Breast Cancer Screening Essay

1805 words - 8 pages

An analysis of the effectiveness of population-based screening for breast cancer.

Breast cancer is the leading cause of death due to cancer in women, with statistics from the USA showing that one in eight women will develop the disease.1 Studies in the UK show that 90% of women diagnosed in the early stages survive the disease, while this figure is only 15% if diagnosed at a later stage illustrating the importance of an effective screening programme to reduce mortality.2 In the following essay I will review various randomised control studies and cohort studies in order to establish how nationwide screening programmes best reduce mortality, looking at the targeted sector of the population ...view middle of the document...

It should also be stated that screening programmes only reduce mortality rates if followed up by treatment of any identified problems. Treatment could be in the form of surgery to remove tumours before they metastisize or by chemotherapy if metastasis is at an early stage.3

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 further or metastasizing.4

While randomised control trials show that screening beginning at 40 versus 50 has an added reduction in mortality there is also data showing that screening at 40 increases the chances of false-positives occurring.5 Furthermore, “extending screening beyond biennial examinations from 50 to 74 to annual screening from ages 40 to 84 results in an additional 15.5% mortality reduction, reducing the 2.3% probability of death further to 1.8%.”5 Therefore in order to maximise the benefits of a mammogram and reduce harmful outcomes such as unnecessary biopsies a balance needs to be found between the two. With the majority of tumours being slow growing it has been established from various studies that biennial screening is the most effective time frame. This is due to the identification of slow growing tumours at an early enough stage for recovery and at the same time ensures a reduced rate of false-positives compared to annual mammograms.5 “In addition, since the proportion of DCIS is highest in younger women, screen detection of DCIS that may not be clinically significant could be considered a further harm.”5 Therefore it is the woman’s prerogative whether the risk of cancer outweighs the possibility of coming into contact with the aforementioned harms.

With the implementation of mammograms as a population based screening program the targeted population must be scrutinised, because although it is common practice for women over 40 to be covered by health...

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