Benefits, Limitations and Methodology of Population Screening for Breast Cancer - Essay Example

?Discuss the benefits, limitations and methodology of population screening for Breast cancer Introduction Breast cancer is considered to be the most common cancer among women. The incidence of this disease is also increasing in both developed and developing countries mostly because of the unhealthy lifestyles which have pervaded most parts of the globe (World Health Organization, 2012). Although some advancements in medicine have improved the management of this disease, the disease is still very much pervasive and significant in its impact on the female population. Due to its pervasive nature, the management of the disease has been refocused towards the reduction of risks as well as the early diagnosis of this disease (WHO, 2012). In this regard, various screening methods have been established and setup in clinics and hospital settings. In general, this paper shall discuss the benefits, limitations, and methodology of population screening for breast cancer. This study is being carried out in order to establish specific elements in breast cancer screening and provide a basis for adjustments in the management of the disease. Body Cancer cells or malignant cells as seen in instances of neoplasia include cells which manifest with shorter generation times when compared to other similar cells belonging to the same tissue (Chabner and Thompson, 2012). The first tumour growth is often followed by the plateau phase where the cell death would often be the same as the rate at which the daughter cells form. Later the decrease in growth rate is mostly attributed to the depletion of nutrients and of oxygen which assists in the expansion of the tumour (Chabner and Thompson, 2012). As the tumour grows, the nutrients are usually gained by the cells through diffusion and normal blood circulation. Their local growth is also assisted by enzymes which then impact on nearby cells and tissues. When the tumour volume increases, the angiogenesis factors are released in order to secure the formulation of blood supply which is essential for the further expansion of the tumour (Chabner and Thompson, 2012). The tumour usually discards or sheds cells into the circulation. As these cells circulate, some are killed intravascularly, others however may lodge themselves in the endothelium and enter surrounding tissues. This is known as metastasis at distant sites. Through such metastasis, cancer cells are distributed to other parts of the body (Chabner and Thompson, 2012). The primary assessment of breast cancer includes physical examination, mammogram, chest x-ray, and in some cases, CT scans (Virtual Medical Centre, 2005). The final assessment is however carried out through pathological testing, this testing would establish an accurate means of establishing the extent of the growth or spread of the tumour. The extent of spread of the disease usually also determines the stage of the cancer (Huzarski, et.al., 2012). In turn, the stage of the cancer is used as basis for the management and the prognosis of the disease. Under these conditions, the size of the tumour, and the involvement of the other adjacent organs – the skin, chest wall, and lymph nodes are also used as determinants for metastasis or spread (Virtual Medical Centre, 2005). These elements can be detected through pathological testing. Through the physical examination or mammogram, suspicious lumps can be discovered. A biopsy would likely follow the discovery of the lump (Karssemeijer, et.al., 2009). The biopsy is carried out through percutaneous fine needle aspiration, percutaneous core needle biopsy, or excisional biopsy (Virtual Medical Centre, 2005). Fine needle aspiration draws out sample cells from the mass; for the core needle biopsy, a larger needle is used to extract sample cells from the mass; for excisional biopsy, surgery is involved with the radiologist and surgeon participating in the process (Virtual Medical Centre, 2005). In relation to constraints placed on the tissue examination during biopsies, bleeding, bruising, as well as infection are common risks and issues seen (Agency for Healthcare Research and Quality, 2009). Pain can also be a significant constraint following biopsies, especially where there is excision biopsy involved (AHRQ, 2009). In these cases, pain medications are often prescribed following biopsy in order to relieve pain. During surgical biopsies, local anaesthesia is used in order to numb the area where the excision would be carried out (AHRQ, 2009). A 1-2 inch cut is made on the breast and a part of the mass or suspicious tissue is taken out by the surgeon. During core-needle biopsy, local anaesthesia is also used. The doctor usually inserts a hollow needle into the breast and extracts some of the suspicious tissue (AHRQ, 2009). The area where the insertion is made is usually marked by the surgeon. In ultrasound-guided core needle biopsy, ultrasound is used to guide the surgeon in his aspiration during the extraction process (AHRQ, 2009). Computers in some cases are also used to guide the extraction process. Freehand core-needle biopsies are also applied in some cases, especially if the lump/s can be felt through the skin (AHRQ, 2009). Needle biopsy Following the biopsy, the extracted sample is sent to a pathologist to be tested. Possible results obtained may either indicate a malignant or a benign tumour. The results may take about a week to discover (Baum, 2009). If no cancer cells are found in the sample, the tumour is considered benign and the appropriate treatment is often applied, mostly involving the excision of the mass. If cancer cells are found, more imaging and laboratory tests are often carried out in order to determine