BREAST CANCER

Breast Cancer

Breast Cancer

Introduction

Breast cancer is the second most common cancer among women, the first being skin cancer. It is a major problem through out the world and is more common in the developed countries. In the United States of America every eight women is suffering from breast cancer. According to recent statistics, 175,000 American women were diagnosed with breast cancer in one year and 43,300 died of the disease. About one third of these women did not have a family history of breast cancer (National Institutes of Health, 1995).

Breast cancer has also been detected among men. 'In 1999, an estimated 1,300 men in the Unites States will be diagnosed with breast cancer, and 400 will lose their life to the disease. While breast cancer is rare among men, this disease will impact many American men's lives'. (Breast Cancer Awareness: Important to Each Woman, Man and Family)

Problem Statement

Despite the government's recommendation that women not get a mammogram until 50, it is vital for women to receive earlier screening.

USPSTF's Recommendations

The (US preventive Service Task Force on Mammogram and Breast Cancer) USPSTF's recommendations are based on its assessment of net benefit—identified benefits minus identified harms. The USPSTF will only make a recommendation if it judges the available evidence to be of high enough quality that it can have high or moderate certainty as to the magnitude of the net benefit.

Interventions that are deemed to have substantial net benefit receive an A grade; interventions with moderate to substantial net benefit receive a B grade; interventions with small net benefit receive a C grade; interventions that have no net benefit (have harms that exceed the benefits) receive a D grade. If the evidence does not meet USPSTF standards, an "I statement" is issued.

Each letter grade is accompanied by a suggestion for practice. For A and B recommendations, the suggestion is to "offer/provide this service." For C recommendations, the suggestion is to "offer/provide this service only if other considerations support offering or providing the service in an individual patient." For D recommendations, the suggestion is to "discourage the use of this service." For I statements, the suggestion is to "read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms." (ACOG, 2009)

Grade C recommendations highlight the need for individualized decision making that considers the patient's own assessment of benefits and harms. The American College of Obstetricians and Gynecologists strongly supports shared decision making, and in the case of screening for breast cancer it is essential. Surveys have shown that women are more concerned about their risk of breast cancer than heart disease, which is more common. Many women, after weighing the benefits and risks for their own particular situation, will choose to have screening mammography.

The USPSTF's recommendations are based on its assessment of net benefit—identified benefits minus identified harms. The USPSTF will only make a recommendation if it judges the available evidence to be of high enough quality that it can ...