Breast Cancer Screening

Question: Discuss about the Breast Cancer Screening. Answer: Introduction In evidence based nursing and public health, the professionals to be updated with recent research in their field. This is because this knowledge helps them to gain skills which they can apply in the provision of care to the patients (Berg et al., 2012). The clinicians should therefore perform appraisal of the volumes of literature which are published by researchers annually. This includes the methodologies, the study design, data analysis and the data presentation as well as interpretation. Breast Cancer Screening Through Mammography The meaning of the term screening varies among different people, settings as well as beliefs. However, the basic issue is that screening is concerned about finding for the proof of the existence of a disease in a group of patients who are otherwise thought to be healthy (Bjurstam et al., 2016). The main objectives of breast cancer screening are to detect and destroy the early precursors of breast cancer and to detect the tumors early enough while they are still in a stage where treatment can be done. Breast cancer is caused by the inflammation of the breast tissues as a result of increase proliferation of the cells. This leads to formation of dimples, oozing of fluids from the nipples and an alteration of the integrity of the shape of the breasts (Bleyer and Welch, 2012). The risks which could lead to onset of breast cancer could be family history of breast cancers, lack of children or getting them at late ages, lack of regular exercises, obesity, undergoing hormone replacement at menopause and gender (females are more prone than men). In other cases, breast cancers are as a result of hereditary genes that code for onset of this form of cancer. This cancer arises from the increased proliferation of the cells lining the milk ducts which transport milk to the ducts and are thus referred to as the duct carcinomas. In other cases, the uncontrolled cell proliferation can arise from the breast lobules and the resulting type of cancer is referred to as the lobular carcinoma. This therefore calls for more screening of breasts cancers so as to determine the prevalence rates as well as other epidemiological data regarding this disease. In some instances, the biopsies from the growing lump in the breast are taken for laboratory examinations. After diagnosis, the biopsy is then taken through other tests to determine the rate of spread of the cancer (Friedewald et al., 2014). The determination of the spread is important because it allows the clinicians to determine the stage at which treatment can be done as well as the efficacy of the treatment. Most treatment includes the surgical removal of the lump or the breast itself, chemotherapy and drugs like raloxifene and tamoxifene. Due to the increasing cases of breast cancers in both men and women with more severe cases and prevalence being on women, there is a need to carryout routine breast cancer screening. The survival rates of breast cancer vary depending on the age of the individual and the extent of the sp read in the body. Moreover, the survival also depends on the social economic status of the patients whereby high survival rates are noted in the developed world while low survival rates occur in the low or underdeveloped countries (Broeders et al., 2012). The most common screening method is the mammography. This screening involves the recruitment of women who are assumed to be healthy to find out whether there are early symptoms associated with breast cancer. Mammography involves the application of special techniques that make use of images and X rays of low doses such that they can visualize the breast tissues internally. The pictures that are generated from the mammography are transferred to a computer system where the radiologist reviews and stores them permanently (Ciatto et al., 2013). Breast Screening Case Study Considering the work on mammography performed by Anderson et al., 1988, it is crucial to take consideration of some facts with regards to the mammography. Initially, it is believed that the density of the breast tissue increases the risks of contracting breast cancer. This attributed to the fact that a breast tissue which is fatty is translucent as compared to one a light one which is composed of a stromal tissue. This is the prime reason as to why mammography classification of the types and stages of breast cancer is based on the proportion of the breast which is covered by dense tissues. Moreover, women with denser breast tissues are said to provide obstruction to the x rays during mammography. In this case, there is a possibility of poor X rays penetration make the picture resulting from the radiology to appear blurred. In long run, the sensitivity of the mammography is compromised making the identification of the presence or absence of breast cancer to be very difficult (Gotzsche and Olsen, 2000). It is also likely that the low sensitivity results into interval cancers which are characterized by grade three breast tumors. The organization of cancer screening programs to be difficult due to low sensitivity of the dense tumors. Therefore the author of this article was justified in his choice of the study on whether the repeated mammographic screenings were responsible for a reduction in the cases of breast cancer. If such screening is done periodically and using controlled groups, then early treatment and other intervention programs can be initiated to reduce the mortalities and other complications. Therefore there is need to improving the sensitivity of the screening equipment so as to offer a quality assurance to the patients that they are likely to get quality services from the health set up (Kerlikowske et al., 1996). Moreover, the administration of drugs like tamoxifen would help in lower side effects of the breast cancer, reduce the incidences of this cancer and improve the probability of getting a clear and quality mammography during screening. During, the intervals after the first round of screening, approximately seventeen percent of the women used in the study developed breast cancer. This is indicative of the low sensitivity of the mammography screening or probably such cancers were overlooked leading to interval cancers. In most cases, the women who are diagnosed with interval breast cancers means that they did not benefit from the initial screening (Kerlikowske et al., 1993). However this finding is acceptable because several breast cancers have a longer than usual period before visible signs are evident. As a result, some breast cancers are detected in between the intervals of screening via mammography. The factors associated with onset of interval cancers include the pre-menauposal status, increased body mass index and use of hormone therapy by the patient. These factors are linked to the increase in the density of the breast tissue which in turn masks the tumors and makes them less visible. The higher are fatality rate of breast cancer in the control group as compared to the study group in the first seven calendar years was illustrative of the lead time and length time bias that could be associated with screening. Since the attendance was lower in the older women, then it means that the younger women were the majority. This could lead to the possibilities of interval cancers and over diagnosis hence the overall conclusion of the lack of reduction of breast cancer mortalities through mammography (Nystrm et al., 1993). The majority of the deaths as a result of breast cancer could be due to the fact that there was a possibility that the invited women had cancer which was at its advanced stages and could not be treated. This means that although mammography possibly helped in identification of such cancers, there were no intervention methods that