Breast Cancer Screening

Breast Cancer Screening

 
BreastCheck is an Irish Government-funded programme that provides free mammograms to eligible women every two years.

According to the BreastCheck website:

BreastCheck is being extended and by the end of 2021, all eligible women aged 50 to 69 will be invited for routine screening. This will be done on a phased basis and will be achieved by inviting women who were aged between 50 and 66, on the 1st January 2018, for mammograms until they reach the age of 69.

The aim of BreastCheck is to reduce deaths from breast cancer by finding and treating the disease at an early stage.

Women should be aware, however, that substantial research indicates that regular mammograms may do more harm than good.

A study published in 2017 in the New England Journal of Medicine involving thousands of breast cancer cases, concluded that a significant proportion of tumors detected through mammography are not small because they are found early. Instead, the tumors are small because they are biologically prone to slow growth.

Mammograms can result in over diagnosis and unnecessary treatment according to this study. Mammograms can also be very painful according to this study involving 50-year-old Finnish women attending their first breast cancer screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely).

In this study 89,835 women, aged 40-59, were randomly assigned to mammography (five annual mammography screens) or control (no mammography). Conclusion: Annual mammography in women aged 40-59 does not reduce mortality from breast cancer…

This study conclused:
Screening with both MRI and mammography might rule out cancerous lesions better than mammography alone in women who are known or likely to have an inherited predisposition to breast cancer.

In an interview with National Public Radio, Donald Lannin, a professor of surgery at the Yale School of Medicine, who led the study, said “It takes 15 or 20 years for [these small tumors] to cause any problems. And you can kind of imagine that a lot of patients will die of something else over that 15 or 20 years.

That means a significant proportion of women who get screened for breast cancer with a mammogram go through biopsies, surgery, chemotherapy, radiation — and experience a lot of stress — for tumors that may never pose a health threat.

In the same interview, H. Gilbert Welch, a professor of medicine, community and family medicine at Dartmouth College, who was not involved in the study, said “It appears that screening disproportionately finds good cancers — cancers that may be better off not found,”.

“I think that we all need to realize that we’ve probably oversold the idea that looking for cancer early is the best way to avoid it,” Welch says. “Mammography’s a really close call. It’s a choice. We’ve exaggerated its benefit and we’ve sort of understated its harms.”

2018 update

The National Cancer Institute’s Breast Cancer Screening (PDQ®)–Health Professional Version (updated June 1, 2018) includes the following :

Theoretically, in a given population, the detection of more breast cancers at an early stage would result in a subsequent reduction in the incidence of advanced-stage cancers. This has not occurred in any of the populations studied to date. Thus, the detection of more early stage cancers likely represents overdiagnosis. A population-based study in the Netherlands showed that about one-half of all screen-detected breast cancers, including DCIS, would represent overdiagnosis and is consistent with other studies, which showed substantial rates of overdiagnosis associated with screening.


Swiss Medical Board call for end to Mammography Screening

In 2013, the Swiss Medical Board recommended that Mammography Screening be abolished in Switzerland ( The New England Journal of Medicine ) because of the emerging evidence that the harms of mammography outweigh the benefits.

Furthermore, a Cochrane review of 10 trials involving more than 600,000 women showed no evidence that mammography screening reduced overall mortality (deaths).


This is an eye-opening documentary on breast screening.

Get the full documentary at thepromisefilm.net


No Mortality Benefit of Breast Cancer Mammography Screening in 25-Year Follow-up of Canadian National Breast Screening Study

By Matthew Stenger
Source: The ASCO Post

Mammography Screening Reconsidered
Anthony B. Miller, MD

As reported in BMJ by Anthony B. Miller, MD, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, and colleagues, the 25-year follow-up of the Canadian National Breast Screening Study has shown no mortality benefit of annual mammography screening for breast cancer compared with physical examination or usual care. Mammography screening was associated with substantial overdiagnosis.

Overdiagnosis

By the end of the 5-year screening period, there were 142 excess cases of breast cancer in the mammography group (666 vs 524). At 15 years after enrollment, the excess number of cancers in the mammography group became constant at 106 cancers. The excess number represents 22% (106/484) of all screen-detected cancers. Thus, there was one case of overdiagnosis of breast cancer for every 424 women screened by mammography during the trial.

