Open Journal Systems

LETTERS TO THE EDITOR

Comment on mammography and breast cancer

Guillermo Murillo-Godínez^a

^aMédico internista con consulta privada

Email: tlmx2167747@prodigy.net.mx

A recent editorial¹ analyzes the possible causes that might explain the disparity between the increasing use of mammography as a screening tool to identify breast cancer in early stages, and, on the other hand, the results of research that conclude that mortality has not decreased, that the incidence of breast cancer continues to increase, that there is overdiagnosis from false positive results, and that there is application of unnecessary treatments.

As possible causes of this disparity, the article mentions whether the screening is done in the appropriate population, since, for example, Mexican women go to the doctor for a mammogram only once they have a palpable lesion; that the age of onset of breast cancer in Mexico is 10 years younger than in developed countries; that 70% of the adult female population presents with obesity or overweight, risk factors for developing breast cancer; the differences among the mammographies used, and among the observers of the mammograms. The editorial is related to the article published in the same issue of the journal,² where it is in evidence, for example, that there can be up to about 20% frequency of false-positive diagnoses, which can lead to patients’ refusal to perform subsequent studies because of the anxiety generated, and the implementation of unnecessary treatments.

Other factors that could influence the disparity could be the lack of obligation to report the type of breast density, since, although there are reports of BI-RADS (Breast Imaging Reporting and Data System) categories 1 and 2, considered benign, however with breast density 3 and 4, mammography should be supplemented with ultrasound or MRI; although, it is true, lower breast density does not necessarily preclude the need for diagnostic complementation, as obesity and older age are inversely related to density, but are however also risk factors for developing breast cancer.³

Similarly, another influential factor could be the lack of subtyping of breast cancer before decision-making regarding the most appropriate treatment.⁴

It could also be another factor of non-administration of chemoprophylaxis, if the percentage of calculated risk (Gail model) is equal to or greater than 1.66%.⁵

References

1. Espinosa-Larrañaga F, Ramiro-H M. Acerca del cáncer de mama y la mamografía. Rev Med Inst Mex Seguro Soc. 2014;52(6):604-5.
2. Hernández-Valencia M, Hernández-Quijano T, Zárate A, Saucedo R. Utilidad y riesgos de la mamografía rutinaria para detectar cáncer de mama. Rev Med Inst Mex Seguro Soc. 2014;52(6):704-8.
3. Marcus EN, Yepes M. The conundrum of explaining breast density to patients. Cleve Clin J Med. 2013;80(12):761-5.
4. Sánchez FER. Actualidades en la selección del tratamiento para el cáncer de mama. Prescripción Médica. 2014(444):1-2.
5. Visvanathan K, Hurley P, Bantug E, Brown P, Col NF, Cuzick J et al. Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2013;31(23):2942-62.

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