Early Breast Cancer Screening Effectiveness

Early Mammography Screening in Average Risked Women for Breast Cancer

Kathleen Faloon, Josie Preski, Kayla Wrasman

Nursing, Youngstown State University

30676 Nursing Research

Healsey

June 20, 2021

Early Breast Cancer Screening Effectiveness

Abstract

As women age, the concern for breast cancer becomes increasingly higher. This paper

covers multiple articles speaking about the need for and potential lack of female knowledge

about breast cancer screening and treatment, the new idea of reducing age if it can be proven to

increase the recovery rate, and the controversy of reducing that age because of the risks that are

presented as the screening process begins. One article that was reviewed was based on a survey

of women to show their breast health knowledge which concluded that the majority of women in

this sample were uneducated about the cause, diagnosis, and treatment of breast cancer. Another

topic was based on a study of 40-49 year old women to attempt to discover if that age is better

than 50+ when determining a starting age for screening. This data was inconclusive and will

require more research to come to a decision. The last portion of this paper consists of the

controversy over lowering the recommended age to begin because of the potential risks.
Early Breast Cancer Screening Effectiveness

Early Mammography Screening in Average Risked Women for Breast Cancer

Breast cancer is one of the most common cancers in women worldwide. The number of

cases each year varies and still affects all women, regardless of socioeconomic status. According

to the World Cancer Research Foundation, breast cancer death rates in lower income populations

is 14.3 percent and for higher income populations is 15.4 percent (WCRF, 2021). Mammograms

are essentially X-ray pictures of the breast and physicians use them regularly to screen for breast

cancer (WCRF, 2021) . The American Cancer Society has different guidelines depending on age.

Their guidelines are as follows, “women ages 40 to 44 should have the choice to start annual

breast cancer screening with mammograms if they wish to do so, women age 45 to 54 should get

mammograms every year, and women 55 and older should switch to mammograms every 2

years, or can continue yearly screening” (American Cancer Society, 2020). Because breast

cancer is such a common occurrence in our society, the purpose of this paper emphasizes

researching and identifying any data or information on the methods of screening for breast

cancer and the significant age groups we can recognize as higher risk. Breast cancer screening

education and guidelines are significant to nurses because patients may be lacking knowledge

needed to properly care for themselves and nurses can be present to help them make the best

decision for themselves. The main priority of nursing is patient care, so by being available to

help the patient receive the best care for their breast health and educate them to allow them to

become their own advocate, nurses will always be doing right by their patients.

PICOT

This literature review was conducted to identify the benefits of early detection of

screening breast cancer regarding remission rates. The following PICOT question was

developed: “For breast cancer patients, does an earlier screening age compared to the
Early Breast Cancer Screening Effectiveness

recommended age for screenings improve detection of cancer, and therefore improve remission

rates?”

Search Strategy

Using EBSCOhost, a search was initiated using the terms breast cancer or breast cancer

patients, and education or early detection, and average risk, and remission rates or recovery or

improvement. Databases that were used include Cumulative Index to Nursing and Allied Health

Literature (CINAHL) and Medline. The search was limited to literature from the past 5 years,

meaning 2016-2021. The search also was limited to be written in English, peer reviewed, and

academic journals. Articles were reviewed for inclusion criteria and in relation to our subject of

breast cancer screening effectiveness. Our initial searches provided almost efficient research, but

we added the terms mammography and mammogram to improve our results. After the titles and

abstracts were reviewed, the articles were narrowed to five used in this literature review.

Literature Review

Several themes that had potential to influence early detection and guidance on the

education and remission rates of breast cancer were identified in the literature. More information

was identified conercing education on breast cancer screening as well as breast cancer screening

before the recommended age of 50. The controversy that continues in the conversation of

changing the age and frequency recommendations is also examined.

Female’s Education on Breast Cancer and Screening

The first theme we drew from our literature was the education women had about breast

cancer screening. Many women around the world do not have access to appropriate resources

and thus do not have any background information about breast cancer. One article used to

determine this theme is Knowledge of breast cancer risk factors, screening, and treatment
Early Breast Cancer Screening Effectiveness

methods in patients attending the breast clinic: A survey of 1,018 women, written by Enda H.,

Donal P., Cherry C., Fatemah B., Gerry O., Aidan M., James O.M., Arnold H., and Colm P..

This article focused on the knowledge women had about risk factors, screening, and treatment

methods at a breast cancer clinic. The study took place in two European cancer centers,

Beaumont Hospital (BH) and University Hospital Waterford (UHW), and conducted an

anonymous paper-based survey with 1018 patients. In relation to breast cancer risk factors,

91.4% were aware that family history could play a role, but only 41.8% of these women knew

that BRCA could also be a potential risk factor and most people had never even heard of this

term (Hannan, E., Peter O’Leary, D., Cheung, C., Buhamad, F., O’Donoghue, G., Manning, A.,

Oliver Murphy, J., Hill, A., & Power, C.; 2018). The survey also gives us information on these

women's education about breast cancer screening. More than one third of these patients did not

know what age women should start getting screened, along with one in four of these women

believing that screening was unsafe. Lastly, this survey talked about the knowledge these women

had about treatment. Only 20.9% believed that surgery was always necessary to cure breast

cancer, with the majority of 69.6% being unaware that a lumpectomy could be a treatment option

compared to a mastectomy (Hannan, E. et al., 2018). Since this study was conducted in the

setting of the breast clinic, the women who participated in this survey were more likely to have

been better informed about breast cancer than the general population.

