Dilemma of Breast Cancer Screening by Dr Harold Gunatillake

Dilemma of Breast Cancer Screening

The American Cancer Society recommends breast cancer screening with modifying the suggested ages for annual and biannual preferences in decision making.

Every woman must have a screening check every three years if there is no history of breast cancer in the family. With a history on both sides of the parents a six monthly screening is advised, after the age of 40.

The dilemma here is that approximately 85 % of breast cancers are detected on routine mammography. The rest are detected by self-examination by the women themselves, or by doctors. The best time to self-examine is at the time of soaping whilst having a shower. Breasts are self-palpated gently and carefully with the flat of the palm and feeling every quadrant of the breast, whilst applying soap on the breast skin. The best time to examine is within a week after menses when the breasts are floppy.

It is noted that those who undergo breast screening approximately 95% of all positive findings on mammography screening are false positives.
What this means is that you may be having a breast removal operation in the absence of cancer. There have been so many cases in almost every country when breast issue is sent for histo-pathological examinations, they are found to show negative findings, when the screening showed a positive lesion. This is the dilemma.

Dr. William Skorupski, co-author of the Significance article stated, “Our goal was to caution asymptomatic women that positive mammograms are vastly more likely to be false positives than actual evidence of cancer”
Most breast cancer patients in the early stages are asymptomatic. The cancerous lesion is painless and those originating within the mammary ducts (intra-ductal) there may have a blood stained discharge. Pain comes along when complications such as infection or sudden enlargement occurs.
Now the focus is that the patient should get involved in making the health decisions to decide on the preference to have or not have the operation. This too could be problematic when patients don’t understand to take that responsibility.

It would be a better proposition to have a breast screening with imaging (CT scan) simultaneously if cancer is suspected. For those cases where there is no positive evidence of a suspicion of cancer, this X ray examination may not be required, and further they are subjected to unnecessary excessive X-ray irradiation.

Such cases need to be reviewed by the doctor regularly.

Another suggestion is to do a gentle needle biopsy if there is a suspicion of a tumour or cyst in screening findings. Those older women with increased breast density seen on screening may also need such needle biopsies.

Those cases carrying a mutation of the BRCA1 gene the risk of breast cancer need evaluation as the risk increases by 87% and ovarian cancer by 50%.

The ultimate conclusions are- that early detection of breast cancer is important when the cure rate nears 100 percent. For this endeavour, every woman should be aware of proper frequent self-examination and by the doctor before further action is taken. Those who have a history in the family, six monthly screening and imaging may be required. Also, it is suggested that every woman undergoes a blood test for checking on mutations of the genes. There are now many laboratories performing commercial BRCA1, BRCA2, and PALB2 testing. They report results within 2 to 4 weeks. Abnormalities in other genes have also been associated with breast cancer risk.
Good advice by Dr harold
Ref: MNT

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