could be of use to them. This study used sensitive methods of screening to increase the reliability of the screening as indicated by the low median of the noninvasive carcinomas. Moreover, sensitivity of the screening in this study is confirmed by the proportion of the carcinomas in between the intervals of screening. The free access to mammography which was being provided at Malmo hospital implied that the screening was provided for both the women in the study as well as those in the control group making it more comprehensive. The determination of the cause of the deaths at the end of the screening period was crucial to determine the efficacy of the mammographic screening against breast cancer (Tabar et al., 1992). This is the prime reason as to why a thorough postmortem was carried out due to the increased number of deaths. The use of an independent committee who reviewed the records of the patients whose deaths were linked to breast cancer was used to minimize the possibility of errors. Moreover, there was a reason to take the results to an independent committee because about fifteen out of one hundred and ninety three of the deaths had their causes which were confusing. In the end, the comparison of the deaths that were in the official statistics due to breast cancer and the reports of the independent committee found that ten percent of them were discordant (Andersson et al., 1988). Since the life cycle of the breast cancer is about fifteen years, the screening can only be effective enough if the breast cancer is detected early so that the treatment is started immediately according to the clinical stages. Early treatment prevents the spread of the noninvasive carcinomas and reduces the severity of breast cancer. The findings of this study indicated that overall the screening program did not have any effect to the mortality as a result of breast cancer (Nelson et al., 2016) However, this study found out that the delay in the mammographic screening (involves just counting of the deaths for six years) had an effect in reducing the mortality rates associated with breast cancer by about thirty percent (Kerlikowske et al., 1995). However the findings further reported that the effects of mammographic screening varied with respect to the age of the women. In this case, the mortality rates as a result of breast cancer in women who were fifty five years of age and above reduced by about twenty percent, although the participants were fewer than the young women. On the other hand, the women who were fifty five years and below had mortality rate from breast cancer of about twenty nine percent. The high mortality rates in young women could be as a result of false negatives which possibly reassured such women that they were okay hence delaying their initiation of treatment in good time (Tabar et al., 2003). The overall difference in mortality rates between the old and young women could be attributed to the differences in the biology of the tumors. Benefits and Risks of Mammography There are several risks which are associated with the mammographic screening of breast cancer. In some cases, these techniques are not always accurate since there are possibilities of false positives and false negatives. A breast tissue can hide a tumor such that it cannot be identified in an image obtained from mammography such that the result is that the patient does not have breast cancer. On the other hand, another lump can be misdiagnosed for breast cancer leading to a wrong interpretation of results (Haas et al., 2013). This means that the results of mammographic screening should not be final but should be accompanied by other confirmatory test, while screening itself should be done at intervals. Women are also required to be performing a regular self-examination for the presence or absence of abnormal lumps in their breasts. The women should not be afraid of the X rays used by the mammographic methods because advanced mammography just includes a little amount of radiation which is less than the amount used for conventional X rays (Moss et al., 2006). During screening, the clinicians need to understand the manner in which breast cancer develops. The need for early detection of cancers was started in the United States through campaigns which were meant to educate the people on the need for seeking medical help early in advance. Thus people were urged to be keen for any symptoms associated with cancer because the mortality rates were on the rise. However, there was none of these campaigns which laid emphasis on breast cancer. This is when randomized trials on breast cancers were introduced shortly before the increased adoption of chemotherapy and anti-estrogen drugs for treatment. After such randomized trials, mammography was recommended as the method of choice for breast cancer screening. There have been several debates on the effectiveness of mammography in reducing the mortality rates of breast cancer patients, especially when screening is done outside the experimental settings. Moreover, there have been complaints of the harmful effects of mammography due to over diagnosis (Miller et al., 2014). This refers to the detecting tumors during screening and the progression of such tumors to life threatening stages, a case which would not have happened had screening not be done. The dangers posed to the breast cancer patients as a result of over diagnosing is that all the tumors which are detected are treated including those which are over diagnosed. There needs to be the establishment of some markers for the over diagnosed tumors so that they can be omitted during treatment (Jorgensen and Gotzsche, 2009). The women who have tumors that have been over diagnosed are said to experience harm and the side effects of screening in the course of their treatment. The exact estimation of over diagnosis is difficult because there is no precise method which is available (Puliti et al., 2012). In statistical models, there is a high possibility of the rates of over diagnosis being underestimated since they only test each assumption of the model one at a time (Lauby-Secretan et al., 2015). The assumptions in this case are based on the risk of a possibility of the progression of the tumor to an invasive form of cancer. Several studies indicate that the relative decrease in mortality from bosom malignancy ranges somewhere around twenty five of women aged between 50 to 69 years. Recommendation There is the need for the government to fund the mammography screening programs to reduce the cases of breast cancer (Messersmith et al., 2o15). In some cases, especially in the developing countries, successful mammography techniques are limited by financial constraints and inaccessibility of the services. In most cases, the cost of running these programs exceeds the set budget. It therefore becomes impossible to make follow ups of the women and the whole program may end up being useless. The governments can adopt the mobile mammography method so that that it can increase the ease of access to the screening services. Moreover, there should be mechanisms by the clinicians which enable them to avoid the risks of over diagnosis which comes down with more harm than benefits to the patients. Due to the limited resources which exist especially in the developing countries, it is crucial that the clinicians communicate the benefits and harms of mammography to the patients. This calls for increased prevention and screening interventions to reduce the he incidences of the mortalities arising from breast cancer. Therefore it is advisable that mammography screening remains to be the method of choice for screening the women for breast cancer. More successful screening programs can be enhanced by engaging the community organizations so that more women can be reached. 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