How women are screened for breast cancer in Australia. Change.
There is a global debate on this. age Women must be invited for screening. But an excellent greater change is being considered world wide over whether to screen women. High and low risk Breast cancer in other ways.
But what such a “risk-based” approach to screening looks like in Australia stays unclear.
Here's why researchers and public health officials are changing breast cancer screening in Australia, and what any changes could mean.
Why breast cancer screening may have to alter
Mass screening for breast cancer (called population-based screening) was introduced in Australia and lots of other developed countries within the Nineteen Eighties and 90s.
It was based on Strong research which discovered early detection and treatment of cancer before symptoms appeared, which prevented some women from dying from breast cancer.
These programs offer regular breast cancer screening to women inside a certain age group. For example, In AustraliaWomen aged 40-74 can get a free mammogram (breast x-ray) every two years. The Breast Screen Program sends screening invitations to people ages 50-74.
However, there may be growing evidence that screening mammography could also be inadvertent. loss For some women.
For some people, screening causes a false alarm that may result in anxiety, and unnecessary tests and procedures. Even though these tests rule out cancer, these women may feel anxious and feel that something is unsuitable. For many years.
A more insidious harm is overdiagnosis, where screening detects a non-growing or slow-growing lesion that appears like “cancer” under the microscope, but would progress or harm if left alone. It doesn't occur. This means some women are undergoing unnecessary surgery, radiotherapy and hormone therapy that will not profit them, but may cause harm.
Although trials have shown that screening reduces the danger of dying from breast cancer, questions have been raised about how much it does. Saves lives overall. That is, it's uncertain how much a reduced risk of dying from breast cancer improves a lady's overall survival.
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What about targeting women?
One idea is to focus on screening to those that may gain advantage essentially the most. under such “Risk-based” approach, a lady's personal risk of breast cancer is estimated. This might be based on her age and lots of other aspects including breast density, family history of breast cancer, body mass index, These may include genetics, the age at which her periods start and stop, and the number of youngsters she has had.
Women at high risk could also be advisable to start out screening at an earlier age and to be screened more ceaselessly or to make use of a special, more sensitive, imaging test. Low-risk women could be advisable to start out later and screen less ceaselessly.
The idea behind this more “correct” approach to screening is to direct efforts and resources to the small number of ladies who would profit from screening through early cancer diagnosis.
At the identical time, this approach risks false positives (detection of an anomaly but no cancer present) and overdiagnosis (detection of non-progressive or slow-growing cancer) for giant numbers of those women. will reduce the danger which Not likely to benefit.
At face value this looks like an excellent idea, and may very well be a positive change for breast cancer screening.
But there's lots we don't know
However, it's uncertain how it will play out in practice. For one thing, one's risk of a future cancer diagnosis includes the danger of being diagnosed with each. Over-diagnosed cancer Also potentially fatal. This is proving to be an issue in risk-based screening. Prostate cancerone other overdiagnosed cancer.
Ideally, we would really like to predict someone's risk. A potentially fatal cancer As these are those we wish to catch early.
It can also be still uncertain what number of women were present in it. Low risk Will accept advice for Less screening.
These uncertainties mean we want strong evidence that the advantages outweigh the harms for Australian women before we make changes to the breast cancer screening program.
Many are international. Randomized controlled trials (gold standard for research) to judge the effectiveness of risk-based screening compared with current practice. Therefore, it might be prudent to attend for his or her results before making policy or practice changes.
Even if such trials have provided us with strong evidence, many issues remain to be resolved before a risk-based approach might be applied.
A key issue is having enough staff to run this system, including individuals who have the abilities and time to talk to women any concerns they might have about their calculated risk. do
What about breast density?
Are in women with dense breasts Increased risk of breast cancer. Informing women about their breast density is subsequently advisable as a “first step” on the trail to risk-based screening. However, it ignores many other aspects that determine a lady's risk of breast cancer.
I Legislation United States And some changes Australian states. This means some women are already being informed about their breast density. The idea is to extend their knowledge of their breast cancer risk so that they could make informed decisions about future screenings.
But that is before we all know what the very best options are for such women. one The Australian trial is ongoing. Investigating the impact of breast density reporting on individual women and health systems.
What next?
Stronger evidence and careful planning are needed before risk-based screening or other changes to Australia's breast cancer screening program.
Where changes are made, each must be reviewed first. Advantages and disadvantages. Programs are also needed. Independent, regular reassessments In the long run.