Breast Cancer - Arab Medical Association Against Cancer

Breast Cancer screening 20cause undue anxiety: the confrontation with the possibility of having breast canceris frightening; anxiety is particularly increased in women presenting with a falsepositiveresult, i.e. when abnormalities detected by mammography are subsequentlyfound to be benign. However, documentation on these aspects is scarce. The fewstudies dealing with worry and anxiety show that such reactions seem relativelyinfrequent and tend to regress rapidly. The prevalence of anxiety has been reportedto be significantly greater in women with false-positive results (29%) than in thosewith negative results (13%).Furthermore, mammography involves compression of the breasts, which can causephysical discomfort: 10% to 20% of women reported moderate or severediscomfort. Surgical biopsy, when necessary, involves a risk of infection, scaring,hematoma, pain and breast abnormalities are also possible:Firstly, some screen-detected cancers would never have become clinically apparentduring the woman’s lifetime. The possible magnitude of this effect is uncertain butpredictions give as many as 70% of breast cancers remaining clinically unapparent.Secondly, it is certainly possible that not all in situ cancers become invasive.Thirdly, false-positives based on histology have been reported for small lesions.The difficulty to classify minimal or borderline lesions as benign or malignant isnow recognized and should result in the review of pathological procedures. It hasbeen suggested that women with a false-negative result, might subsequently delayseeking treatment if symptoms develop, because of a false sense of security. Thiscould ultimately result in greater morbidity and poorer prognosis.The increase of life time risk of radiation-induced breast cancer frommammography (if the dose is 0.12 rad per two-view film-screen examination), hasbeen estimated to be less than 1%. Finally, screening can result in a large burden ofunnecessary investigations and treatments when the quality of such interventions isnot assured.Economical CostEffects on health should be considered in relation with the resources allocated forestablishing those effects. The main aim of an economic assessment is to assist therelevant decision makers for an optimal use of the available health care resources.The analysis of the costs components should take into account, the size of the targetpopulation, the investments (equipment), the operating costs (mammography,