CANSA Breast Cancer Screening Position Statement

21 Oct 2011 neil.burman@gmail.com          this Mammography statement by the National Cancer Association of South Africa is abridged, with my comments in italics:

CANSA Breast Cancer Position Statement   September 2010        Compiled by Magdalene Seguin Cancer Association SA. http://www.cansa.org.za/cause_data/images/1056/CANSA_Breast_Cancer_Position_Statement_(2).pdf

“Breast cancer is the leading cancer in women worldwide, with increase in developing countries due to an increase in life expectancy. According to the Globocan Report, 1,38 million women were diagnosed with breast cancer and half a Million women died of it worldwide in 2008. In South Africa the lifetime risk for breast cancer in women is 1 in 29 according to the 2001 National Cancer Registry.  It is 100 times more common in women than men from 60 years of age.

“Breast cancer in males is rare accounting for 1% of all breast cancers.1 in 1,000 men- one in 928 develop it. Men with a faulty BRCA2 gene (which is related to female breast cancer as well), have a 1 in 12 chance of developing breast cancer before the age of eighty.

‘Breast cancer detection in South Africa                                                      Breast self examination (BSE) and clinical breast examination (CBE) are the two most important routine detection methods . They are not diagnostic (nor is any test except tissue exam) but enable further investigation if a lump is detectable. Most breast lumps are benign (non- cancerous ) but new or solitary ones need full investigation.               Ultrasound is mainly utilised as an aid to mammography in persons with suspicious lumps, thus to guide fine needle biopsies (FNB).

 If no optional facilities are available, ‘screening by xray mammography alone, with physical examination of the breasts, plus follow-up of individuals with positive or suspicious findings, will (it is claimed) reduce mortality from breast cancer by up to one-third among women aged 50–69 years.                                    Much of the (screening if any) benefit is obtained by screening once every two to three years as recommended in eg UK..

 ‘Mammography and Ultrasound :Developed specifically for breast tissue radiography, xray mammography is used as a diagnostic tool for symptomatic persons. The imaging system for xray mammography is adapted for the lowest radiation dose possible. The efficacy of mammography depends on the technical quality and the expertise of the radiologist that interprets it. Mammography screening should thus be done in institutions where effective evidence of screening has been proven.

“CANSA advocates an xray mammogram every 3 years from age 35 for non- symptomatic breast screening. The scientific evidence regarding over- exposure to radiation and increased risks in early detection is increasingly established and should be approached with the precautionary principle.

Emerging techniques in breast imaging The following techniques have been assessed globally for potential strengths and limitations as indicated below: 1. The SureTouch breast screening tool : Verified and offered by CANSA, the SureTouch screening device is affordable and small enough to be offered in mobile health clinics. It is CANSA’s aim to equip each of its six mobile health clinics with this effective and affordable SureTouch screening tool, thereby increasing the accessibility and quality of breast cancer screening services to all women in South Africa.                                                                                              Benefits of the SureTouch device include: Sensitive and accurate: The probe houses tactile sensors up to 4 x as sensitive to human touch and is clinically proven to accurately map lesions as small as 5mm.                                                        Real time palpation: Simply palpate suspicious breast lesions and receive instant images of surface stress patterns.                                                                         Objective, reproducible record: Palpation images are reproducible by different examiners, eliminating the subjective nature of a clinical breast exam.  Saves time: Prints an objective electronic record in seconds.                                     Non-invasive and comfortable: Uses a sterile disposable cover and non-toxic, non-irritating lubricant to glide over target areas.                                                           Pain- and radiation free computerised breast imaging:                                          The procedure is totally non-invasive, requires no compression of the breast tissue and uses no harmful radiation to create an image.

” 2 Digital xray mammography or MRI – lower or zero dose radiation but higher in cost than xray mammography

“3.Infrared thermomammography – infrared photographic  measurement of abnormal heat pattern, no harmful radiation.

“4.Transillumination (near infrared spectroscopy light scanning) on infrared sensitive film with a television camera, is less sensitive and specific than xray mammography, no harmful radiation.

“CONCLUSION If you’re over 35yrs in a higher risk category, regular mammograms could save your life. But evidence is increasing that routine xray screening mammography does not save lives, while increasing many risks. The risks do not apply to thermo- or Sure-Touch mammo.

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