Another article used to determine this theme was A Study to Assess the Effectiveness of

Planned Teaching Programme Regarding Breast Self Examination & Breast Cancer among

Aryakanya College Students in Karnal, Haryana, written by Meena Kumari and Manila. This

was a questionnaire study in which 100 students were selected, they first had to take a pre test.

This pre test had questions about breast cancer including risk factors, signs and symptoms, early
Early Breast Cancer Screening Effectiveness

detection and prevention of breast cancer, along with techniques of breast self examination. After

taking the pre-test, they were to participate in the planned teaching programme, where they

would learn about the different subsets about breast cancer. After that they were to take a post-

test of their knowledge after seven days. The scores from the pretest were 12.19 ± 2.773

compared to the post test of 24.90 ± 2.013 (kumari, M., & Manila., 2018). There was a clear gain

in knowledge from pretest to post test. The research hypothesis was accepted in this study

indicating that a planned teaching program on breast self examination and breast cancer was an

effective method for improving knowledge of college students.

As women, having an understanding of breast health is important as life goes on and risk

of breast cancer increases. According to Caughran, after researching the different results and

characteristics in a clinical trial, women under the age of 50 are most likely to present with a

palpable tumor rather than just lesions that are detected on a mammography (Caughran et al,

736). This conclusion gives an example as to how a woman knowing her own normal breast

tissue, how to properly give a self-breast exam, and when to contact a primary healthcare worker

with concerns is very pertinent to continuing female health.

Ultimately, it has been shown that many people don't have knowledge about breast cancer

and that increasing women's knowledge about breast cancer could potentially lead to an earlier

diagnosis and improved survival from breast cancer.

Screening Before the Recommended Age

The primary article used to determine this theme was Screening Mammography for

Women Aged 40 to 49 Years at Average Risk for Breast Cancer, written by the Medical Advisory

Secretariat in 2007. This article focused on breast cancer mortality from annual mammograms in

randomized women, from the ages 40 to 49 and then compares the results with the recommended
Early Breast Cancer Screening Effectiveness

age group of over 50 years. The idea of screening in women under the age of 50 years is fairly

new; there had only been a single research trial performed specifically analyzing women who fall

in the 40-49 age range until March 2006.

The first trial reviewed in Screening Mammography for Women Aged 40 to 49 Years at

Average Risk for Breast Cancer (2007) discusses how there is an insufficient amount of data

concerning women aged 40-49 years. There is no significant reduction in breast cancer mortality

in women under the age of 50 years (Medical Advisory). If a person is at a higher risk, there is a

possibility of screening at an earlier age could still help lower mortality rate. The second trial

reviewed in this article also studied the age group of 40-49 years for mammograms. The

comments from this trial stated the potential benefit in reduction of mortality with an early

diagnosis, but a lack of current evidence remained suggesting the recommended age be changed

to under 50 years. This trial found a relative risk reduction of 18% to 45% for breast cancer

mortality after a 10 year follow up. The third trial was performed by the United States

Preventative Service Task Force (USPSTF) and found similar results including mortality rates

ranging from no effect to a 32% reduction in women 40 years and older. The comments of this

trial are that benefits of early screening still cannot be made.

After reviewing all trials in Screening Mammography for Women Aged 40 to 49 Years at

Average Risk for Breast Cancer (2007), the authors of the Medical Advisory Secretariat

concluded there is still not enough current data to show a survival benefit of early breast cancer

screening through mammograms.

Controversy Over Earlier Ages of Breast Cancer Screenings

Further education of breast self exams, considering their own personal risk factors, and

talking to their healthcare provider among women, the decision to get a mammogram is still a
Early Breast Cancer Screening Effectiveness

difficult personal choice. The final theme addressed is the continuous controversy over earlier

ages of breast cancer screenings. The main article used to construct this theme is Breast Cancer

Screening Benefits: Research and Controversies (2016). This article provided an overview of

benefits, harms, and efficacy of screenings. According to Odle, the American Cancer Society

raised its recommended age to begin routine breast screenings from 40 to 45 in 2015 (Odel,

529M). When recognized organizations like the ACS begin to change their recommendations it

can become confusing for women around that age to make the best choice for themselves.

Another possible outcome of receiving the screening treatment that can lead to confusion in

women attempting to make their decision is that false positives, or overdiagnosing, can occur

especially when a woman is asymptomatic. Overdiagnosing is when the screening shows lesions

that are not invasive and would not have been clinically an issue if not screened (531M).