The investigators concluded, “[O]ur data show that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40 to 59 beyond that of physical examination alone or usual care in the community. The data suggest that the value of mammography screening should be reassessed.”
Continue reading at The ASCO Post

In conclusion, here is a 2017 News Release issued by Nordic CochraneCenter

Overdiagnosis
Definition of Overdiagnosis
(National Cancer Institute)

Finding cases of cancer with a screening test (such as a mammogram or PSA test) that will never cause any symptoms. These cancers may just stop growing or go away on their own. Some of the harms caused by overdiagnosis are anxiety and having treatments that are not needed.

Some cancers that are diagnosed early do not develop symptoms requiring treatment, while others grow so slowly that the patient outlives the cancer and dies of other causes. Many of these are treated unnecessarily, leading to:

  • Unnecessary tests and treatment
  • Exposure to dangerous side-effects
  • Radiation-induced cancers
  • Mental and physical pain
  • Infertility
  • Inflated survival rates

New study finds breast cancer screening leads to substantial overdiagnosis

Women have been told for decades that they need to attend their routine breast screening appointments to detect early signs of breast cancer. However, a new major study, conducted by researchers at the Nordic Cochrane Centre in collaboration with researchers from Norway, looked into the effects of breast cancer screening programmes and have found a high risk of overdiagnosis and raise doubt about their benefits.

Risk of overdiagnosis outweighs the advantages of breast screening programmes

The cohort study, which was recently published in Annals of Internal Medicine, supports previous findings from the Cochrane review: Screening for breast cancer with mammography on the high risk of overtreating women and the doubts raised about the benefit of the intervention.

In an attempt to diagnose breast cancer early, a mammography screening very often detects small tumours that might not necessarily become malignant. In other words, the tumour would more than likely not be a life-threatening illness or health problem for the woman being treated. A breast cancer diagnosis is a life-changing event with profound implications for the psychological well-being and quality of life for women diagnosed and their families. They are subjected to invasive surgery, radiotherapy and sometimes chemotherapy, all of which are known to have serious, sometimes lethal, harms. The study also found that screening did not reduce the number of late stage tumours (those bigger than 2 cm), which means that breast screening is unlikely to reduce breast cancer mortality or lead to less invasive treatment.

Karsten Juhl Jørgensen, the lead author of the study explains, “In Denmark, we have the conditions to carry out a unique study as the screening programme was rolled out across the country in different regions at different times. We, therefore, had a control group of women of the same age during the same time period where the screening programme existed. This group of women were not screened over a 17-year period, making it possible for us not to have to speculate over what would have happened in the absence of screening”.

Additionally, breast screening leads to a 25 % to 50 % risk of being recalled due to a false positive test result if women attend a screening for the often recommended 20-year period. A false positive recall often means more mammograms and often biopsies. The time until a breast cancer diagnosis is excluded can be very stressful, and can have negative implications for many women’s quality of life even well beyond this period.

In his editorial on the study, Chief Medical Officer for the American Cancer Society, Dr. Otis Brawley recognises the need for accepting the limitations of mammography screening, “Acknowledging the existence of breast cancer overdiagnosis challenges the value of screening: it means that the benefits of breast screening have been overstated, and that some women who have been “cured” were harmed because they received unnecessary treatment”.

The main findings from the study are that:

  • Screening did not reduce the number of late stage tumours (those bigger than 2 cm), which means that breast screening is unlikely to reduce breast cancer mortality or lead to less invasive treatment
  • 1 in 3 breast cancers detected in women offered screening are likely overdiagnosed

The authors of this study which looked at cancer overdiagnosis stated: We estimate the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers

This Article, published in 2012 in the New England Journal of Medicine, found: 31% of all breast cancers are over-diagnosed.

This 2016 review concluded:
· At least 20% of Breast Cancer patients, if left untreated would be alive after 5 years
· limited evidence suggests that around 10% of screen detected Breast Cancers may regress.

Should mammography screening be stopped?

Independent expert groups in Switzerland and France have recommended that breast screening be stopped or reduced substantially. Elsewhere, guidelines are already changing as well, i.e. the American Cancer Society now recommend less frequent screening of a narrower age group than just two years ago. Our study supports this development.

