Breast Cancer Screening Pros And Cons

Introduction

I will discuss the advantages and disadvantages of screening for diseases, and particularly, I will focus on breast cancer. In this regard, I will present various sociological explanations, and apply various concepts in regards to breast cancer, which is a health condition that affects many women in the UK. Notably, the NHS introduced various breast cancer screening programs, which currently are inviting women, especially the age of 50-70 years for screening every 3 years (NHS, 2019). From the time these screening programs were introduced, there have been debates that are sharply polarize with time, and which question the magnitude of the benefits associated with breast cancer screening, the harm associated with it and also the balance existing between them. Of importance to note, the major benefit of breast cancer screening is that it leads to reduced rate of mortality, whereas the major harm realized is overdiagnosis, and its associated consequences. Overdiagnosis refers to cancer detection on screening, which cannot become clinically apparent in the lifetime of a woman in the absence of the breast cancer screening (Heywang-Köbrunner et al., 2011). I will take on to provide a detailed analysis on this subject.

According to Tsunoda & Ban (2017), they note that screening refers to a way of determining if people are disposed to a higher risk of a given health problem/condition, such that early treatment can be offered, thus aiding them in making informed decisions. In the UK, breast cancer is commonly diagnosed in women (48, 450 cases in 2010) and it is noted to be one of the most common diseases, causing the deaths of women (12,560 deaths in 2010). Clearly, UK breast cancer has been increasing in all age groups from 1970s and the causes of the increased rates are due to increased usage of hormone replacement therapy, lower parity, increased obesity, as well as heavy alcohol intake in women among other factors (Lee & Lehman, 2016). Moreover there is better ascertainment, particularly in older women. The introduction of screening programs in the UK for women aged 50-70 years has resulted in the increase in incidence. I will present the advantages and disadvantages of breast cancer screening are as follows:

Advantages

Harris (2016) stress that the primary purpose of breast cancer screening is to advance the diagnosis time, such that the prognosis can easily be improved through early intervention. Shah & Guraya (2017) note that the benefit associated with this is that earlier diagnosis increases the apparent incidence associated with breast cancer and also extends the time from the time of diagnosis to death, even in an instance where screening meant no benefit. In this regard, the measure of benefit is that it leads to reduced mortality in women, especially those who have been offered screening as compared to those who have not been offered (Heywang-Köbrunner et al., 2011). Moreover, it is worth noting that the age of women, who have undergone screening in the UK is a significant factor to consider, owing to the fact that breast cancer increases with age. In this regard, it is evident that women who began receiving screening at 50 years, stand to gain no benefit for the first five years. However, Tsunoda & Ban (2017) argue that the reduction in mortality would significantly continue for a period of 10 years upon the end of the screening.

Disadvantages

According to the writings of Tsunoda & Ban (2017), they note that the major harm that is associated with breast cancer screening is overdiagnosis. Whether the overdiagnosis is invasive or non-invasive, it is noteworthy that there is need for conducting long follow-ups, in a bid to assessing the frequency of overdiagnosis that a woman faces. It is evident that most cases of breast cancer that have been detected through screening often experience overdiagnosis (Lee & Lehman, 2016). In this regard, the uncertainty that surrounds the overdiagnosis is often greater as compared to the estimate connected to mortality benefit, owing to the fact that that there is often a few reliable data sources. Overall, Beau et al. (2018) points out that it should be noted that the major issue that hinders most women between the age of 50-70 years from going for screening is the magnitude of overdiagnosis that they face, as it follows them for their entire lives.

The balance of the advantages and disadvantages

An invitation of women in the UK to engage in breast cancer screening is noted to deliver about 20 per cent of reduction in the rate of breast cancer mortality. Notably, for the UK breast screening programs, it is evident that this corresponds to approximately 1300 deaths, which are being prevented yearly. However, according to Tsunoda & Ban (2017), this benefit should be balanced against various harms associated with breast cancer screening, specifically considering the risk associated with overdiagnosis. Nationally, in the UK, for every 10,000 women invited for breast cancer screening between the age of 50-70 years for 20 years, an estimate of about 681 breast cancers (invasive) are bound to be diagnosed, of which about 129 of them often represent overdiagnosis, yet about 43 deaths are prevented from the same (Heywang-Köbrunner et al., 2011). Owing to the fact that breast cancer treatment has improved overtime, a question that is risen is whether its screening is relevant. Shah & Guraya (2017) note that the benefits associated with breast cancer screening and better treatment of breast treatment are considered independent. In this regard, the possible interaction between the benefits associated with screening and contemporary treatment should not be a reason for stopping breast screening (Harris, 2016). Overall, it is noteworthy that a woman cannot know or determine whether she will fall victim of those who will either benefit or get harmed from screening. As such, in an instance where she prefers to be screened, she should do it with the knowledge that she is either accepting a benefit of having her life lengthened and also knowing that she is exposing herself to overdiagnosis as well as unnecessary treatment (Shah & Guraya, 2017). Likewise, a women declining an invitation to screening should be aware that she exposes her life to a risk of suffering and eventually dying from breast cancer.

Conclusion

In conclusion, it is evident that breast cancer purposes to extend lives and for this reason, the NHS had introduced screening programs, for women between the age of 50-70 years, thus has been able to prevent approximately 1300 deaths associated with breast cancer. This poses as a significant benefit to women. However, it is noteworthy that breast cancer treatment has a cost to the well-being of women. This is because it addition to having their lives extended through detection, as well as early treatment, the screening results into overdiagnosis. In this regard, the consequences associated with overdiagnosis. Overall, is recommendable that breast cancer screening possesses significant benefits, which outweigh the disadvantages and as such, should continue. In this regard, the NHS should ensure that more campaigns are brought forth, in order to encourage women to undergo screening, as it would significantly reduce the rate of mortality, owing to the fact that there are many deaths experienced in the UK, due to breast cancer, which often go unnoticed and untreated. Moreover, the NHS should enforce a clear communication regarding the benefits, as well as harms associated with breast cancer in women, as it is considered to be of utmost significant and thus, goes beyond the manner in which a modern health system ought to function.

References

• Beau, A. B., Andersen, P. K., Vejborg, I., & Lynge, E. (2018). Limitations in the effect of screening on breast cancer mortality. Journal of Clinical Oncology, 36(30), 2988.
• Harris, R. P. (2016). The importance of observational evidence to estimate and monitor mortality reduction from current breast cancer screening. In Breast Cancer Screening (pp. 87-101). Academic Press.
• Heywang-Köbrunner, S. H., Hacker, A., & Sedlacek, S. (2011). Advantages and disadvantages of mammography screening. Breast care, 6(3), 199-207.
• Lee, C. I., & Lehman, C. D. (2016). Digital breast tomosynthesis and the challenges of implementing an emerging breast cancer screening technology into clinical practice. Journal of the American College of Radiology, 13(11), R61-R66.
• NHS. (2019). NHS screening. Retrieved online from https://www.nhs.uk/conditions/nhs-screening/ [accessed on 9th Jan, 2020]
• Shah, T. A., & Guraya, S. S. (2017). Breast cancer screening programs: Review of merits, demerits, and recent recommendations practiced across the world. Journal of microscopy and ultrastructure, 5(2), 59-69.
• Tsunoda, H., & Ban, K. (2017). Verification of Recall Criteria for Masses Detected on Ultrasound Breast Cancer Screening. Ultrasound in Medicine and Biology, 43, S16-S17.