Breast screening
Mammography Screening
Instructions:
Write one essay of 1500 words. Prepare your essay in a word-processing package like Microsoft Word. You must write your essay in this word document template. This template has been created to support you to write an ethics essay, as this is a new task for many of the students in this course. Essay topics Respond to ONE of the following statements, making your position clear and giving reasons for your answer. Each of these statements reflects a policy position recently proposed by a relevant stakeholder
Topic 1 The BreastScreen NSW program should continue to be offered and promoted to the population. However it should be available only to women who have demonstrated that they understand the epidemiological evidence about the potential benefits and harms of participation.
Topic 2 All Aboriginal people receiving welfare payments should receive these payments on a cashless welfare card. To improve health in Aboriginal communities, 80% of the money on this card should be prohibited from being spent on cigarettes or alcohol. 20% of the money on the card could be taken as cash.
Solution
Mammography Screening
TITLE: The BreastScreen NSW program should continue to be offered to the population but only to women who fully understand the benefits and harms of participating.
TOPIC: Should the BreastScreen NSW program be offered to the public?
Argument: I will argue that the BreastScreen NSW program should be continued but all participants should be properly sensitized.
Background: Mammographic screening is currently offered as an extensive, organized public health program (15). I will show that there has been considerable controversy over the outcomes of mammographic screening programs in the last two decades, with widely divergent conclusions about the balance of benefits to harms; however, the evidence suggests mammography prevents some women from dying from breast cancer due to early detection (18). I will also show that women in the population tend to value an opportunity to avoid breast cancer highly.
I will then argue that:
Both benefits and harms of breast screening accrue to individuals and not collectives.
Breast cancer is not an infectious disease that could cause a massive outbreak (3). It does not affect the masses, but it effects at an individual level. Breast screening is done to women even if they don’t display any symptoms (21). When women come in for testing, the practitioners should make it clear that the individuals are the primary beneficiaries of the program (20). Breast Cancer is a very personal topic for most women, and it should be handled in a delicate and humane manner (2). The stigma that comes with cancer scares off some women from even considering these tests. Therefore, during mammographic screening, the outcomes weigh heavily on the individual and all the necessary procedures such as expert advice and professional discretion should be on hand. Women who take place should be made aware of the various benefits as well as the side effects of engaging in the mammography. In that case, they can make the right and informed decisions. The screening will help in reducing mortality of cancer. The main advantage of digital mammography is speed and high contrast resolution compared to mother methods (20).
Women appear to value an opportunity to benefit from screening and the evidence regarding harms seems to be uncertain.
Studies suggest that a majority of women who face the risk of breast cancer will stick to the required guidelines on mammographic screening (17). There have been more and more calls for women to visit health institutions and get tested for breast cancer. Breast cancer is the second deadliest cancer for women after lung cancer (16). Our most effective means of reducing cancer related deaths is by early detection (4). Some people have been saying that a mammography is a painful procedure, and this couldn’t be further from the truth. When the two plates apply pressure on the breast, there is only a slight discomfort since the plates have to be clamped tight. The pressure can be reduced if the woman informs the physician (15). The other disclaimer of mammography tests has been the threat of radiation. It is true that the breast is exposed to a very low amount of radiation (like being exposed to natural environmental radiation for 18 weeks) but that should not discourage people. It is by far the most efficient method for identifying breast cancer in women. The benefits that come from screening, therefore, outweigh the side effects and hence it can be considered to be a viable undertaking by the women. This testing program should continue, and more and more women should be made aware of its existence. Many other radiographic techniques have come up but to date, mammography is still the best and most efficient method of performing breast examination (16).
Participation should be an autonomic decision on the part of the individuals.
The benefits and harms of mammographic screening, as seen above, only accrue at the personal level. People who participate in this program should do so at their will without undue external coercion. For people to make good decisions, they have to be well informed on the particular issue. Breast cancer is not a contagious disease, and hence there is a very small risk of an epidemiological outbreak (15). In cases where there is little risk to the general public, there is no coercion on behalf of the government. In the event of breast cancer, the government does not seek her immunity and hence they should just play the role of sensitization. Furthermore, if the individuals were to be coerced, it would force some even further away from the program. Since the benefits and side effects are personal, the decision to go in for a mammography screening should be left to the individual. It is critical that the people are given accurate information that is based on robust findings (19). Inaccurate information may be used as a way of ensuring that more people enroll in the program but that is not how it should be done. Accurate information is the right of the individual, and it should be availed at all times through a variety of mediums so as to be able to reach many recipients. The harm principle essentially says that government will intervene in such cases only where there is a significant risk of injury to other people (20). Since breast cancer does not pose this risk, the process should be purely autonomous.
Current conditions for mammographic screening, (firm persuasion and insufficient information) potentially undermine the autonomy of women considering participation.
The advantages and disadvantages of this screening must be laid out in a clear and precise manner. When viewing the results of a mammogram, the women ought to know the right questions to ask the doctor (1). According to a study conducted by The International Agency for Research on Cancer, they discovered that mammographic screening of women in the 50-69 age bracket reduced breast cancer mortality by 25% (15). There was little evidence to support the same for women below that age bracket. The difference between a diagnostic mammography and screening mammography should be made clear. Insufficient information may cause negative reactions such as undue panic among the said individuals. In the case of autonomy, it is best to believe the people, that they want the best for themselves and their well-being. Accurate information also goes a long way in demystifying some conceptions that people have regarding the screening process. Most women think that after screening the next stage is usually diagnosis and this is very far from the truth (8).
