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| You-Lin Qiao, MD Ph D Professor Dean, Department of Cancer Epidemiology Cancer Hospital Chinese Academy of Medical Science Chairman-elect, Chinese Cancer Epidemiology Society, CAS |
New Breast Cancer Screening Consensus
In November 2014, World Health Organization's International Agency for Research on Cancer (WHO/IARC) in Lyon, France, 25 experts of 16 countries convened together, evaluated the existing advantages and disadvantages of different breast cancer screening program guidelines, updated the breast cancer screening manual. This new consensus manual will provide guidance to countries around the world to develop breast cancer screening strategies.
The consensus published online on June 3, in the New England Journal of Medicine (N Engl J Med), on June 3, 2015.
Youlin Qiao, MD, Professor, Cancer Hospital, Chinese Academy of Medical Sciences, was the China expert to participate the working committee. Here are parts of the interview by "China Medical Tribune".
The new "Consensus" practical and instructive
With development of mass screening programs for breast cancer, the excessive medical treatment becomes more and more serious.
In 2002, IARC established mammography as the best screening method, and it's efficacy will be further verified by the latest follow-up data. Other imaging methods, breast clinical examination and self examination also need to evaluated.
Mammography for breast cancer screening effective
A large amount of data shows that mammography screening can significantly reduce mortality in 50~69 year old female.
In 70~74 year old female, mammography also significantly lower mortality.
But for women aged 40~49, existing evidence is limited.
Risks such as over diagnosis, short-term negative psychological effects and examination radiation impact on the incidence of breast cancer.
Considering the screening benefit significantly greater than the harm, IARC strongly recommends women aged 50 to 69 to screen by mammography regularly.
But the existing evidence is still unable to determine the optimal screening interval.
Other imaging methods, clinical breast examination and self breast examination
The Consensus points out that, ultrasound, as mammography's secondary screening method, can improve detection rate in breast density of women with dense breast tissue, but also increase the probability of false positives.
It is important to note that all current research on ultrasound screening, are from observational studies.
There is no high quality, rigorous prospective randomized controlled clinical trial available, so we are unable to evaluate whether it can reduce breast cancer mortality.
Similar to ultrasound, clinical examination also lacks of prospective randomized controlled clinical trials, it is difficult to assess its impact on mortality.
Clinical examination could only detect smaller tumor, and earlier stage tumor, compared to no examination, suggested in existing data.
CT, in adjuvant of mammography only can significantly increase detection rate in carcinoma in situ and invasive breast cancer, but the impact on the population mortality evidence is inadequate.
A variety of screening technology combination effectiveness in high-risk groups, such as magnetic resonance imaging(MRI) plus mammography/ultrasonic has yet to be confirmed by research.
Rigorous on screening evaluation literature
The Guidance updates all kinds of breast cancer screening program effectiveness around the world.
Almost all the data used for screening evaluation from developed countries, with rigorous prospective randomized controlled clinical trials and part of the large sample case-control study.
No documents meets the selection criteria from China.
How to guide the breast cancer screening in China
As health reform major project, the Chinese government launched a 3 years, 2009-2011, free clinical breast examination program, for 1.2 million rural women in 35~59 age range.
Using ultrasound, plus clinical examination to screen, the project expands to another 3 years in 2012-2014, 3.6 million rural female, based on expert recommendation considering Chinese female breast with high density, small volume, and the breast cancer peak age is ahead of Europe and United States developed countries.
Exactly what kind of screening method is bests for Chinese women?
Large, perspective, randomized controlled clinical study needed
Large sampled, population-based, perspective, randomized controlled clinical trials, to compare mammography, ultrasound and clinical examination in China are badly needed.
These will provide scientific evidence for the country to launch major programs that benefit hundreds of millions of women's health.
Reference:
乔友林教授谈IARC共识对我国乳腺癌筛查的指导价值 2015-06-26 中国医学论坛报 今日肿瘤 公众微信
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