New technology can bring breast cancer screening into the twenty-first century
20 February 2012
Breast cancer has made regular news headlines over the past year, from the annual breast cancer awareness month, to the PIP breast implant scandal. Arguably the most significant breast cancer news in the UK broke in October 2011, with the announcement by national cancer director, Sir Mike Richards, of the first independent investigation of the UK’s breast cancer screening programme since the mammogram system was first implemented by Margaret Thatcher’s government in 1988. Jack Kaye, CEO of Westhouse Medical Services, provides insight into the situation, and analyses the options available for the progression of breast screening.
The medical profession relies on the continued advancement of technology not only to enable the identification and treatment of an increasing number of conditions but to keep improving the quality of healthcare delivered. Breast cancer care is no different. Our current mammogram screening system undoubtedly saves lives, proved by a decrease of 6,000 deaths per year from breast cancer since the launch of the UK Breast Screening Programme in 1988. However, the mammogram-based system is now outdated, hugely expensive at a time of financial pressure and struggling to cope with an aging population. Can new technology improve the situation?
The Government’s decision to review the screening programme comes at a time when a number of issues relating to accuracy, cost and the real benefits have come to light. The mammogram’s ability to detect small tumours, and even smaller collections of cancer cells, has been queried. Of the tumours ‘detected’ 10% are false alarms, according to researchers at Southampton University.
Breast screening should be deliberately non-specific — aiming to indicate a wide range of pathologies, which mammograms unfortunately do not. This way, should a pathology be identified, it can be investigated with more specific diagnostic tests.
Moreover, many believe the invasive, physical nature of mammogram screening may actually do more harm than good. Mammogram researcher Peter Gøtzsche, director of the independent Nordic Cochrane Collaboration, recently claimed the procedure harms ten out of every 2,000 women scanned.
As there is no precursor to the mammogram, Gøtzsche argues, women who do not have the disease are subjected to a treatment that may damage the breast and increase chances of breast cancer development later in life — ultimately costing the National Health Service (NHS) more through further treatment.
Cost has become an increasing issue due to the current economic climate, as well as changing population demographics in the UK. Government cuts in healthcare expenditure are forcing the NHS to reform financially. Each mammogram costs an average of £53.63 in the UK. There are 2.3 million mammogram scans performed a year at present, giving a total bill of over £120 million.
Due to the UK’s aging population, and a widening footprint of women being tested at a younger age, the total number of tests conducted is rising rapidly. It is predicted that three million scans will be performed by 2013/14 as the scan footprint widens by 35%. If alternative breast screening methods are not adopted, mammograms will cost the NHS £160 million a year by 2014.
The research by Gøtzsche affirms the reality that breast cancer screening needs revolutionising. However, Gøtzsche recommends that ‘women do nothing apart from attend a doctor if they notice anything themselves'. This conclusion ignores the fact mammograms have resulted in the UK breast cancer death rate dropping from 18,500 a year to 12,500 over the last 25 years. Consequently I believe the removal of the mammogram per se is unjustified; however, it is essential alternative screening methods precede it.
Alternative to mammogram
New technological advances will provide some alternatives in the screening dilemma. Westhouse Medical is currently developing a breast scanning device that can act as an effective, low-cost precursor to mammogram screening. The new scanner responds to a large variety of pathologies of the breast because it works on temperature differentials; many pathologies (including tumours) cause higher skin temperatures in the region near them due to a build up of blood capillaries.
Currently women have no easy, regular access to breast scanning until they pass fifty. The new device can be used at home, or at the GP’s surgery, potentially by women of all ages, allowing women to opt for a mammogram should the pre-scan indicate any anomalies in the breast.
Consequently only those in actual need of further screening will undergo the mammogram procedure — creating a broader more efficient multi-layered system, capable of increasing early detection rates and reducing mortality. Furthermore, Westhouse Medical’s breast scanner will cost a quarter the price of a mammogram, giving it the potential to save the NHS close to £100 million.
It is now nearly 33 years since the Thatcher administration came to power, so Sir Mike Richard’s independent investigation of the UK breast cancer screening programme is both timely and very welcome. It is the case, though, that in in the intervening years both the demands on the NHS and the potential for new technological approaches to increase the quality of care patients receive have both risen.
It is essential that a thorough examination of the potential of new technology to increase both the efficiency and effectiveness of breast cancer screening is carried out. Innovative medical devices have the capability to alleviate pressure on the NHS and provide the UK with a successful, effective and cost-efficient breast screening system suitable for the twenty-first century.
1. James Raftery, Possible net harms of breast cancer: updated modelling of the Forrest Report. BMJ.com. 8 December 2011.