metastasis to other organs of the body (Baum, 2009). Surgery is also carried out in order to excise the tumour and prevent its growth. Radiotherapy or chemotherapy is usually recommended in order to eliminate the cancer cells from the body, especially the breast area and/or other parts of the body where metastasis may be found (Nelson, 2009). Normal versus cancerous cells (Stephan, 2012) Based on various studies, different etiological factors can lead to cellular changes. First and foremost, gender is an accepted and apparent element in one’s diagnosis for breast cancer, especially as women are 100 times more likely to get it as compared to men (American Cancer Society, 2012). Various authors attribute such element to the role of hormones in the manifestation of breast cancer (Mosher, 2007). Aside from gender, age also seems to be a risk factor in the development of breast cancer. Aging involves the process of cellular wear and tear, and with accumulated elements considered, this can cause the cells to change (Biernacka, et.al., 2012). This would help explain why majority of women found to have breast cancer are 55 years old or older (Biernacka, et.al., 2012). Genes are considered one of the more significant etiological elements involved in the manifestation of breast cancer (Sotiriou and Pusztai, 2009). Cellular changes are often seen in BRCA1 and BRCA2 genes among breast cancer patients. With changes in these genes, women have an 80% chance of developing breast cancer (American Cancer Society, 2012). In effect, a family history of breast cancer may also place one at risk for developing the disease (Sotiriou and Pusztai, 2009). It is common therefore to see sisters or mothers-daughters being diagnosed with the disease. Etiological factors causing cellular changes may also include women not having children or having children later in life. The specific scientific explanation for this has not yet been established, however it has been noted by different studies that women who have not had children or who have their first child past the age of 30 had a slightly increased risk for breast cancer (American Cancer Society, 2012). Having been pregnant or having the first pregnancies below the age of 30 seems to present a lower risk for breast cancer (Newcomb, et.al., 2011). Some researchers do agree that this phenomenon may be related to the fact that pregnancies decrease total number of menstrual periods which seem to affect the development of the disease (Newcomb, et.al., 2011). The use of birth control pills also seems to increase the risk for breast cancer. Stopping the use of pills seems to reduce this risk as women who have stopped taking pills do not seem to have an increased risk for the disease (Smigal, et.al., 2006). Hormone therapy after menopause is also considered a risk factor in the development of breast cancer, mostly in terms of oestrogen and progesterone balance (Beral, et.al., 2011). Oestrogen alone seems to increase breast cancer; progesterone helps reduce the risk. In effect, the hormone therapy must be based on a combined process (Beral, et.al., 2011). The use of alcohol is also linked to a higher risk for breast cancer. Women drinking 2-3 drinks a day have a higher risk as compared to women who do not drink alcohol (American Cancer Society, 2012). The lack of exercise and being overweight can also increase one’s risk for developing breast cancer. Breast cancer is seemingly related to the extra fat around the waist with patients having excess abdominal fat being more likely to be diagnosed with breast cancer (American Cancer Society, 2012). The results of the biopsy have a significant impact on the further management of the patient. If cancer cells are seen during the biopsy, the management of the patient would involve initial surgery and chemotherapy (Hugosson, et.al., 2010). For breast cancer patients, the management usually includes a more aggressive process as compared to non-breast cancer patients. Excision is essential for benign tumour especially when the lumps are easily palpable from the skin surface (Brennan, et.al., 2010). Further testing may sometimes be needed in order to establish the extent of metastasis for breast cancer. Oncologists would usually recommend further tests, including a full body scan to determine any other suspicious growths in other parts of the body (Hugosson, et.al., 2010). The results of these tests would guide the direction of the treatment. The presence of metastasis on other parts of the body, including the liver, the lungs, the colon, and the brain, would likely also indicate surgery to remove such tumours and control the spread of the cancer cells. Conclusion Based on the above discussion, breast cancer screening is one of the most significant options in securing women’s health. Breast cancer is one of the major health issues which women often encounter, and yet, its early detection and management can easily be secured with breast cancer screening. Breast cancer screening provides results which can guide further management of the disease. Once the cancer is detected early, surgery and chemotherapy can be carried out immediately and the metastasis of cancer cells can be controlled the soonest possible time. Under these conditions, the outcomes for patients are improved. References Agency for Healthcare Research and Quality, 2009. Having a breast biopsy: A guide for women and their families [online]. Available at: http://www.effectivehealthcare.ahrq.gov/ehc/products/17/407/core%20needle%20consumer%20guide.pdf [Accessed 01 February 2013]. American Cancer Society, 2012. Breast cancer overview [online]. 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Available at: http://www.who.int/cancer/detection/breastcancer/en/ [30 January 2013]. Read More