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Screening mammography + clinical breast exam more effective at detecting breast cancer

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By David Liu, PHD

Saturday Dec 15, 2012 (foodconsumer.org) -- A study in Breast Cancer suggests that screening mammography when used together with clinical breast examination is more effective at detecting breast cancer than screening mammography alone.

M. Kawai from Tohoku University Graduate School of Medicine in Miyagi, Japan and colleagues examined data from 126,537 women aged 40 to 59 years who ere enrolled in the Miyagi Cancer Society Screening program and found mammography screening together with clinical breast examination led to a better survival, suggesting that with this method, breast cancer could be detected earlier.

Among breast cancer patients, 429 cases were found by mammography screening, 522 by clinical breast examination and 3,047 by self-detection.

The researchers found during the follow-up until death or Dec 31, 2007, the five-year survival was 96.8%, 92.7% and 86.6% in women who were diagnosed with breast cancer by mammogram screening coupled with clinical breast examination, clinical breast examination alone, and self-detection, respectively.

The death rate among patients aged 40 to 49 years whose breast cancer was detected by clinical breast examination and self-detection was 2.38 and4.44 times, respectively, as high as that for those whose breast cancer was detected by mammography screening together with clinical breast examination.

Patients aged 50 to 59 whose breast cancer was detected by clinical breast examination and self-detection were 3.00 and 4.51 time as likely to die within five years of diagnosis as those whose disease was detected by mammography screening coupled with clinical breast examination.

The results did not mean that mammography screening coupled with clinical breast examination by themselves have any protective effect on the prognosis of breast cancer.  It is possible that using both screening mammography coupled with clinical breast examination can detect the disease earlier.   Earlier detection was always linked with seemingly better survival.

It should be noted that the survival time seemingly improved by earlier detection may not actually extend the lifespan in women with breast cancer.  For instance, a patient is diagnosed with breast cancer in 2012 and treated after diagnosis and dies within five years, say in March, 2004.  In this case, she is not a survivor.  However, if the disease is diagnosed in 1998 (earlier detection), she receives the same treatment, and dies in March, 2004. In this case, she is a 5-year survivor even though she dies in the same year (the treatment and earlier diagnosis does not have to actually extend the lifespan for the patient).  In other words, early diagnosis allows doctors to start counting the time of survival earlier, in this case, the patient  is more likely to be counted as a survivor even if the same old treatment is used and the patient dies in the same year.

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