MAMMOGRAPHY SCREENING

About?

Breast Cancer brieflyScreening methods brieflyMamography Screening ProtocolsEfficiency and Recent Discussions

BreastMass: benign / malignant

Lobular carcinoma in situFibrocystic changesFibroadenomaSclerosing adenosisDuctal carcinomaDuctal carcinoma in situ Papilloma

Breast CancerSignificant health concern of womenMost commonly diagnosed Second leading cause of cancer deathRisk increases

with ageScreening; our

only option

SCREEING Complicated Self examination : noninvasive. Has not beneficial effect. Increases the number of biopsies performed. Mamography : 1963-80 studies decreased risk of breast cancer death. Now being questioned as a screening methodMRI : better at ruling out breast cancer but more likely to produce false positive results. Suggested for high risk womenUSG : suggested for younger high risk women However European Group for Breast Cancer Screening : no evidence to support its use as a screening at any age!Scintimammography no role as a screening methodPET : no clear advantage over others. High cost

Back to MAMMOGRAPHYX-ray examination of breast

Some breast cancers

identified 2 years beforethey reach a size detectable by palpation American College of Radiology "Detection, characterization and evaluation of findings suggestive of breast cancer and other breast disease"

MammographyProtocols: diagnostic / screening Diagnostic briefly ; Complaints/symptomsImplantsPrevious history of breast cancer follow upScreening : AgeAsymptomatic

MAMMOGRAPHY AS SCREENINGWomen

MAMMOGRAPHY AS SCREENINGAsymptomatic women age 40 and older who are at avarage risk for breast cancer

C) Self requesting women D) Women with breast augmentation

MAMMOGRAPHY AS SCREENINGAdequate craniocaudal (CC) and mediolateral oblique (MLO) views of each breastThere is no defined upper age limit at which annual mammography screening should end. Most effective between ages 50 and 59

Recent DiscussionsSWISS MEDICAL BOARD, 2013 Benefits of mammography screening overweighed the harms20% risk reduction in mortality BUT at a cost of repeated mammographies, subsequent biopsies and overdiagnosis ! 21.9% overdiagnosis ! Unneccessary treatments,

surgical interventions, radiotherapy, chemotherapy and negative psychological effects

Recent Discussions - Shock goes on...10 year course of annual screening : 73% likely to have false positive mammogram14-20% undergoes unneccessary biopsies0.6-2.8 % underdiagnosed with breast cancer

Recent DiscussionsSwiss Medical Board emphasizes; women are too pessimistic about their chance of developing breast cancer. Do women really know the efficiency of mammography? Not Really; Most are overoptimistic! According to a survey; only 20% women estimated the relative risk reduction of mammography truelly. The rest thought that it reduces mortality by 50-75%

WHAT IS THE CORRECT ESTIMATE?

Recent DiscussionsAnother study - Elmor and Carney; studied the computer aided detection of breast cancer . Sensitvity of mammogram decreases and false positive results increase !

OverdiagnosisOverdiagnosis in Cancer, Welch and Black, 2009

Recent DiscussionPeter C. Gotzsche; No relation between breast cancer mortality and screening effectiveness. The effect of screening is not clear since the size of bias is similar to the estimated effect. But it seems like biases are in favor of screening.

NHS; psyhological consequences of false positivesPsychological distress for 3 years affecting mood and functioningPrevents 3% women from attending their next screeningWhat else NHS says? Sufficient information must be given about their recall/procedures but not too detailed to make them scared and distressed.

On the other hand Researchers and medical staff are concerned that if women are fully informed on efficacy of mammography, participation to screening will reduce and this will affect screening programs considerably. However all agrees that women should be educated and informed about the facts, benefits and harms sufficiently to make their own decisions.

What to do now? Apart from informing women about efficiency of mammography, there is not much to do since it is the only justified way of screening and detection of early breast cancer and diseases. Some experts think that overdiagnosis and false positives are better than missdiagnoses.

What to do now?Reccomendations by Swiss Medical Board: No new systematic mamography screening programs should be introducedA time limit should be placed on existing programs Quality of all forms of mammography screening should be evaluated Clear, balanced information should be provided to women regarding the benefits and harms of screening

SummaryMammographyHigh density of breast is contraindicationCompared to other methods, best way of detecting early cancer.Mortality reduction: 20%But high rates of overdiagnosis and false positives : unneccessary biopsies, surgeries, chemotherapies and radiotherapies.Better method of screening is needed.

THANK YOU FOR YOUR PATIENCE !