The current increase in cases of breast cancer has led to the evaluation of awareness programmes and scrutiny of screening procedures. Unfortunately, studies have yet to compare methods used in developed countries as well as third world countries. Through an extensive case study we will be able to finally have a thorough investigation of what transpires as data collected from England and Iran will be able analysed to give a more vivid picture of what transpires in the approach they use to combat this deadly disease. This paper will cover areas concerning the age limit of breast screening, methods of screening used, frequency of screening, mammographic accuracy, percentage of DCIS and methods of teaching breast self-examination to patients. The limitations to this research model are acknowledged and suggestions to improve in this area are included as well.
The author would like to extend gratitude to the doctors who took their time to respond to the authors survey and numerous email interviews to the best of their knowledge (for privacy reasons the doctors names will remain withheld). The data collected from the Cancer institute, Tehran University of Medical Sciences and Cardiff Breast Unit and University Hospital Llandough them proved to be valuable beyond measure and is what is centred on in this model.
Cancer is slowly becoming one of the principle causes in death in the twenty first century. It affects the young and the old and does not discriminate. The early myths that categorized it as the disease of the rich has since been dumped into the dustbin of history as cases of the disease has no boundaries and spreads far and wide touching every continent and affecting almost every household. In women, the most common types are cervical and breast related. Of the two, the one most commonly occurring is the cancer of the breast. It dates back to the eighteenth century when an Italian doctor by the name Bernardino Ramazzini noticed the declining number of cervical cancer cases as opposed to breast cancer in patients that he treated which led to more findings and understanding of its regular occurrence in women. Since then strides have been made in identifying the root cause of the disease.
As of 2008, breast cancer (BC) is the major cause of female morbidity and mortality with incidences of 450,000 new cases and 140,000 reported deaths in European Union member countries with the highest being reported in Western Europe (coincidentally being the highest number in the world). Its wide spread prevalence rate, the high cost of treatment and the strain it causes on health services has made it a major concern in both developed and developing countries. It is with this reason that our case study is focused on and the difference in screening techniques used in two different regions that face the same disease. By highlighting the different methods used, better strategies can be developed which will aid in the defeat of this killer disease.
METHODOLOGY AND RESEARCH DESIGN
The same questionnaire was administered to both health facilities and the questions asked were based on the parameters set below:
I would like to start with some background questions:
Clinic/Hospital that you work for ________________________________________
Your current role _____________________________________________________
Length of time involved with the above role _______________________________
Your Educations ______________________________________________________
Questions regarding the study were derived from the prevailing topic and were formulated to aim for a specific kind of data that is relevant with the study.
Research related questions:
I would like to ask you a few research related questions:
What is the current age limit for breast screening?
What methods of breast cancer screening are currently being used?
How accurate is mammography?
What is the current frequency of breast screening?
What percentage of DCIS is being identified currently?
AGE LIMIT FOR BREAST SCREENING
ACCURACY OF MAMMOGRAPHY
FREQUENCY OF BREAST SCREENING
% OF DCIS
IRAN N/A Mammography Medium to high 40 to 50 years every 2years and 50 to 70 years is annually 10%
U.K 50-70 years Bilateral mammograms Less sensitive in younger women and more sensitive in older women Every 3 years 20%
Cancer of the breast is the most common cancer type amongst ladies, in Iran, it involves 21.4% of female malignancies. There are a few screening modalities for breast malignancies including breast self-examination, clinical breast examination and mammography. This exploration surveys the writing encompassing the usage of these screening approaches in the Islamic Republic of Iran. After gathering results from the two health facilities, I went ahead and combined them around 200 articles, a sum of 90 articles were incorporated in light of the fact that they particularly tended to epidemiological attributes of breast malignancy, society, religion, wellbeing looking for conduct, screening programs and the wellbeing framework in Iran. This results demonstrated that breast self-examination and clinical breast examination were most normal as there is no population-based mammography screening program in Iran. Also, most ladies seem to get data through the broad communications. Additionally, it demonstrated that Islamic convictions and public sensitization can be adjusted and also utilized to advance bosom disease screening in Iran. These outcomes highlight that there is a requirement for forceful precaution measures concentrating efforts on breast self-examination and slowly moving towards national mammography programs in Iran spread through the media with government support.
Screening is a backbone to BC identification whose primary shortcoming is the rate of cooperation of the women population. National strategies and medical services ought to go for expanding support in controlled areas identifying areas of potential occurrence so as to initiate screening programs and bringing down any hindrances that will discourage women to attend, with a perspective to bring down screening costs by involving the government or insurance agencies.
