Nida Khaliq

Cancer Screening II Literature Review

Jan 25th 2012

Breast Cancer History, Risk Factors & Screening Breast Cancer starts in the cells of the breast. There are two main types of breast cancer. The one that starts in the ducts (thin tubes) is called the ductal carcinoma whereas the one that starts in the lobules (glands that produce milk) is called lobular carcinoma. An estimated 23,600 cases of breast cancer have been reported in Canada in 2011 and resulted in 5,100 deaths. History of Breast Cancer: Breast cancer may be one of the oldest known forms of cancerous tumours in humans. The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Ancient Egyptian medical text, Edwin Smith Papyrus, also describes different cases of tumours or ulcers of the breast. In 17th century, when work on the circulatory system was carried out, a link between the breast cancer and lymph nodes in the armpit was discovered. The earliest known treatment of breast cancer involved removing the lymph nodes, breast tissue and underlying chest muscle. Causes & Risk Factors: There is no single cause of breast cancer, but some factors increase the risk of developing it. Some of these factors are age, personality history, family history, over exposure to estrogen (lack or delay in child bearing, taking hormone replacement therapy), life style factors (overweight, alcohol usage etc. Breast Cancer Screening: Screening options for breast cancer include Breast Examination, Mammography, Molecular Breast Imaging (MBI), Breast MRI, BRCA testing. Breast Examination: Breast examination, wither self or clinical, is the physical examination of breasts for any lump or abnormal physical abnormality. It was once widely recommended but its effectiveness has been criticized by many. It creates a lot of false positives. The precision of this method is difficult to determine because of the lack of consistent and standardized examination techniques. Mammography: Mammography is a common screening method. It is relatively fast and widely available. In this method, low energy x-rays are used to examine human breast. However, it is not very much useful in finding tumours in dense breast tissues. Most aggressive tumours are found in dense breast tissues and therefore this screening method is only restricted to aid in clinical diagnosis of the cancer or in women with a family history of breast cancer.

Nida Khaliq

Cancer Screening II Literature Review

Jan 25th 2012

Molecular Breast Imaging: It is a new nuclear medicine technique and is currently under study. It uses high resolution functional images of the breast to analyze breast tissues for anomalies. Breast MRI: Magnetic Resonance Imaging is also used to detect cancerous tumours in dense tissues of breasts that could not be identified by Mammography. But the probability of a false positive in this type of screening is quite high and it is cost has made it unfeasible for general screening purpose. BRCA Testing: It is a genetic screening that is useful in women with family history of breast cancer. It detects the anomalies in BRCA1 and BRCA2 genes that result in breast tumours. This can also be not used for general screening purposes because only 2% of women carry this gene. Breast Cancer Prevention: There is no proven way of preventing breast cancer altogether but there surely are ways to reduce the risk of having breast cancer. Scientific studies have shown that both increased body weight and weight gain as an adult are linked with a higher risk of breast cancer after menopause. Alcohol also increases risk of breast cancer. Even low levels of alcohol intake have been linked with an increase in risk. Many studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk .A diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products has also been linked with a lower risk of breast cancer. Women who choose to breast-feed for at least several months may also get an added benefit of reducing their breast cancer risk. Breast Cancer in Canada: According to the Cancer Statistics of 2011, breast cancer is the biggest contributor of new cancers in females with a contribution of approximately 28%. It is the second most reason for cancer related deaths in Canadian women, the first being lung cancer. The Canadian Breast Cancer Initiative (CBCI), was launched by the federal government in 1993 with a commitment of $25 million over five years to support research, care and treatment, professional education, programs for early detection, and access to information for women. The CBCI has a Community Capacity-Building (CCB) funding program to help community groups participate in breast cancer support and enhance their ability to provide information and support to people affected by breast cancer. Many provinces have set up breast screening programmes for high risk population According to Statistics Canadas 2008 Canadian Community Health Survey, Newfoundland and Labrador has one of the highest uptakes of mammography testing in the country. Almost 90 per cent of women in Newfoundland and Labrador between the ages of 50 to 69 have had at least one mammogram and almost 60 per cent of women between the ages of 40 to 49 have had at least one mammogram.

