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Breast cancer is the most common cancer in the UK

Breast cancer occurs when breast cells grow abnormally and uncontrollably. It is the most common cancer in the UK. This is indicated in the pie chart below where breast cancer accounts for the highest percentage occurrence among women, that is about 26% . An estimated 46 000 women are diagnosed every year. [1] The two main risk factors for breast cancer are gender – being a woman and age – growing older. [2] In fact 8 out of 10 of the diagnosed patients are women above 50 years old. [1] 90% of breast cancer is caused by environmental factors while the remaining 10% is due to genetic defect.[2] Breast cancer can be treated if it is detected at an early stage, making the patients’ chances of survival greater. Among the symptoms of breast cancer are the presence of a lump or thickening in the breast tissue.

Figure 1 : Cancer occurance among women.

A Possible Solution – Mammogram

In my opinion all women especially those above the age of 50 and those with a strong family history of breast cancer should go for regular mammographic screening. A mammogram is very important for breast cancer screening and early detection. It is an X-ray photograph of the breasts where results are studied to detect any abnormalities or locations of suspicious tissue. According to the National Health Service (NHS) UK, 1 400 lives are saved because of screening. [4]

There are a few differences between screening mammograms and other mammograms. Screening mammography is carried out when there is no lump or visible signs of cancer. However, if a specific lump needs to be looked at, then a diagnostic mammography is done. Here my research is based on screening mammography. [25]

There is a significant difference in opinion regarding how often women should go for mammograms. The American Cancer Society (ACS) suggests that all women over 40 should go for mammograms once every year while the National Cancer Institute (NCI) of the US advises women to go every 1-2 years. [5] I agree with NCI as their suggestion would mean that women are not exposed to radiation too often. Increased exposure to radiation increases the risk of getting cancer.

Figure 2 : Woman undergoing mammogram. (http://i.dailymail.co.uk/i/pix/2006/06/mammoREX020606_228x179.jpg)

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A mammogram is conducted on an outpatient basis and lasts for about 30 minutes. [6] During the procedure, a qualified radiologist helps place one breast at a time on a small flat plate that has an X-ray plate under it. Above the breast there is another flat plate. The machine presses the breast down between the plates holding the breast in position and improving the sharpness of the image. The discomfort only lasts for the short time the breast is compressed.[7] Little bursts of radiation, something like radio waves is produced by the tubes in the machine and is passed through the breasts. The image formed is recorded on photographic film or a special digital image recording plate. The breast is less dense in comparison to the tumor. Therefore the breast appears in gray shades on the mammography while the tumor is white and the air is black as it is the least dense.

Figure 3 : Breast cancer tumor shown

(http://breastcancer.about.com/od/mammograms/ig/Mammogram-Images/Breast-Tumor.htm)

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A radiologist will study the images and look out for any signs of cancer. A signed report is sent to the doctor who will explain the results to the woman.

When a woman goes for this procedure, she is told not to wear any deodorant, powder or lotion in her armpits or her breast as these would appear as calcium spots on the mammogram.[6] Sometimes instead of tumors doctors may find cysts, calcifications and fibroadenomas on the mammograms. Calcifications are not breast cancer but can be an indication of precancer. They are small quantities of calcium that appear in the soft tissue of the breast. Fibroadenomas are benign tumors made of fibrous and glandular breast tissue that are removed as a precautionary step. Cysts are benign fluid - filled sacs that are not related to cancer. [8]

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Effectiveness

Figure 4 : Breast cancer rates by stage

Figure 5 : Breast cancer mortality rates

(http://mole.health.state.ny.us/diseases/chronic/screening.htm)

From the first graph, it is observed that the rate of early diagnosis of breast cancer had significantly improved because of the increase in the number of women who underwent mammography. Consequently, the rate of late diagnosis of breast cancer decreased. The second graph shows that when breast cancer is detected early, there is a decline in the mortality rate. [9] I strongly believe that diagnosing breast cancer early through mammography helps improve women’s chances of survival.

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A newspaper article by Reuters in Washington, US dated October 6th 2009 stated that a study conducted by US researchers found that 75% of women who died of breast cancer never had a mammogram, or were diagnosed after their first ever mammogram. [22]

Dr Blake Cady of Cambridge Hospital Breast Cancer and Harvard Medical School in Massachusetts said:

“ Women who are in screening programmes have only a 4.7% mortality. Women who are not screened have a 56% mortality.”

( http://www.reuters.com/article/idUSN0644662320091006 )

To further prove mammogram effectiveness, below is a summary from a real life breast cancer survivor. [10]

Pam’s story

‘Diagnosed at 46 with breast cancer, after having skipped her mammogram for a couple of years, Pam’s treatment involved mastectomy, radiation and chemotherapy. She wants women to get an annual mammogram, starting at age 40, to catch cancer early and avoid extensive treatment like hers.’

( http://www.mammographysaveslives.org/Stories.aspx?pl=stories&item=1#stories)

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Implications

While conducting this research, I encountered one social issue that is, not all women realize the importance of getting a mammogram. This level of awareness varied due to different levels of education among the women. The graph below supports my statement.

