Detection of breast cancer

Article Abstract:

The five-year survival rate of women with early breast cancer is better than 85 percent. However, if the cancer is diagnosed when the tumor has already spread to the lymph nodes, the five-year survival drops to 53 percent or less, making positive lymph nodes the most potent predictor of outcome. Unfortunately, the majority of women have positive lymph nodes at the time of diagnosis. Since we do not know what causes breast cancer, nor how to prevent it or cure it, the best we can do at the moment is to diagnose it as soon as possible. The author recounts the historical development of mammography as an accepted means of early detection. The author himself was a key figure in organizing what today is called the Health Insurance Plan (HIP) Study. Although the benefits of mammography had been demonstrated in some studies, the results were not widely accepted in the medical community at the time. Against considerable opposition in the National Cancer Institute, the study was funded and began to determine if mammography might have an impact on mortality due to breast cancer. The organizers of the study were pessimistic as well, and determined that 60,000 women must be included in the study so that a mortality drop of 10 percent could be detected with statistical reliability. Seven years later, the 30 percent reduction in breast cancer mortality among the women receiving mammography must have been satisfying indeed! The author reviews the currently accepted guidelines for breast cancer screening: women between 35 and 40 should have a baseline mammogram taken, women between 40 and 50 should be examined annually and have a mammogram biannually, and women over 50 should have both an examination and mammogram every year. The author points out that women should be encouraged not only to accept regular mammography, but to demand it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical examination, Breast

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The Health Insurance Plan of New York Study: clinical aspects

Article Abstract:

Over 20 years ago, a pilot project conducted by the Health Insurance Plan (HIP) of Greater New York laid the foundation for confidence in the value of early breast cancer screening. At the time, there was a general belief in the medical community that, given the seriousness of breast cancer and the lack of an actual cure, early diagnosis would not translate into improved outcome and a reduction in mortality. Against some opposition within the National Cancer Institute, funding was obtained for a large study involving 30,000 subjects from HIP medical groups. The study was designed hoping to detect a 20 percent reduction in mortality due to early screening; after seven years a reduction of 34 percent was achieved. The results have persisted, and after 18 years the reduction in mortality is still 23 percent. These results had important consequences for public health, as they firmly established the value of early screening in the reduction of breast cancer mortality. Other results are important, though perhaps less widely known. The study found that the palpation of breasts during medical examination is complementary to mammography. There are tumors which may be palpated and missed by mammography, as well as tumors which are missed by palpation and detected upon mammography. Although preliminary data from the study seemed to suggest that the reduction in mortality did not extend to women younger than 50, as the study progressed it became clear that both women under 50 and those older benefitted from early screening. Newer methods of mammography are more sensitive than those used in the original HIP study, and require less radiation exposure. We may expect, therefore, that the current and future benefits of early breast cancer screening will be greater than those demonstrated in the pioneering study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Self-examination, Medical, Self examination (Medical)

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Factors to be considered in organizing systems for breast cancer detection

Article Abstract:

There are many decisions that need to be made when organizing a breast cancer screening program. A community center is often preferable to a hospital location; it is usually less costly and often preferred by women. A mobile unit may be useful for introducing women to mammography, particularly in low-income areas, but should be affiliated with a medical center for patient follow-up. Some health workers have advocated a single, lateral-oblique, mammographic view as adequate, thereby significantly cutting costs. However, many radiologists prefer having a second view (two X-rays of each breast) to help evaluate ambiguities. The potential for missing a lesion on just one view also suggests that using two views is more prudent. There is some evidence that finding the average breast tumor by mammographic screening saves about one year; this suggests that yearly screening is most appropriate. Although it is clear that breast cancers develop at different rates in different women, the present inability to identify which women are more likely to have slow-growing tumors indicates that the annual mammogram is still preferable over two- or three-year follow-up studies. Another consideration is whether a clinical examination should be included with mammographic screening. While figures vary, it is clear that omitting a physical exam will result in missing 10 to 15 percent of breast cancers in their early stages. The exam need not be performed by a physician. In fact, most physicians lack the experience to perform a satisfactory breast examination and a highly-trained technician is likely to do a superior job. The most challenging aspect of developing a screening program, however, is educating and motivating women to take advantage of the potentially life-saving methods of early breast cancer detection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Management

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