up-to-date literary sources it is claimed that in the field of modern breast cancer prevention and identification the main emphasis should be made on the most optimal screening technology. Development of an integrative approach in screening of patients with potential breast cancer risk should be made with respect to many external factors. Thus, not only technological progress in the field of medicine, but also reliable social screening should be taken into account in the modern medical paradigm. References Barratt AL, Les Irwig M, Glasziou PP, et al. 2002, Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review. Med J Aust. 176(6):266-271. Carter KJ, Castro F, Kessler E 2005, Simulation of begin and end ages for mammography screening. J Health Qual. (1):40-47. Kauhava L, Immonen-Raiha P, Parvinen I 2006, Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer. Breast Cancer Res Treat. 98(2):143-150. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan B, Nygren P, Humphrey L 2009, Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force. Evidence Review Update No. 74. AHRQ Publication No. 10-05142-EF-1. Rockville, MD: Agency for Healthcare Research and Quality. Mandelblatt J, Saha S, Teutsch S 2003, The cost-effectiveness of screening mammography beyond age 65 years: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 39(10):835-842. Neeser K, Szucs T, Bulliard JL, et al 2007, Cost-effectiveness analysis of a quality-controlled mammography screening program from the Swiss statutory health-care perspective: quantitative assessment of the most influential factors. Value Health 10(1):42-53. Ohnuki K, Kuriyama S, Shoji N, et al 2006, Cost-effectiveness analysis of screening modalities for breast cancer in Japan with special reference to women aged 40-49 years. Cancer Sci. 97(11):1242-1247. Read More