The full report is titled: “Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis.” The authors are K.J. Jørgensen, P.C. Gøtzsche, M. Kalager, and P. Zahl.

For more information on breast cancer screening and the implication of the findings, please read the Cochrane Review on mammography screening or mammography screening information leaflet.

Karsten Juhl Jørgensen, the lead author of the study, can be contacted via email: [email protected].


Should you undergo regular breast screening using mammography? That’s your call. The above information is for educational purposes only.

If you notice any symptoms or changes in your breasts, you should consult your GP without delay.


Molecular Breast Imaging (MBI)

Molecular Breast Imaging: Potential New Tool for Detecting Cancers

Source: Oxford Journals

Mammography may be a “gold standard” for breast cancer screening, but for some women, its interpretation amounts to little more than a coin flip. In women with dense breasts, which contain more stromal and epithelial tissues than fat, interpretation of mammograms is difficult. Among these women, tumor detection rates with mammography barely exceed 60%. Both tumors and breast tissues appear white on a mammogram, but fat looks black. Clinicians can easily detect cancerous lesions against the darker fat backdrop, whereas dense tissues obscure tumors that could be life threatening.

Now researchers at the Mayo Clinic in Rochester, Minn., say that a different screening method— molecular breast imaging (MBI)— may offer a promising alternative for women with dense breasts, who make up much of the female population. Deborah Rhodes, M.D., an assistant professor at the Mayo Clinic, said roughly a quarter of all women older than 40 years have breast tissue that is more than 50% mammographically dense.

Compared with mammography, she said, MBI detected three times as many cancers among a population of 940 dense-breasted women who also had at least one additional breast cancer risk factor, such as a family history of the disease. These preliminary findings, announced in September at the American Society of Clinical Oncology’s 2008 Breast Cancer Symposium in Washington, D.C., came from an ongoing, comparative study of MBI and mammography that was launched at the Mayo Clinic in 2005. “We’re talking about a supplement to mammography that could be readily adopted by communities, instead of just major academic institutions,” said Rhodes, who is also the study’s principal investigator. “While [mammography is] terrific for some women, it doesn’t work well for others. For them, we need a better test, and that’s what MBI could provide.”
Read more at Oxford Journals


Note: Molecular breast imaging is a new technology, so it isn’t yet widely available.


Breast Imaging
New breast exam nearly quadruples detection of invasive breast cancers in women with dense breast tissue

Source:Science Daily
Date: January 23, 2015

Source: Mayo Clinic
Summary:
Molecular Breast Imaging (MBI) is a supplemental imaging technology designed to find tumors that would otherwise be obscured by surrounding dense breast tissue on a mammogram. The new breast imaging technique nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue, according to the results of a major study.
Read more at Science Daily


Deborah Rhodes: A test that finds 3x more breast tumors, and why it’s not available to you.

Source: TED.com

Working with a team of physicists, Dr. Deborah Rhodes developed a new tool for tumor detection that’s 3 times as effective as traditional mammograms for women with dense breast tissue. The life-saving implications are stunning. So why haven’t we heard of it? Rhodes shares the story behind the tool’s creation, and the web of politics and economics that keep it from mainstream use.

See the video at TED.com


Digital Infrared Imaging (Thermography)

DII AS A RISK MARKER FOR BREAST CANCER
Source: breastthermography.com

Studies show that an abnormal infrared image is the single most important marker of high risk for developing breast cancer, 10 times more significant than a family history of the disease (5). Consequently, in patients with a persistent abnormal thermogram, the examination results become a marker of higher future cancer risk (4,5). Depending upon certain factors, re-examinations are performed at appropriate intervals to monitor the breasts. This gives a woman time to take a pro-active approach by working with her doctor to improve her breast health. By maintaining close monitoring of her breast health with infrared imaging, self breast exams, clinical examinations, mammography, and other tests, a woman has a much better chance of detecting cancer at its earliest stage and preventing invasive tumor growth.

Angiogenesis, or new blood vessel formation, is necessary to sustain the growth of a tumor. Digital Infrared Imaging may be the first signal that such a possibility is developing (3).

See full article at breastthermography.com

Where can I get this test?
This test is now available at numerous medical facilities including:

Ireland

Hollywood Health (Northern Ireland)

United States
Breast Thermography (list of testing centers country-wide)

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