Communicating about screening should change to provide the conditions to support free choice by potential participants.
Autonomous decision making will only take place in a scenario where the individuals involved have complete information on a topic (19). In the case of mammography tests, information, both positive and negative impacts, should be made available through the relevant forums. Alarmist statements and unfounded statistics should be avoided at all costs so as not to influence the decision makers (17). People ought to know that screening is not a death sentence and hence embrace it more since it is now treatable with early detection (18). Out of every ten women that get breast cancer, don’t have a history of the disease in their family. Information like this should be communicated clearly. The medium of communicating should be one that is accessible to the people engaged in the program (women aged 50-74). Emerging information should also be communicated promptly to the individuals. During diagnosis of breast cancer, issues like breast density have been found to be pertinent. The denser the breast, the sensitivity of the mammography is reduced and hence cancer cells may go undetected (16, 17).
Provisional conclusion: mammographic screening is an important health program that should be continued, but the participants should be armed with the relevant knowledge to support autonomy (19).
Counterarguments: There are some objections to the argument for the mammography program. One of the major ones is the fact that it is an expensive undertaking on the part of the government using public funds. It is a legitimate argument since the funds could be utilized in other more meaningful ways. When individuals, who consider themselves healthy, are encouraged to participate in screening, it heightens their fear of cancer risk. Overdiagnosis has also emerged as a counterargument to the program (14). There are very many types of cancers, and it has been said that some of these cancers are harmless and therefore don’t matter. Intensive screening might end up exposing such cancers, and this only puts undue pressure upon the individual (14,19). The individual ends up being distressed and using the money to cure cancer. At the screening stage, it is impossible to single out life-threatening breast cancer strains. The odds that are stacked against cancer screen are very huge. The mammography screening is prone to error too since cancer cells might be present but remain undetected. There will always be lingering reservations about the effectiveness of mammography screening. Exposure to radiation is also dangerous and other methods such as MRI have been viewed to be a better bet since no radiation is involved and hence no chance of induced cancer (10,8).
Conclusion:
Mammographic screening ought to continue being offered to the public as a
government health program. Despite all the counterarguments, it is well known
that mammography exposes cancers when they are too small to be seen or felt.
Out of those screened, some can detect cancers early on when chances of
treatment are very high thus avoiding a mastectomy (19) or death by breast
cancer (21). However, women should be given information and allowed to make
informed decisions on whether to participate or not.
References
1. Harvey JMarch D. Making the diagnosis. Philadelphia, PA: Saunders/Elsevier; 2013.
2. Peacock J. Breast cancer. Mankato, Minn.: LifeMatters; 2001.
3. Majure J. Breast cancer. Berkeley Heights, NJ: Enslow; 2000
4. Tabár L, Tot T, Dean P. Breast cancer. Stuttgart: Thieme; 2005.
5. Breast cancer screening. Lyon: IARC Press; 2002
6. Kaiser W. Signs in MR-mammography. Berlin: Springer; 2007.
7. Andolina VLillé S. Mammographic imaging. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2011.
8. Kopans D. Breast imaging. Baltimore, MD: Lippincott Williams & Wilkins; 2007.
9. De Paredes Ede Paredes E. Atlas of Mammography. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.
10. Morris E. Rethinking Breast Cancer Screening: Ultra FAST Breast Magnetic Resonance Imaging. Journal of Clinical Oncology. 2014;32(22):2281-2283.
11. Cardenosa G. Breast imaging companion. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
12. Brennecke C. Breast Imaging. London: Elsevier Health Sciences; 2012.
13. Howell A, Anderson A, Clarke R, Duffy S, Evans D, Garcia-Closas M et al. Risk determination and prevention of breast cancer. Breast Cancer Research. 2014;16(5).
14. Cancer Screening I – Benefits and Harms [Internet]. YouTube. 2016 [cited 22 September 2016]. Available from: https://www.youtube.com/watch?v=sUn1Eyrf_Zs
15. Home (BreastScreen NSW) [Internet]. Breastscreen.nsw.gov.au. 2016 [cited 22 September 2016]. Available from: http://www.breastscreen.nsw.gov.au/?gclid=CJyW0cfHl80CFYMrvQod3G8Exw
16. Dronkers D. The practice of mammography. Stuttgart: Thieme; 2002.
18. Pories S, Moses M, Lotz M. Cancer. Santa Barbara, Calif.: Greenwood Press; 2009.
19. Breast cancer screening – NHS Choices [Internet]. Nhs.uk. 2016 [cited 23 September 2016]. Available from: http://www.nhs.uk/Conditions/breast-cancer-screening/Pages/Introduction.aspx
20. Wang L. Mammography and Beyond: Building Better Breast Cancer Screening Tests. JNCI Journal of the National Cancer Institute. 2003;95(5):344-346.
21. Jin J. Breast Cancer Screening: Benefits and Harms. JAMA. 2014;312(23):2585.
22. Cardeñosa G. Clinical breast imaging. Philadelphia: Lippincott Williams & Wilkins; 2007.
