The impact of mammography screening on the surgical treatment of breast cancer

Abstract

Marcon et al conducted a retrospective study in Switzerland and evaluated the impact of mammography screening on the surgical treatment of 262 women with breast cancer. Mastectomy was performed in 16/92 patients (17.4%) whose breast cancer was identified at screening and in 55/170 (32.3%) whose diagnosis was based on clinical findings. Conservative breast surgery was performed on 82.6% of the patients whose diagnosis was made at screening and on 67.6% of those whose diagnosis was clinical. 1In Brazil, despite the geographical and population differences, advancement in the surgical treatment of breast cancer has been similar. In a recent analysis of 193 596 breast surgeries performed within the Brazilian National Health Service between 2008 and 2014, a reduction was found in the number of simple mastectomies and of lymphadenectomies, while the rates of conservative surgery remained stable. Nevertheless, the overall rate of patients undergoing breast reconstruction increased from 15% in 2008% to 29.2% in 2014. 2 This outcome may be a consequence of the cancer being diagnosed at earlier stages due to the increased coverage of mammography screening in Brazil. 2,3 Among the limitations of the study conducted by Marcon et al, the small sample size and the fact that the surgeries evaluated were performed at a single treatment center merit particular attention.Therefore, the indications for surgery may reflect regional peculiarities and may not necessarily be a result of mammography screening.In Brazil, for example, a study conducted in a referral hospital for breast cancer treatment analyzed the 403 surgeries performed between 2002 and 2009 and found an annual increment of nine mastectomies (P = 0.04). 4 Nevertheless, over the same period, there was an increase in the number of advanced cases of the disease in that hospital, which explains the differences between these findings and the nationwide patterns. 4Finally, the difficulties in accessing health care services found in some regions of Brazil 5,6 should be emphasized, as well as the absence of an effective population-based screening program. 7,8 In 2013, the nationwide estimated mammography coverage within the public health care system was only 24.8%, ranging from 7.5% to 35.7% in the different states in the country. 8 The barriers to mammography screening in Brazil include the limited access of the population to information and to health care services, the geographical distribution of mammography machines that tend to be concentrated in the major cities, the inadequate quality of mammography in some centers, and the delay in treatment following a diagnosis of breast cancer. 5-7 Therefore, the consolidation of organized population-based breast cancer screening and the elaboration of public policies for the management of breast cancer in Brazil will make the advances associated with the surgical treatment of the disease more effective. O R C I DLeonardo Ribeiro Soares A. Influence of breast cancer opportunistic screening on aesthetic surgical outcome: A single-cente...

Difficult Access and Poor Productivity: Mammography Screening in Brazil

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Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

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