Breast Cancer - Arab Medical Association Against Cancer

Breast Cancer Screening 25Similarly, the Global Summit Early Detection Panel concluded that mammographicscreening is not currently a realistic goal for most countries with limited resourcesand recommended that early detection efforts first be focused on the education ofpatients and physicians and increasing general social awareness about breastcancer.The Summit Panel suggested the following sequential approach: 1) promote theempowerment of women to obtain health care, 2) develop the infrastructure todiagnose and treat breast cancer, 3) begin early detection efforts through breastcancer education and awareness, and 4) when resources permit, expand earlydetection efforts to include mammographic screening if breast cancer treatment isavailable for all detected cancer.The Panel argued that although such programs will first provide care to a portion ofthe population and could serve as pilot programs for more extensive programscovering larger populations, and ultimately the entire population, as resourcesbecomes available.As completely new technologies emerge, such as the ability to identify genetic riskfactors, new challenges also emerge. We cannot be satisfied with simplyidentifying women at particularly high risk. We must be prepared to counsel themabout the risk and to propose them some solution.Within the past 10 years, work defining the basis of genetic susceptibility to breastcancer in general and the identification of BRCA1 and BRCA2 specifically hasenhanced the accuracy of breast cancer risk prediction. The subsequent diffusion ofrisk prediction tools, such as genetic susceptibility testing and the National CancerInstitute's “Risk Disk” have resulted in the identification of many women atincreased risk of breast cancer. Although this information has implications formany areas of medical care, its potential impact is particularly great in the area ofcancer screening. In theory, the ability to stratify breast cancer risk allows intensivescreening regimens to be targeted to women at high risk who are most likely tobenefit, with more limited screening for women at lower risk. This approach bothreduces complications associated with low-risk biopsies and saves health careresources. The challenges now are translating this approach into practice.In a recent study by Brekelmans et al., the effectiveness of breast cancersurveillance in BRCA1/2 gene mutation carriers and women with high familial riskwasdemonstrated.