Breast Cancer

Breast cancer (BC) is the most frequently occurring cancer and the second leading cause of cancer deaths in women, where one out of twelve Australian women will suffer from BC (National breast cancer foundation 2009). Screening programs play a critical role in improving diagnosis and successful treatment. Hence, millions of dollars are spent every year in the health sector to reduce the rate of mortality due to cancer. Cost-effective (CE) analysis is a financial methodology widely used to inform governments about the value of these methods in comparison with the longevity of patients. Therefore, an essential role of CE analysis is to weigh the economic advantages and disadvantages of these screening programs. It is important to maximise the benefits of BC treatment by ensuring that the costs gained towards this treatment are being used efficiently.
The guidelines programs participate in a vital function to improve the accuracy of diagnosis and the successful treatment. Breast Self examination (BSE) is an option for women starting in their twenties and an early way to detect the deformities in breasts by the patient herself or by a practitioner (Breast cancer.org 2008). The effectiveness of this technique links to the regularity and to the correct way of examination. A study carried out in Bangkok was undertaken after a training course of BSE confirmed that the period between the first recognition of symptoms or signs through BSE and the histological diagnosis of BC was short in women performing BSE (National centre for biotechnology information (ncbi) 2008, p1). This method of examination is cost free and will direct patients to the required examinations only when needed, limiting the expenditure which is not required. However, the effectiveness of this technique becomes limited for women with familial risks as formal examinations are needed regularly. Also, this form of detection is not useful when a small tumour is existent as some forms of tumours cannot be diagnosed by self examination alone (American Cancer Society (ACS) 2009, p.1 of 11). While BSE is cost-effective, its general effectiveness towards the detection of cancer is restricted.
Mammography plays a key role in the early detection of breast cancer, as it can show changes in the breast up to two years before a patient or physician can physically feel the tumour. Digital Mammography Screening (DMS) as a computer code image is a safe and beneficial method used to investigate the most common types of tumours with a small amount of radiation (National centre for biotechnology information (NCBI) 2009, P1 of 1). Research has reported improved breast cancer detection and mortality reduction with DMS. (Australian Institute of Health and Welfare (AIHW) 1993, p.1of 1)Therefore, many studies in Australia have relied upon this method to demonstrate the benefits of regular DMS for women over forty years with a family history of BC in regards to the financial cost. According to Australian Institute of Health and welfare (AIHW)(1993, p. 1 of 1 ) has shown that DMS every two years for women over fifty years old is reasonable value for money, and improves life expectancy, while the mortality benefit and CE is less clear for women under this age. This is because cancer is most common at this age through inheritance, while their high breast density makes it harder for DMS to capture cancerous cells. According to the study was made in Hong Kong by the department of Community and School of public health, Wong (2007) showed that as the mortality rate of BC is low; DMS may not be cost effective. The results of this study were based on the low incidence of BC among Chinese women because of their genetic insusceptibility (Wong et al (2007). Consequently, the effectiveness of screening by mammography for mortality reduction is less clear and the CE is controversial and related to the rate of the populations’ incidence.
Therefore, scientists have found another accurate method for the detection of breast tumours. Magnetic resonance imaging screening (MRI) is one of main methods used to evaluate and observe women with a hereditary risk for BC (American Cancer society 2009) .MRI uses strong magnetic fields to generate images that can help diagnose the illness. A study made by the ‘UK Magnetic Resonance Imaging’ in breast screening of women between thirty five to forty nine years at high familial risk of breast cancer, have found that MRI is more sensitive than mammography. However, MRI is approximately ten times more expensive than mammography (Cristofer 2009). Furthermore the specificity of breast MRI is variable and costs are high because many studies have shown both false positive and false negative MRI results. Cost-effectiveness analysis can play an important role to clarify the benefits of MRI in screening women at high-risk for breast cancer. MRI has not yet shown the efficacy in decreasing the rate of mortality. (Grills 2008). Further research into the appropriate role and cost-effectiveness of screening breast MRI will better clarify which specific risk groups are more likely to benefit from MRI screening.
According to statistics taken from the American National Institute (2009), approximately five to ten percent of BC victims have a family history. Therefore, genetic testing is a method that identifies the inherited mutations among members of suspected families of BC. Many research projects are developed to evaluate the effectiveness of detecting cancer in its early stage by looking at genetic factors associated with BC. Genetic testing, such as the BRAC1 and BRAC2 tests (Davidson 2007) could distinguish the mutation in women who are genetically susceptible to developing cancer. This method is effective in spotting the category of women who have the genetic weakness of developing BC. Although genetic testing will identify women at a greater risk, not all women with this mutation will develop cancer. While this will avoid the costs incurred by other methods such as MRI and DMS, which are regularly carried out on patients who are not at such a high risk of cancer (Garber 2006), genetic testing carries a heavy cost on the healthcare system.
A correct diagnosis is needed to undertake the appropriate treatment for BC, while doctors should be aware of the kinds of cells in suspicious lesion. Breast biopsy (BB) is a surgical method which depends upon removal of a sample of breast tissue for examination and specifies the specificity of tumour, either benign or malignant. (Davidson 2007). The benefits of this process are significant and the quality is high, but the CE is expensive in relation to the associated medical conditions. As this practice is performed by a surgeon in the operating room, and requires general anaesthesia, the patient is put under the risk of surgical complications, only for the diagnostic plan. Stereo tactic core biopsy (SCB)as a new way of biopsy has been shown to be a useful alternative to surgical biopsy in the evaluation of non-palpable mammographic lesions of intermediate to high suspicion (National cancer institute). SCB as a procedure made through the skin is simple to do and well tolerated by women in outpatient departments without any surgical requirements. The profits of this procedure can include less disfigurement, lower potential for complications and less costs compared with open biopsy. Therefore, while BB may not be highly cost-effective, the newer method of SCB has proven to be a more cost-effective method.
In conclusion Due to the large amount of available examinations and the large sector of methods, the economic implications of mass screening to detect BC in the early stages are a controversial subject in the health field. Premature detection tests for breast cancer have saved thousands of dollars which may have been spent at the time of treatment when the cancer becomes invasive and incurable. Therefore, the responsibility of detection of BC before the symptoms starts is related to the woman herself asking for help regularly and to the doctor following the guidelines for early detection. All strategies could be useful by improving the chances that BC can be diagnosed and treated successfully. Although BSE is the most comfortable method for women and the least costly, it plays a minor role in the detection of breast cancer. Therefore, BSE is complementary to mammograms which identify several deformities before being detected by doctors.MRI is a very effective way to find tumours of small sizes which mammography often misses, while the high-cost of this method makes it controversial in relation to economic value. Image-guided core biopsy can be cost-saving compared with surgical biopsy, particularly when the mammographic abnormality is classified as low suspicion. Moving to a policy in which core biopsy is the preferred approach in these settings has the potential to result in significant cost savings and it can give the accurate histological diagnosis.



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