Screening for Health
Breast cancer incidence is increasing worldwide. How are radiologists getting involved?
Breast cancer is the is the most common cancer affecting women across the globe, according to the World Health Organization.1
"Breast cancer is a major international health problem," says Murray Rebner, MD, FACR, director of breast imaging at Beaumont Hospitals' Royal Oak Campus in Michigan and professor of diagnostic radiology at Oakland University's William Beaumont School of Medicine.
"The disease burden of breast cancer is increasing," says Robert A. Smith, PhD, senior director of cancer screening at the American Cancer Society. "As more and more women have access to so-called modern lifestyles, risk factors associated with breast cancer are increasing," he notes. "Unfortunately, in many nations, deaths from breast cancer also are increasing due to the lack of early detection programs and inadequate capacity to diagnose and treat breast cancer." "It's really a true increase," Rebner adds. "Part of the rise is due to improved detection, but mostly environmental and reproductive factors are causing the incidence to go up." While not all of these factors are negative, they do impact breast cancer rates.
In an effort to catch breast cancer in the early stages, communities across the globe have implemented breast cancer awareness and screening programs. However, many particularly in the developing world, lack funding, infrastructure, and well-trained personnel, Smith notes.
Rebner says that screening efforts must be adapted based on the existing resources of each country. Nations' resources are commonly classified as basic, limited, enhanced, or maximum, he adds.
Nations with basic resources — such as those in east Africa — do not have abundant food, fresh water, clothing, or housing. "In these areas, the initial goal should be the early detection of breast cancer in symptomatic women by means of clinical histories and clinical breast exams," Rebner says. "In combination with the teaching of breast health awareness, these strategies help improve early detection and improve breast cancer outcomes."
In countries with limited financial means — such as Jamaica and Albania — programs should focus on teaching physical breast exam and bringing diagnostic imaging (ultrasound with or without mammography) to those
with positive physical exams and at-risk populations.
In countries with better economies, such as Morocco and Uruguay, some screening programs may exist, but more can be done. "We're talking about improving awareness about general health and women's heath," Rebner says. Screening programs, which would include regular physical breast exams and mammograms, could be extended to asymptomatic women aged 40 to 69.
In the maximum resource group, which includes the United States and other developed nations, "there is the need for complete public education and awareness about the benefits and risks of screening on a national level," Rebner says. "We want to campaign for breast health." This includes annual mammography starting at age 40, with supplemental imaging for high-risk populations. (The United States does not currently have a national screening program in place.)
The United States in Context
While current screening practices in the United States have contributed to a decrease in the mortality rate, that decrease is not as high as in countries with established national screening programs, such as Sweden, says Michael N. Linver, MD, FACR, director of mammography at X-Ray Associates of New Mexico, P.C., and clinical professor of radiology at the University of New Mexico School of Medicine.
Rebner agrees: "As a country, we can do much better," he says. "It's simple, the more women who get screened, the more lives will be saved."
By learning how other countries are grappling with screening issues, American radiologists can learn how best to help impoverished areas of the United States, Rebner says. Learning about the global situation can also keep American radiologists grounded, Rebner notes. "With an abundance of technology at our disposal, we radiologists need to realize how fortunate we are to practice in this country," he says.
The knowledge of the global situation, and global needs, also helps American radiologists be "better allies in this war against breast cancer," Linver adds. "Because it is truly a war, and it should be thought of as such."
Breast Imaging at ACR 2015
Learn more about the future of breast imaging economics at ACR 2015. Sessions include "Breast Imaging Economics, Breast Cancer Epidemiology, and the Role of Preoperative MRI." See the complete program. Looking for more Breast Imaging Resources? Visit the ACR breast imaging resource page.
By Cathy Cardno, freelance writer for the ACR Bulletin