Prevention of Breast Cancer in the United Kingdom and Iran

Prevention of Breast Cancer: A comparison of the Breast Screening Programme in women in the United Kingdom and Iran

DEDICATION

This work is dedicated to my loving mother Saideh for her unconditional support, love, care and commitment to my life, teaching me to love, being kind, and respect. She is too a breast cancer survival and was the main reason for me to choose this topic. I wish you all the health in this world and may you always stay healthy and smiley.

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ACKNOWLEDGEMENT

I would like to thank my supportive family; my beautiful parents for their true support and prayers during my exams times. Thanks for being there for me whenever I needed someone to talk to. I love you both so much.

Special thanks to my dear husband for his endless love and support, without you I would not have been able to fulfill my dream and completing my studies with a great achievement, thank you for being such an amazing friend, husband and for all your understanding and advises.

I would like to thank Prof. Sewell for his kind support and or running such an amazing programme at the Cardiff University, this course has definitely taught me a lot. A big thanks to my lovely supervisor Dr. Julia Gee for her attention to details and advising me where needed.

I like to express a great appreciation to Prof. Sweetland at the Cardiff University, Dr Davies and Dr Wallis at Cambridge University Hospitals NHS Foundation Trust for their time spent on interviews.

Last but not least, a massive appreciation goes to Dr. Kheradmand at the University of Tehran for his prompt responses and kind support.

TABLE OF CONTENTS

DECLARATION I
DEDICATION II
ACKNOWLEDGEMENT III
TABLE OF CONTENTS IV
LIST OF ABBREVIATIONS V
ABSTRACT VI
CHAPTER ONE: INTRODUCTION 1
BACKGROUND
THEORETICAL FRAMEWORK
RESEARCH QUESTIONS
STUDY OBJECTIVES
General Objectives
Specific Objectives
STUDY JUSTIFICATION
STUDY SIGNIFICANCE
CHAPTER TWO: LITERATURE REVIEW
CHAPTER THREE: METHODOLOGY
INTRODUCTION
STUDY DESIGN AND SETTING
INCLUSION AND EXCLUSION CRITERIA
Inclusion
Exclusion
MEASUREMENTS
DATA COLLECTION
ETHICAL CONSIDERATION
CHAPTER FOUR: RESULTS
INTRODUCTION
RESPONSE FROM CONSULTANT IN IRAN
RESPONSE FROM CONSULTANT IN THE UK
CHAPTER FIVE: DISCUSSION
BREAST CANCER SCREENING METHOD IN IRAN
BREAST CANCER SCREENING METHOD IN UK
IMPLICATIONS OF THE FINDINGS
LIMITATIONS OF THE STUDY
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
CONCLUSION
RECOMMENDATION
BIBLIOGRAPHY
LIST OF ABBREVIATION
DCIS - ductal carcinoma in situ
WCRFI- World Cancer Research Fund International
CRUK - Cancer Research UK
MRI - Magnetic Resonance Imaging

ABSTRACT

Introduction:

Method:

Results:

Analysis:

CHAPTER ONE: INTRODUCTION

Background

Cancer is a disease which is caused by an uncontrolled division of abnormal cells in the body. Cancer cells can also spread through the bloodstream or lymph to other parts of the body. There are different types of cancer which can be divided into the following sections:

• Carcinomas
• Lymphomas
• Leukaemias
• Brain tumours
• Sarcomas

Cancers may also be categorised according to what part of the body it starts from, such as liver cancer, lung cancer and breast cancer. Breast Cancer is the second most common cancer after lung cancer and the first most common cancer amongst women worldwide. In 2012 nearly 1.7 million new cases (World Cancer Research Fund International (2015)) were diagnosed Worldwide. Breast cancer is a malignant tumour which initiates in the cells of the breast. These are group of cancer cells that invade the surrounding tissues or metastasize to other areas of the body. There are two types of breast cancer and each divides into different sections. Primary breast cancer divides into non-invasive breast cancer and invasive breast cancer. Primary breast cancers which are found in the milk ducts of the breast are known as non-invasive breast cancer, the most common type of non-invasive breast cancer is ductal carcinoma in situ (DCIS). This type of breast cancer could spread to surrounding tissues at later stage. On the other hand, primary breast cancers which have spread to the surrounding tissues in the breast and armpit are known as invasive breast cancer. Secondary breast cancer or metastatic breast cancer is when cancer spreads from the breast or armpit to other areas of the body.

According to the 2012 statistics by the Cancer Research UK (CRUK), breast cancer is the third most common cause of cancer death in the UK. Breast cancer death rate has reduced in the UK which is due to advancement in detection and the treatment of breast cancer sooner as well as increased level of breast cancer awareness within the population using surveys and screening procedures.

