Know the Benefits and possible harms of Breast Cancer Screening

Pink Ribbon-Breast Cancer

#BeInformed: What you should know about Breast Cancer Screening

There are many reasons to dislike the ‘C’ word for Cancer. In the first place, our exact understanding of what causes cancer is still very limited. And in most cases, cancer treatment requires radical therapeutic procedures like radiotherapy or chemotherapy, each of which has their own very strong side effects. The closest breakthrough from scientific knowledge for the prevention of cancers is that:

  • #Healthy-living by eating right, No Tobacco, and avoiding obesity and limiting alcohol intake reduces the likelihood of cancers (and other chronic diseases like diabetes, hypertension, heart diseases); and
  • As a rule of thumb, cancer survival is best when caught early; and this is the premise for advocating the importance of undergoing regular screening exercises and creating more awareness for people to know what to look out for.

Breast and Cervical cancer are the commonest cancers in females all over the world. For Breast Cancer, the current advice is: frequent breast examinations and periodic mammograms.

Breast self examinations, BSE are to be done frequently so that every woman is expected to get used to ‘feeling her normal breast tissue’. That way, she can easily notice an anomaly such as a lump or skin change if any arises. Clinical Breast Examination, CBE is similar but done by a doctor/nurse. But this hardly suffices because many times, some breast cancers start off as really small lumps that can very easily be missed out by touching alone, hence the need for the mammogram.

breast-cancer-screening-awareness 1Mammography is the use of a special x-ray machine to take pictures of the breast tissue and it is generally advised that all women above 50 years should do a periodic mammogram. Globally, the UK has the best and most organized breast screening program which started since 1988 and they invite women between the ages of 50 – 70 (now 47 – 73) years for screening every 3 years. (The US Centre for Disease Control, CDC recommends every 2 years, while the decision for women between 40-49 years should be individualized and discussed with her personal doctor based on her risk factors like genetics or family history).

What does a Mammogram result mean?

Many women’s results from breast screening exercises come out as normal. A few others that do not look normal are then called back for a more comprehensive follow-up. Cancers accidentally picked up at this stage would have eventually being found later- but it may be too late by then. Follow-up at this point is typically an offer for early treatment for either a lumpectomy (lump removal) or a mastectomy (breast removal) and possibly alongside with other treatment options like chemotherapy or radiotherapy.

HOWEVER, some tumours found by a mammogram may never develop further to become life threatening. This is where it gets somewhat tricky because: to date, there is NO WAY for doctors to know which cancer will progress further or not at this stage. This then justifies the next rational question: are breast cancers over-diagnosed?

Over-diagnosis of Breast Cancers?

This question of possibly over-diagnosing (overdiagnosis here meaning, “Cancers detected at breast screening that would not have otherwise become clinically apparent in the woman’s lifetime”) has been on raising a debate about whether breast cancer screening benefits out-weighs its harms or not.

breast-cancer-screening-awareness

Last week, The Lancet published the findings of an independent panel that was established to review breast cancer screening in the UK. They found that:

“Routine breast screening leads to a 20% relative risk reduction compared with no screening. This means for every 235 women invited for screening, one breast cancer death will be prevented, representing 43 breast cancer deaths prevented per 10 000 women aged 50 years invited to screening for the next 20 years. Additionally, the Panel found that some overdiagnosis occurs. 19% of breast cancers diagnosed in women invited for screening would not have caused any problem if left undiagnosed and untreated (a rate of 129 per 10 000 women). However, owing to the scarcity of reliable data in this area, more research is needed to accurately assess the magnitude of overdiagnosis.”

According to Cancer Research UK, here are the figures simplified:

“For every breast cancer death prevented through screening, about 3 women will have treatment for a cancer that would not have caused them problems. Their doctor would not have known that at the time because they can’t reliably tell which breast cancers are life threatening and which aren’t.”

With all of this in mind, the Independent Panel, Cancer Research UK, and even the women in a focus group all still concluded that going ahead with regular breast cancer screening exercises is the current best option. The new emphasis is that this information should be made available in a transparent and objective way to women invited to screening so that they can make informed decisions.

As the popular saying goes; “Prevention is better than cure!”

 

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