Dr Rajendra Badwe, director of Tata Memorial Hospital, considered to be the best in India for cancer treatment, spoke to DNA on the best methods to detect cancer.
A recent study published in an international journal of clinical oncology states that mammograms pick up merely 33% of breast cancers as compared to magnetic resonance imaging (MRI) screening, which detects up to 93% of cancers. Interestingly, MRIs are not used for screening cancers in India. The study highlights that even ultrasound is more sensitive than a mammogram. With a very high number of Indian women detected with breast cancer every year, Dr Rajendra Badwe, director of Tata Memorial Hospital, considered to be the best in India for cancer treatment, spoke to DNA on the best methods to detect cancer.
A study has termed mammography as an ineffective technology….
Mammography is useful, but only in women above 50. In women below 50 or those in the pre-menopausal state, mammography does not help save lives. No country offers mammography for women below 50 except the USA. However, after much uproar, the US stopped it a few months ago. Mammography is known to have saved one in four women above 50. For younger women, a physical examination is the key.
Is a physical examination enough to detect breast
cancer?
A thorough physical examination is best at the moment. It is as good as a mammography. A physical examination does not increase the incidence of cancer by diagnosing unnecessary cancers.
Is this accepted all over the world?
A combination study was carried out wherein a physical examination and a mammography were performed on 20,000 women above 50 years while another set of 20,000 women were not put through any tests. After a 10-year follow-up, the study revealed 25% reduction in death rate in the first set of women. However we did not know whether the reduction was due to the physical examination or mammography. To take the study further, another study was carried out in Canada where a physical examination was done on 40,000 women and a physical examination and mammography was done in another 40,000 women.
After a 17-year follow-up, researchers found no difference in death rate but there was a 25% increase in incidence of cancer when mammography was done. Due to increasing precision of diagnosis, we are only getting more cases. Mammography should be used only when a physical examination is not possible or doctors are not trained for it.
An MRI screening or an ultrasound also detects more number of cancers….
As I said, we need to understand whether the increased precision of diagnosis is helping save lives. As a clinician, I don’t want to pick up innocuous cancers. I only want to detect killing cancers. Thus, technology like MRI, ultrasound, etc, is good but should be tested well and confirmed whether its use is needed at all. For example, if I do an ultrasound on 100 women above 50 years, at least 20 women will have cysts in their breasts. Such reports will only make the women anxious even if these cysts will never become cancerous. Thus it only raises false alarm.
When is mammography best done?
When a woman comes with a lump in the breast, a mammography is done to see the multicentricity of the tumour.
What are the main causes for breast cancer in India?
Some of the the main reasons in India are age, late first pregnancy, lack of breast feeding and obesity.
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
)
){kind=small}
){kind=small}
)
)
)
)
)
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}