On the other hand in the developing countries such as Iran, there has been an increased mortality rate which could be related to the lack of patient awareness and effective screening (Taghavi. A et. al (2012)). According to the chairman of public associate of Iran one in four women will be diagnosed with breast cancer in Iran, despite the fact that the diagnosis of breast cancer have improved, however, this statistics have dramatically increased during the past decade in Iran. In addition, age of women who diagnosed with breast cancer has also reduced to 30 years of age and younger. According to the current statistics in Iran, 90 thousand patients are currently living with cancer in Iran, of which 30 thousands of them lose their lives each year. 3% of these populations are children, however, nearly 80% of all paediatrics cancer patients are treated successfully, and however, this is reduced to 50% in adults. According to oncologists and practitioners within this field, it has been said that gastric cancer is the lead in Iran. This is followed by breast and prostate cancers. Recent statistics have shown that 30 in every 100 thousands Iranian women are diagnosed with breast cancer.

Several studies have shown a relationship between breast cancer screening and mortality from breast cancer. There is also support for the hypothesis that breast cancer screening will not reduce breast cancer mortality. Breast cancer screening has an effect on breast cancer frequency and mortality rates. The purpose of the program is to decrease number of deaths as a result of breast cancer by variety of screening programmes such as mammography. An increase in number of breast cancer occurrence and mortality indicates the significance of a good and well-developed screening program.

A study by S. Haghighat et al (2012) was aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to normal female population. This study showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. Another study aimed to investigate about female knowledge of breast cancer and self-reported practice of breast self-examination in Iran (A. Montazeri (2008)), in this study the finding concluded that women awareness of breast cancer warning signs and effective screening methods such as clinical examination and mammography were very inadequate which means health education programmes to rectify the lack of women awareness id urgently needed. There are similar studies based in the UK as well, such as the study of The effectiveness of breast cancer screening, (Dingemanse (2013)), this study concluded that the implementation of a screening program leads to a decrease in mortality and increase in incidence rate.

Five year breast cancer survival rates are higher than 70% in most developed countries and less than 40% for most developing countries; mainly due to low awareness levels, lack of access to early diagnosis and treatment options. This research project aims to compare the current methods of breast cancer screening in both developed and developing countries.

1.2 Theoretical Framework

In this theoretical framework the breast cancer screening is explained. Then the dissertation will focus on the goals which can be divided into the following sections:

• What is the current age limit for breast screening in UK and Iran?
• What methods of breast cancer screening are currently being used in UK and Iran?
• How accurate is mammography in UK and Iran?
• What is the current frequency of breast screening in UK and Iran?
• What percentage of DCIS is being identified currently in UK and Iran?

Different forms of screening programmes in general will be explained in more details. This is then followed by a literature review about the current screening programmes in both countries including clear rationale for or the gap to be filled by this dissertation.

Main method of detecting breast cancer prior to progressions of breast cancer and early detection of the disease symptom is breast screening, this can help find cancer at an early stage which means abnormal tissue or cancer would be easier to treat. This could result in decrease in potential number of deaths due to breast cancer. This hypothesis has been supported by previous studies and literature. There are different methods of breast screening which include of self-examination to check for signs of disease such as lumps, screening tests such as mammography which is an x-ray image where a radiologist analyses the image for any abnormal findings. Mammography is given routinely after a reach of certain age. Laboratory tests, and diagnostic tests such as biopsy which are given to patients who are assumed of having breast cancer due to the presence of symptoms or result of screening test and genetic tests which look for specific gene mutations that are connected to some type of cancers.

There are different types of screening; opportunistic or organised screening and population-based screening. Organised screening is the most common method of screening which categorises into six sections: 1. a standard guideline that states the target population, method of screening and its frequency, 2. A transparent target population, 3. Departments or individuals responsible for inspecting the screening centres, 4. Structured and defined responsibilities for healthcare expertise, 5. Quality assurance system handling appropriate data and 6. A specified system that analyses cancer incidences within the target population. This research project focuses on the category 1: target population, method of screening and its frequency.

1.3 Research Questions

• What is the current age limit for breast screening in the United Kingdom and Iran?
• What methods of breast cancer screening are currently being used in the United Kingdom and Iran?
• How accurate is mammography in the United Kingdom and Iran?
• What is the current frequency of breast screening in the United Kingdom and Iran?
• What percentage of DCIS is being identified currently in the United Kingdom and Iran?

1.4 Study Objectives

General Objectives

The aim of this study is to compare the current methods of breast cancer screening in two developed and developing countries; United Kingdom and Iran.

Specific Objectives

• To determine the current age limit for breast screening in the United Kingdom and Iran?
• To determine methods of breast cancer screening are currently being used in the United Kingdom and Iran?
• To determine accuracy of mammography in the United Kingdom and Iran?
• To determine the current frequency of breast screening in the United Kingdom and Iran?
• To determine the percentage of DCIS is being identified currently in the United Kingdom and Iran?

1.5 Study Justification and Stu...