Following the presentation of the UK National Health Service Breast Screening Program (NHSBSP) in 1988, there has been a huge increment in the rate of ductal carcinoma in situ (DCIS). Consequently, in the year prior to the presentation of screening (ONS, 1998), 295 instances of DCIS were recorded in England and Wales, in ladies matured 5064, while 2500 cases were recognized, by going for check-ups , in the year 2008/2009 (NHSBSP and ABS, 2010), DCIS now represents around 20% of screen-distinguished breast malignancies (Evans et al, 2001, NHSBSP and ABS, 2010; Virnig et al, 2010). One of the primary explanations behind this expansion is that DCIS is generally simple to distinguish on a mammogram attributable to the smaller scale classification that is often presents (Morrow et al, 2002). Fewer instances of DCIS is projected at around 80% of this cases are non-palpable and are analysed by a mammography alone (Mokbel and Cutuli, 2006; Virnig et al, 2010). In any case, it is important to note that, in 2006, in England, only 40% of DCIS was reported outside the national screening program (NCIN and NHSBSP, 2009). The expansion in the occurrence of DCIS and the increasing number of how BC is harmful, if left untreated, have prompted dialogs about effective diagnosis (Welch et al, 2008; Jorgensen and Gotzsche, 2010). These are not simply limited to non-invasive breast growth, and the contentions about delayed diagnosis in screening, when all is said in done (Zahl et al, 2004; Duffy et al, 2010; Jorgensen and Gotzsche, 2010), follow-up is the advantage of screening which has helped over the years.
Furthermore, ductal carcinoma in situ (DCIS) is generally alluded to as Stage 0. With DCIS, irregular cells are create from cells that line the milk pipes; be that as it may, these anomalous cells have not attacked the encompassing mammary tissue. Expanded mammogram screening has prompted an expansion in DCIS analyse due to improvements made in the field. The American Cancer Society assesses that around 60,290 new instances of DCIS will be analysed in ladies in 2016, alongside about 230,000 new instances of intrusive breast related tumours. Around 40,290 ladies will bite the dust from bosom malignancy this year.
In August, the disease diary JAMA Oncology distributed two essential papers about DCIS that tests our comprehension of DCIS and its part in obtrusive breast growth. The primary, "Breast Cancer Mortality after a Diagnosis of Ductal Carcinoma in Situ," found that a fraction of the time intrusive bosom growth creates, it has no connection to an earlier DCIS. This discovery challenges the customary perspective that DCIS is the first tissue from which most obtrusive ductal carcinomas (the most well-known type of breast growth) starts.
This most likely means DCIS is a marker a lady might have cells some place in the breast region that either are or will get to be obtrusive growth; however these cells are right now imperceptible. At the end of it all, DCIS is still a dangerous element as opposed to a mild cause of any incidences reported.
1.1 percent of ladies with DCIS have died from breast cancer disease by the 10-year point and 3.3 percent of ladies at the 20-year point. These rates, while low, are twice that of the Iran population.
More than a large portion of the bosom disease regarding DCIS in ladies were not connected with an intrusive in-breast repeat. This recommends nearby treatment alone is insufficient to treat "forceful" DCIS.
Local treatment (surgery and/or radiation treatment) reduced the in-breast intrusive disease rate. In any case, it didn't decrease the demise rate from the intrusive disease. DCIS that recurred in the bosom as obtrusive illness was connected with a higher death rate.
This study is essential since it is colossal providing details regarding more than 100,000 ladies with DCIS and in light of the fact that it depends on entrenched study information from 18 diverse U.K. growth registries. Its discoveries are like those from a much littler and prior study from Sweden. The way that two unique studies have reported the same general conclusions makes these discoveries more trustworthy.
Various variables were distinguished that anticipate whether obtrusive breast tumours were more present in Caucasian ladies as opposed to Arabic women. The demise rate was higher in Arabic women and in ladies who were analyzed before age 35, making both of these key danger elements. Additional hazard variables include:
a DCIS that is bigger than 1 cm. (1/2 inch).
a DCIS that is uncaring to hormones (no estrogen or progesterone receptors).
a DCIS that is of higher evaluation (more growth like).
a DCIS indicating expanded cell demise (comedonecrosis).
While these components have been subject for quite a while, having them affirmed in such a huge study makes us more agreeable in sorting out which DCIS patients are pretty much liable to die from complications associated to breast malignancy. DCIS is connected with risky breast cancer symptoms andelements, it might be more helpful to consider systemic treatments, similar to chemotherapy or hormonal treatment. The second paper distributed in JAMA involves, "Reconsidering the Standard for Ductal Carcinoma in Situ Treatment," surveys treatment alternatives in light of these new discoveries. Things being what they are, what would you do if by chance you are diagnosed to have DCIS?
As usual, the best decision would be to get a second opinion, and t...
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