Breast Cancer Detection Objectives: Explain the different types of breast cancer detection, focusing on the mammogram etc,

the procedure, accuracy, side effects, cost effectiveness for the NHS and the life expectancy.

Introduction- Statistic of women with cancer, increasing? Ethinic group? Since when early detection became important. (100) Awareness of detection and statistic of those using it and ideal use of it. Types of detection. Overview of essay/signposting (200 words) Types: mamorgram (200) Other types (300)- compare them Cost effective, life expectancy (100) Conclusion(100)

READ FROM HERE: Breast Cancer is one of the leading causes of deaths for women worldwide. According to the World Health Organization (WHO), there are around 12.7 million new cases of cancer diagnosed worldwide in 2008. It results in 7.6 million deaths. (1) Breast cancer is the second most diagnosed cancer in the world. It stands as the fifth most common cancer deaths behind lung cancer, stomach cancer, liver cancer and colorectal cancer. (2) Nevertheless, with proper diagnosis and treatment, breast cancer sufferers generally have a higher survival rate. Even though the incidence of breast cancer has increased drastically over the past 10 years, its mortality rate has decreased. Recent statistics showed that an early detection of the disease greatly increases the rate of survival. According to the National Cancer Data Base, an early detection of cancer at stage one will increase the patients survival percentage by almost six fold compared to a detection at stage four. (3) This scientific report will cover the types of tests normally used with a special focus on mammography, their advantages and disadvantages, clinical trials results and also guidelines recommended regarding tests that should be carried out by women of different age group.
5-year Survival Rate 93%

Stage 0

I IIA IIB IIIA

88% 81% 74% 67%

IIIB IIIC IV

41%* 49%* 15%

Table 1: The percentage survival rates of breast cancer stages.

Since the 1970s, there has been increasing awareness amongst women to undergo screening and tests for detection. Mammography is currently the most widely used method of detection. A mammogram is an X-ray picture of human breast. There are two types of mammogram: the screening mammogram and diagnostic mammogram. The screening mammogram is performed when a woman has no signs or symptoms of the disease. It involves two X-ray pictures of each breast which detects small tumours that cannot be felt physically. If a lump or any other symptoms of the disease has been found, a diagnostic mammogram is then carried out. This process takes longer time because more X-rays are needed to obtain views of the breast from several different angles. Suspicious areas are magnified to produce a more detailed picture for more accurate diagnosis. [4] According to an article published in the Lancet Medical Journal in 1993, it was found that randomized trials carried out in 11 hospitals in Sweden involving 282,777 women for a period 5-13 years revealed a 24% significant reduction of breast cancer mortality among those who were invited to mammography screening compared with those that were not invited. The largest reduction of breast cancer mortality of 29% was observed among women aged 50-69. There were less significant reduction among other age groups. However, there were no evidence of detrimental effect of screening in terms of breast cancer mortality in any age group, signifying a success in the usage of mammograms. (5)

Figure 2: Cumulative mortality from breast cancer in the Swedish Two-County screening trial. A reduction in mortality from breast cancer of 30% was found in the group of women that was invited for screening relative to the control group. However, there are still disadvantages in using the mammogram method. For example, a mammogram may show a false negative: the result shows a negative even the patient actually does have breast cancer. The incident rate if false negative in mammogram is relatively high. About one in five cancer patients failed to show positive result at the time of screening. The main cause of such failure is high breast density. The greater density of the breast is caused by the greater amount of fibro-grandular tissues. In the mammograph, both the fibro-glandular tissues of the breast and the tumour would, due to their similar density, appear as white areas while the fatty tissues appear in black. This confuses the fibro-gradular tissue with the tumour tissue in the mammograph. Tumours are therefore harder to detect in women with denser tissues. Younger women tend to have denser breast and hence are at risk of getting an inaccurate result. (5)

Another method of examination is the manual examination of the breast for lumps and any other symptoms of disease. It is usually done within 1 to 2 weeks after the start of the menstrual cycle when then breast tissues are tender to make it easier to detect abnormalities. It could be done by a woman by herself, or, if she wishes, by the help of a healthcare professional who provides a Clinical Breast Examination procedure. The
procedure includes a detailed examination of each breast, underarm and collarbone area for changes in breast size. It will also examine skin changes and signs of injury or infection (such as bruising or redness). The American Cancer Research outlines some guidelines regarding tests that should be carried out by women of various age groups. For women in their early 20s, it is recommended that they

perform breast self-examination and report promptly any new breast symptoms to a health professional. They should also have their technique reviewed on the occasion of a periodic health examiniation. For women in their 20s and 30s, it is suggested that clinical breast examination

(CBE) be part of a periodic health examination, preferably at least every three years. For women age 40 and above, an annual mammography is recommended. [6] Although mammography has been evidently helpful in the detection of breast cancer, according to the 2003 National Health Interview Survey in the United States, most survivors
(57%) from the 361 women who were diagnosed with breast cancer from 1980 to 2003 reported a detection method other than mammographic examination. Women often detected breast cancers themselves, either by self-examination (25%) or by accident (18%). This shows that self examination still plays a vital role in the detection of symptoms.

In conclusion, since it has been prove that early detection of breast cancer is vital in increasing the survival rate of cancer patients, countries all around the world should take action to increase awareness of early detection. Although mammography is currently the most used technique, other techniques like using ultrasound, MRI, functional imaging, breast specific gamma imaging are considered as a better option in certain classes of women for better diagnosis.

Data source: National Health Interview Survey Public Use Data File 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. American Cancer Society, Surveillance Research, 2009

1. http://www.who.int/cancer/en/ 2. http://info.cancerresearchuk.org/cancerstats/world/the-global-picture/cancer-overallworld 3. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-survival-bystage 4. http://www.cancer.gov/cancertopics/factsheet/detection/mammograms 5. http://www.sciencedirect.com/science/article/pii/014067369391067V 6. http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final 90809pdf.pdf