Mammography for Early Diagnosis
Mammography for Early Diagnosis
2022-05-20 12:24:59/ Kategori : Gynecology and Obstetrics, Radiology
Breast cancer ranks first among cancers in women. It is the most common cancer in women in our country and its incidence is increasing. Despite its prevalence, breast cancer-related deaths have decreased by approximately 25% in the last 20 years. The most important factor playing a role in this decrease is seen as the increase in early diagnosis with effective screening programs, that is, with regular mammograms.
While the principle that women should have regular mammography every year from the age of 40 for early diagnosis of breast cancer in the USA has been generally accepted, the new guidelines published by the United States Preventive Services Task Force in November 2009 have started a great debate. . Accordingly, the USPSTF recommends that women have a mammogram every 2 years from the age of 50. Despite this view, the American Cancer Society, the American College of Obstetrics and Gynecologists, and the American College of Radiology have declared that they will act according to the old principles by opposing the new criteria. They listed the evidence that could support this as follows; the onset of screening at an advanced age, This will lead to the diagnosis of cancers at more advanced stages, which will increase the cost of treatment and patients will be exposed to more aggressive methods for wider treatment. According to large studies that have been done, deaths from breast cancer have decreased by an average of 2% per year since the 1990s. This decrease is more than 3% for each year in the under 50 age group. Since 1989, when deaths from breast cancer peaked, deaths have decreased by about 29%, with mammograms for early detection playing a major role. This decrease is more than 3% for each year in the under 50 age group. Since 1989, when deaths from breast cancer peaked, deaths have decreased by about 29%, with mammograms for early detection playing a major role. This decrease is more than 3% for each year in the under 50 age group. Since 1989, when deaths from breast cancer peaked, deaths have decreased by about 29%, with mammograms for early detection playing a major role.
Mammographic screening also allows us to detect cancer at a younger age. While the average size of breast cancers diagnosed in the early 1980s was 3 cm, when only 13% of women had regular mammography, in the late 1990s the average tumor size decreased to 2 cm when the proportion of those who had regular mammography reached 60%. In addition, according to the data of the American Cancer Society, 17% of the deaths from breast cancer in 2006 were patients diagnosed between the ages of 40-49. Again, according to the data of the National Cancer Institute, with the inclusion of the age range of 40-49 in screening programs, deaths from breast cancer decreased by 3% each year. Cessation of screening in this age group will lead to an increase in deaths and negate the benefits gained in 20 years. The USPSTF, on the other hand, acknowledged the benefit of screening between the ages of 40-49 in its defense, but stated that the disadvantages of screening in this age group reduce the benefit. The need for additional imaging due to the difficulty of distinguishing cancerous and benign tissues with mammography due to denser breast tissue under the age of 50 and the increase in the number of unnecessary biopsies were described as the most important harm, and also pain, anxiety and stress were stated as other harms. Another justification is that although screening between the ages of 40-49 saves lives, it requires more women to be screened for 1 life to be saved. While it takes 556 mammograms, 47 additional imaging and 5 biopsies to detect a cancer between the ages of 40-49, 294 mammograms, 22 additional imaging and 3 biopsies are required after the age of 50. In my personal opinion, the most important drawback here is the cost of early screening. Again, in a study conducted in the USA, an average of $21,400 is required for each year saved by breast cancer screening between the ages of 50-69, while $105,000 is required for each year gained by screening those aged 40-49.
When it comes to our country, the Ministry of Health recommends mammography every 2 years starting from the age of 50. Social security institutions also make repayments in this context. However, in the 1st National Breast Cancer Consensus Meeting held in 2006, the voting age for breast cancer screening was accepted as 60% to 40 years old, and the screening interval to be 60% once a year. The incidence of breast cancer is increasing in our country. Again, in some studies conducted in our country, it has been shown that the incidence of breast cancer at young ages is approximately 2 times the statistics of Western societies. Considering all these, it would be more accurate to accept the screening age as 40 years old. Ladies need a clear message. Early diagnosis is indispensable for success in the treatment of breast cancer. Mammography is our most important weapon for early diagnosis. It should not be argued that the screening age should start at 40 in order to reduce the number of deaths and success in the treatment of breast cancer. In this context, it is clear that no expense is more important than human life.