Percentage of US women aged 40 and older who Have Had a Mammogram in the last 2 years by Education Level

Figure 6

( http://www.cdc.gov/cancer/breast/statistics/screening.htm )

Based on the graph women with more than a college education are most likely to have had a mammogram in the last 2 years compared to women with lower levels of education.[11] I think these women are aware of this important screening tool. I also feel there should be more public health education because a lack of information can lead to misinformation. For example, Indian women with breast cancer have to use separate utensils because of the mistaken believe that the disease is contagious. [24]

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I would also like to address an economical issue concerning the use of mammograms. The American Cancer Society suggests that women above 40 should get a mammogram every year but many women are forced to skip their mammograms because they simply cannot afford it. Researchers at Brown University in 2002, discovered mammograms costing US$400 is a challenge for many women. [20]

Despite this, conditions in the US are still not as bad as in some developing countries as seen in quote below.

“The United States spends about US$ 8.1 billion to diagnose and treat breast cancer, but in the city of Poona, India, home to 3.5 million women, only one medical facility provides comprehensive breast cancer diagnostic and treatment services.”

( Masilamany J., February 5th 2009, page 12 )

Also, women living in poverty-stricken countries like Kenya feel helpless and just wait to die because they cannot afford to go abroad for treatment. It is expected that 70% of all breast cancer cases will be in developing countries by 2020. [24] This is why I think governments should try to find a way to ensure all women get their mammograms done.

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Benefits and Risks of Mammography

A video by ‘NHS choices’ entitled “Having A Mammogram” highlights the advantages of having a mammography as it can detect abnormalities which are 3-4 millimeters in size. These abnormalities are impossible to feel if a person were to examine her own breasts.[21] Sometimes a mammogram is more accurate than other diagnostic procedures. A specific pattern of calcium deposits known to cause breast cancer can only be seen clearly on a mammogram. [25] Having a mammography would not leave any radiation in a patient’s body. X-rays normally have no side effects in the diagnostic range. A tumor detected early is more likely to be cured.[6]

Mammograms have certain flaws however. Sometimes false-negatives can occur. This is when breast cancer is present even though the mammograms appear normal. It happens mostly in young women because they have denser breasts compared to older women whose breasts are more fatty making tumors easily visible on mammograms.

At the same time, false-positives also occur because radiologists mistakenly decide the mammograms are abnormal when actually there is no cancer present. This causes unnecessary anxiety and stress for the woman. To avoid false-positives, an ultrasound and a biopsy is conducted.

The doses of X-ray in mammograms is very small but when it is done repeatedly it is harmful and can increase the risk of getting cancer.[13]

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Alternative Solutions

New ‘Breast Pap Smear’

An article titled New ‘Breast Pap Smear’ was written by Duke Medicine News and Communications. This test is currently undergoing three clinical trials nationwide in the US. It works by using a slender needle to extract cells from sections of the whole breast. [15] The quote below further explains the test.

Dr Victoria Seewaldt, a scientist and breast oncologist at the Duke Comprehensive Cancer Center said :

"Just as we do with a cervical pap smear, we can now survey cells from the whole breast, examine them under the microscope and test for early changes that often precede breast cancer. Then we can give women a preventive agent to see if we can eradicate her abnormal cells and thus prevent cancer from developing."

( http://www.dukehealth.org/health_library/news/7450 )

A specific gene known as RAR beta controls how breast cells use vitamin A to ensure their good health. Research done has shown that the genes in breast cancer patients lose its ability to function. This ‘pap smear’ test can detect the presence or absence of this gene. Without it, the possibility of developing cancer is higher. Hence RAR beta acts as a molecular marker to determine the onset of cancer. [15]

I strongly believe that the new breast ‘pap smear’ is an excellent breakthrough in the fight against breast cancer. Once the clinical trials are deemed successful, this should be carried out on all women.

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Ultrasound Imaging

Ultrasound Imaging, also known as Ultrasound Scanning provides pictures of the internal structures of the breasts. During an ultrasound, a physician may use Doppler Techniques to evaluate the blood flow or lack of blood flow in a breast mass. At times it is possible to determine the cause of the mass. Doppler ultrasound is a technique used to evaluate blood flow through a blood vessel.

Breast ultrasound functions to help diagnose breast abnormalities detected during a physical examination and to characterize potential abnormalities seen on a mammogram. A breast lesion detected and classified sometimes cannot be interpreted adequately through mammography alone. An ultrasound can also differentiate if an abnormality is solid or fluid-filled (benign cyst) or both solid and cystic. A solid may be a benign or malignant tumor. Ultrasounds show additional features of the unusual areas on the breast.[14]

Figure 4 : A patient undergoing a breast ultrasound.

( http://www.radiologyinfo.org/en/photocat/gallery3.cfm?image=LbreastMR-vnr-009.jpg&pg=breastus&pid=1, )

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Source Evaluation

In my opinion, the ‘National Health Service Choices UK’ website ( nhs.uk/Conditions/Cancer-of-the-breast-female ) is very comprehensive and factual. This source aims to give objective information and guidance to the public on breast cancer. It is approved by a clinical expert and is funded by the Department of Health. It has been certified as a reliable health and social care information source by The Information Standard and has to meet certain editorial policies. So I think this is a reputable source. I retrieved information on the importance of having a mammogram for early diagnosis of breast cancer as stated on page 9. The following two websites; http://www.mammographysaveslives.org/Stories.aspx?pl=stories&item=1#stories and http://www.radiologyinfo.org/en/info.cfm?pg=mammo#part_one also provided the same information.

An article from the Time magazine entitled The Changing Face Of Breast Cancer, volume 170 published in October 2007 is another reliable source. I believe this article is well researched because it has included views from women across the world. The information that breast cancer is the most common disease among women is also found in http://en.wikipedia.org/wiki/File:Most_common_cancers_-_female,_by_occurence.png). The quote on page 8 from the Sun newspaper is also found in this article.

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