Nida Khaliq

Cancer Screening II Literature Review

Jan 25th 2012

Prostate Cancer: Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing but there are a few forms of prostate cancer that grow rapidly. The largest number of new cases of prostate was reported in 2011 in Canada. It is the 4th leading cause of cancer related deaths in men in Canada. Risk Factors: Some of the risk factors of prostate cancer are age, diet, medication exposure and family history. Prostate Cancer Screening: Prostate cancer can be detected using a PSA test and a digital rectal exam. PSA is Prostate Specific Antigen. This antigen is present in small quantity in the semen of health men but an elevated amount is found in case of prostate cancer. United States Preventive Services Taskforce does not recommend its use in healthy men anymore because of the harm associated with subsequent evaluation and treatments. However, its use in Canada has been subjected to the risk factors. On the other hand, Digital Rectal Exam or DRE is a fairly simple procedure but its effectiveness is dependant on the experience of the examiner Importance of Cancer Screening: Many of the available treatments of cancer can only target a specific part of the body. They are highly ineffective once the cancerous cells from the original tumour are separated and spread to other parts of the body. It makes screening highly desirable so that a cancer is detected at an early stage and treated effectively. Conclusion: Awareness needs to be created among the population about the healthy choices of living to avoid cancers to the maximum extent that we can. The link between certain risk factors and cancers is very strong e.g. smoking and lung cancer and it is all about making a adapting a healthy life style. Unfortunately, there is no effective breast cancer screening test available as it is for some other cancers that could fit the criteria of an Inexpensive, Safe, Rapid, Acceptable and Simple test. The widely recommended Breast Self Exam is no more recommended because of the results of a study being published in October 2002. The results of the study showed that the BSE did not significantly contributed to early detection of the cancer and did not add to the life expectancy of the diagnosed patients. The most commonly used Mammography has several disadvantages and has a high failure rate. There is thus a need to invest extensively in breast cancer research programs to find a screening test that could be used to screen general public for this hard to detect killer. Although many researchers are of the opinion that BSE should be discontinued, but looking at the current stats and an absence of a reliable and safe screening option, I believe that BSE should be continued with focus being on setting the guidelines and procedures for performing this examination. At the same time community based programs should be started to create awareness about the disease and its risk factors.

Nida Khaliq

Cancer Screening II Literature Review

Jan 25th 2012

References: Breast Cancer: Understanding your diagnosis. Canadian Cancer Society 2011.
http://www.cancer.ca/NewfoundlandLabrador/Publications/Alphabetical%20list%20of%20publications/Breast%20cancer%20Understanding% 20your%20diagnosis.aspx?sc_lang=en&r=1

Canadian Cancer Society Statistics 2011 Incidence and Mortality by cancer type
http://www.cancer.ca/Newfoundland-Labrador/Publications/Cancer%20statistics.aspx?sc_lang=en

Breast Cancer History, Classification, Screening, Epidemiology

http://www.news-medical.net/health/What-is-Breast-Cancer.aspx

Breast Cancer Screening Health Ontario

http://www.health.gov.on.ca/en/public/programs/breastcancer/screening.aspx

Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? JAMA 1999;282:12701280. Molecular breast imaging Michael O'Connor, PhD, Deborah Rhodes, MD, and Carrie Hruska, PhD
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748346/

BRCA1 and BRCA2: Cancer Risk and Genetic Testing

http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

Canadian Breast Cancer Initiative Community Capacity-Building Component (CBCI CCB)

http://www.phac-aspc.gc.ca/cd-mc/funding-cbci-iccs-eng.php

Recommendations on screening for breast cancer in average-risk women aged 4074 years - Correspondence to:The Canadian Task Force on Preventive Health Care, CMAJ November 22, 2011 vol. 183 no. 17 doi: 10.1503/cmaj.110334
http://www.cmaj.ca/content/183/17/1991 Government of Newfoundland Press Release Nov 2010 http://www.releases.gov.nl.ca/releases/2010/health/1104n04.htm

Digital Rectal Exam and its Accuracy

http://www.realage.com/mens-health/prostate-screening-digital-rectal-exam-dre

Prostate Cancer
http://www.cancer.ca/NewfoundlandLabrador/Prevention/Get%20screened/Early%20detection%20for%20prostate%20cancer.aspx?sc_lang= en&r=1