Question

List a primary, secondary, and tertiary intervention for breast cancer, what would you recommend as a screening policy?

Answer 1

Three categories of intervention for breast cancer primary, secondary and tertiary

PRIMARY PREVENTION

The goal of primary prevention is to reduce or eliminate exposure to cancer-causing factors, which include environmental carcinogens and lifestyle factors related to nutrition and physical activity.

Approaches to primary prevention include:

• Immunization against, or treatment of, infectious agents that cause certain cancers.
• Use of tobacco control programs.
• Reduction of excessive alcohol consumption, overweight and obesity.
• Pharmacological intervention.
• Dietary intervention, education about healthy and safe habits

SECONDARY PREVENTION

The main objective of secondary prevention through population based screening programs is detection at a stage at which curative treatment is possible. Interventions for the early detection of cancer can help reduce mortality from cancer only if they are part of a wider cancer control strategy that includes effective diagnostic and the follow up procedures and treatment. Implementing programs to return people to their original health and function to prevent longterm problems.The following are the examples

• Regular exams and screening tests to detect disease in its earliest stages (mammograms to detect breast cancer).It aims to identify individuals with an abnormality suggestive of cancer.
• Low dosage of aspirins and diet and exercise programs to prevent further heart attacks or strokes.
• Modified work so injured or ill workers can return safely to their jobs.

TERTIARY PREVENTION

Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries in order to improve as much as possible their ability to function, their quality of life and their life expectancy. The following are the examples

• Cardiac or stroke rehabilitation programs, chronic disease management programs.
• Support groups that allow members to share strategies for living well.
• Rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

MRI is used along with mammograms to screen women who are at high risk for getting breast cancer.

Breast cancers that are detected when smaller or nonpalpable are more treatable and thus are associated with a more favorable prognosis.The following are the Imaging studies used in breast cancer screening

• Mammography

• Ultrasonography

• Magnetic resonance imaging (MRI)

• Clinical Breast Examination (CBE)

• Breast self examination (BSE)

MAMMOGRAPHY

Mammography is a special type of low-dose x-ray imaging used to create detailed images of the breast. Mammography is the best available population based method to detect breast cancer at an early stage, when treatment is most effective. Mammography can demonstrate microcalcifications smaller than 100 µm.

Mammography is less likely to find breast tumors in women with dense breast tissue. Because both tumors and dense breast tissue appear white on a mammogram, it can be harder to find a tumor when there is dense breast tissue. Younger women are more likely to have dense breast tissue.

There are 2 types of mammography examinations:

• Screening:
  • Screening mammography is done in asymptomatic women.
• Diagnostic:
  • Diagnostic mammography is performed in symptomatic women.This examination is more involved, time-consuming, and expensive than screening mammography and is used to determine the exact size and location of breast abnormalities and to image the surrounding tissue and lymph nodes.

ULTRASONOGRAPHY

Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. Ultrasound is generally used to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. Ultrasonography was used primarily as a relatively inexpensive and effective method of differentiating cystic breast masses, which did not require sampling.However, it is now well established that ultrasonography also provides valuable information about the nature and extent of solid masses and other breast lesions.

It is recommended that ultrasonographic screening for breast disease be reserved for special situations, such as for highly anxious patients who request it and for women who have a history of mammographically occult carcinoma.

MAGNETIC RESONANCE IMAGING

A breast MRI uses magnets and radio waves to take pictures of the breast. MRI has been explored as a modality for detecting breast cancer in women at high risk and in younger women. A combination of T1, T2, and 3-D contrast-enhanced MRI techniques has been found to be highly sensitive to malignant changes in the breast.

Breast self examination (BSE)

The practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommend for raising awareness among women at risk rather than as a screening method.

Clinical Breast Examination (CBE)

CBE, A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.