Because the point of these screenings is to detect cancer at an earlier stage including in

asymptomatic people, the notion that the result is not always accurate may concern people about

cost and the possible harms of undergoing the screening without the reference of a primary care

physician.

Typically, screening programs offer mammograms beginning at 50 because there has

been a concern that risks for younger women outweigh the benefits. The age recommendation is

continuing to rise because it is known that there is higher incidence of breast cancer with

increasing age. There is debate over when to stop receiving screening as well so that they are not

overused in the older population, but again, that is contraindicated when it is known that the risk

increase is directly related to age. The USPSTF changed its frequency recommendations from

every year to every other year for screenings of average-risked women from the ages of 50-75

(Ode, 534M). The decision to alter the frequency is based on the science and research that shows
Early Breast Cancer Screening Effectiveness

tumor growth times and the point in the cancer process when the lesion would be detectable on

the scan. While trying to make clear guidelines for women to use when making decisions about

screening, some organizations go against others and ultimately make it difficult for women to

come to a conclusion on their own.

Recommendations for Practice

One thing nurses can do in their practice is to make sure they are educating their patients.

Enhancing their patients' knowledge about breast self examinations and breast cancer. In

addition, making sure they know when they should start getting mammograms. Nurses can be a

resource for women who are considering starting to get screened by providing knowledge, an

outlet, and direction as the patient goes through the personal process of choosing to get screened.

This type of relationship can be very helpful especially when the patient is considering the

screening without a primary care provider’s specific request to do so. Nurses also should update

their knowledge, acquire skills, and provide high quality care to their patients. They should be

involved in education programs to help them with the changing climate of the health care

delivery system.

Conclusions

The guidelines for average-risked women to receive breast cancer screenings or

mammograms have been constantly changing over the years. These changes have to do with new

knowledge of the disease itself or the scanning process from the perspective of physicians and

medical research organizations, and also the education that is available to women considering

undergoing the process. As medical knowledge and public education increase on this subject,

changes are constantly being made in an attempt to give women the best options possible. By

improving women’s knowledge about possible factors in their body that may lead to a higher risk
Early Breast Cancer Screening Effectiveness

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and teaching the importance of self breast exams that allow the patient to know what is normal

on them, it increases the chances of them getting checked out if something is out of the ordinary

and being generally concerned about their breast health as they age. According to the trials

mentioned that were conducted on women aged 40-49, there has been no significant proof that

routine screenings performed earlier in life are responsible for lower death rates in women. Even

so, earlier detection always makes cancer easier to respond to with the best treatment. With that

being said, for breast cancer screenings specifically and earlier age start is not always the best

way to approach it. Odel stated that the potential harms can be worse compared to the benefits of

early screening when speaking about younger women (below 45). As practicing nurses, it is a

responsibility to enhance patient education including self-breast exams and encouraging, when

needed, breast screenings. Nurses need to be honest and full of knowledge in order to provide

good breast care for women. There is still so much knowledge and research that needs to be

conducted thoroughly in order to determine the best way for women to continue to have good

breast health.
Early Breast Cancer Screening Effectiveness

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References

Breast cancer: World Cancer Research Fund International. WCRF International. (2021, May

19). https://www.wcrf.org/dietandcancer/breast-cancer/.

Cancer Screening Guidelines: Detecting Cancer Early. American Cancer Society. (2020, July

30).https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-

guidelines-for-the-early-detection-of-cancer.html.

Caughran, Jamie MD, FACs (2018). The Effect of the 2009 USPSTF breast cancer screening

recommendations on breast cancer in Michigan: a longitudinal study. Wiley: The Breast

Journal, 2018;24;730-737. DOI: 10.1111/tbj.13034

Hannan, E., Peter O’Leary, D., Cheung, C., Buhamad, F., O’Donoghue, G., Manning, A., Oliver

Murphy, J., Hill, A., & Power, C. (2018). Knowledge of breast cancer risk factors,

screening, and treatment methods in patients attending the breast clinic: A survey of

1,018 women. Breast Journal, 24(6), 1094–1096.

https://doi-org.eps.cc.ysu.edu/10.1111/tbj.13082

Kumari, M., & Manila. (2018). A Study to Assess the Effectivess of Planned Teaching

Programme Regarding Breast Self Examination & Breast Cancer among Aryakanya

College Student in Karnal, Haryana. International Journal of Nursing Education, 10(3),

158–162. https://doi-org.eps.cc.ysu.edu/10.5958/0974-9357.2018.00088.0
Early Breast Cancer Screening Effectiveness

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Medical Advisory Secretariat (2007). Screening mammography for women aged 40 to 49 years

at average risk for breast cancer: an evidence-based analysis. Ontario health technology

assessment series, 7(1), 1–32.

Odel, Teresa G. BA, ELS (2016). Breast cancer screening benefits: research and controversies.

Radiologic Technology, 87(5), 529M-543M. https://web-a-ebscohost-

com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=11&sid=3348530f-aa05-4634-9bb9-

cd4a38af7908%40sessionmgr4007
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