Screening for breast cancer

Article Abstract:

Screening for breast cancer among women over the age of 50 is known to reduce the mortality of the disease. There is also evidence to suggest that screening can reduce the number of deaths of women who are younger than 50 years old. The two main methods for screening breast cancer are physical examination and mammography. The probability that a woman of average risk will be diagnosed with breast cancer in the next 10 years is 130 in 10,000 for a woman who is 40 years old, 230 in 10,000 for a woman who is 55 years old and 280 in 10,000 for a 65-year-old. The chances of dying from breast cancer within the next 10 years are 90 in 10,000 for a 40-year-old, 123 in 10,000 for a 55-year-old and 120 in 10,000 for a 65-year-old. It is predicted from mathematical models that screening by physical examination can decrease the chances of dying from breast cancer by 25 in 10,000 for women in all three age groups and will increase the life expectancy by approximately 20 days. The inclusion of an annual mammogram in the screening will decrease the probability of death by 50 in 10,000 and increase life expectancy by 40 days. Women who have a family history of breast cancer have a two to three times higher risk of developing breast cancer. The actual reductions seen in controlled trials are slightly lower than those that are predicted by the mathematical models. If 25 percent of the women who are of the ages 40 to 75 are screened annually with both a breast physical examination and mammography, deaths from breast cancer could decrease by about 4,000 in the next 10 years. The costs of the screening by breast examination and mammography would be approximately 1.3 billion dollars. The benefits of a screening program must be weighed against its costs and risks. Options in the screening programs include screening women of certain risk categories; women of certain ages; and changing the frequency of examination. It is recommended that women who are at average risk have physical examinations annually after the age of 40 and mammography every 1 to 2 years starting at the age of 50. For high-risk women, mammography should be done annually after 40. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Statistics, Breast cancer, Mammography, Medical examination, Periodic health examinations

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Screening for osteoporosis

Article Abstract:

Osteoporosis, the loss of mass of mineralized bone, is the most common metabolic bone disease. The depletion of minerals reduces the strength of the bone, and creates a high risk of fracture, which is the only symptom of osteoporosis. It is estimated that 250,000 hip fractures, 250,000 wrist fractures, and 500,000 vertebral fractures can be attributed to osteoporosis in the United States each year. The national cost of osteoporosis is estimated at over $6 billion annually. Early detection and treatment of osteoporosis can reduce the incidence of these fractures. To determine whether a screening program might be effective, the medical literature on bone mass assessment was reviewed. Bone mass measurements may be accomplished by a number of different techniques, all of which involve radiation. Quantitative computed tomography may be used. Another method is single-photon absorptiometry, which calculates bone mass by measuring the absorption of gamma rays. This technique has been greatly improved by the introduction of dual-photon absorptiometry, which measures gamma absorption at two different wavelengths to achieve greater precision. Likewise, dual-energy X-ray techniques have now been introduced for the same reason. Prospective studies have clearly indicated that women with greater bone mass loss have a greater risk of fracture. Estimates suggest that a single bone mass scan at menopause might reduce the lifetime risk of hip fracture from 10 to 8 percent, a reduction of 20 percent. However, these numbers are based on many assumptions. Prophylactic treatment involves estrogen replacement therapy for decades, and it is uncertain what levels of patient compliance could be expected. There have been no studies on the efficacy of prophylactic treatment based on early bone mass measurements. The development and preliminary trial of a screening program will be necessary before the public health impact of such a program can be determined. Until such data are available, screening should be limited to women with other indication of osteoporosis, such as an abnormal X-rays. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bone diseases, Osteoporosis

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Screening for lung cancer

Article Abstract:

In 1988, there were 152,000 new cases and 139,000 deaths from lung cancer. Although men are most commonly affected, the incidence of lung cancer has been increasing among women as more women have been smoking. Lung cancer recently became the primary cause of death due to cancer in women. In addition to its high incidence, this disease has a poor prognosis and is difficult to treat. Hence, early detection of lung cancer by screening methods may help to reduce the death rate. Two main tests used to screen for lung cancer are chest X-ray and sputum cytology, the examination of cells contained in sputum, the substance expelled by coughing or clearing the throat. Five human studies were unable to show that screening reduces death due to lung cancer even in high-risk individuals, such as smokers. The Mayo Lung Project demonstrated that the death rate due to lung cancer in high-risk men, who were screened by chest X-ray and sputum cytology every four months, was 3.1 per 1,000 person-years as compared 3.0 per 1,000 person-years in normal subjects. Chest X-ray and sputum cytology tests produced false-positive results in smokers of about 5 and 0.5 percent, respectively. Thus, lung cancer screening is not recommended due to the lack of evidence of benefit, and its potential harm and costs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Testing, Cancer, Lung cancer

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