Review of evidence on the early detection and treatment of breast cancer

Article Abstract:

Numerous major studies have followed the New York HIP study, which began in 1963 as a randomized study and screened 30,239 women for breast cancer. A Swedish study screened 78,085 women, and a British study screened 45,841 women. The overwhelming majority of studies have confirmed the HIP study, which revealed a reduction in mortality due to breast cancer as a result of screening and early detection. The clearest reduction in death rate is among women from 50 to 74, while the value of screening women from 40 to 49 is less certain. Any reduction in mortality in the younger group will take longer to appear than in the older group. There is virtually no data on the value of screening for women under 40, and regular screening is likely to be of little value if for no other reason than the low rate of breast cancer in this group. Among women over 74, the results are equivocal primarily due to the high mortality rate in this group due to other causes. It is worth noting that, although some organizations, including the American Cancer Society, propose that a baseline mammogram be taken in women under 40, research studies have not established its value. Furthermore, there is little reason to think that such a mammogram will have value for comparison purposes years later. According to recent studies, improvements in breast screening technology have not resulted in the expected further reduction in mortality. Several possible reasons were cited to explain these results. The current trend is to do less frequent screening. The greatest contribution to the reduction in mortality may be from the most easily detectable tumors. Physical examination may be declining as more confidence is placed in mammography. New techniques may take diagnosis from 'early' to 'earlier', which might not have an influence upon the success of treatment. Although early detection is important, improvements in breast cancer treatment may make further improvements in detection less significant. It should be emphasized that these reasons are all speculative at the present time. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Breast cancer detection and community practice: executive summary report of a workshop cosponsored by the General Motors Cancer Research Foundation and the American Cancer Society

Article Abstract:

From February 2-4, 1989, the General Motors Cancer Research Foundation and the American Cancer Society sponsored a workshop on early breast cancer detection. Although it is widely agreed that early detection is of great benefit for the health of women, screening is still underutilized. Several factors might contribute to wider acceptance of breast cancer screening. Primary physicians should take a stronger role in promoting screening and educating patients and staff. Primary physicians must also maintain a close relationship with radiologists and surgical staff. Health care professionals should contribute to the development of a national consensus on breast cancer screening. In addition, any efforts that result in reducing the cost of breast screening will also contribute to the overall effort. Although various organizations have proposed different guidelines, those published by the American Cancer Society and modified by the American College of Radiology and National Cancer Institute have been widely publicized: breast self-examination should begin at age 20. Clinical breast examination (by a clinician) should be performed every three years to age 40 and, then, annually. A baseline mammogram should be taken for women between 35 and 39 years of age. From 40 to 49 a screening mammogram should be taken every one or two years, and women 50 and over should have a mammogram on a yearly basis. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Community programs: breast cancer detection awareness

Article Abstract:

Although there are disagreements about the precise ages of women to screen, and about the risk factors which might suggest screening, there is no reason not to make screening for breast cancer widely available and accessible to women. In 1986, the American Cancer Society announced the Breast Cancer Detection Awareness program. The program included informational activities for both medical professionals and lay people. The program promoted legislation at the state and federal levels, some of which resulted in Congress providing coverage for mammography under Medicare. Media events were promoted to popularize breast cancer detection; important among these were events which attempted to convince women that spending money on a mammogram is a bargain. The program promoted telephone hotlines with cancer information, and instruction in breast self-examination. Surveys have shown that the program has produced favorable results, both in terms of the number of women who have had mammograms and the number of physicians following the Society Guidelines for Mammography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Political activity, Health education, American Cancer Society

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