technology and screening reduce mortality

The health technology applied to the screening of the population of breast cancer The way this disease is diagnosed and treated has changed. In particular, it has been shown that reduces the use of neoadjuvant chemotherapy and mortality of patients by promoting early diagnosis. cristina romerohead of the radiology service and radiological coordinator of the breast unit of the university hospital complex of Toledo, analyzed firsthand the advantages of using the mammography technique Digital breast tomosynthesis (DMT).

Thanks to this technique, “health professionals can prevent cancer get to the diagnosis sooner. The difference is huge for women because they will receive less aggressive treatments and improve their quality of life,” explains Romero. In this sense, the population screening of breast cancer is fixed in women for 50 years; however, this same year, Europe recommended lower it to 45 years and some territories have already adopted this measure a long time ago, as in the case of Castile-La Mancha.

Likewise, the specialist appreciates the need to do so measure and analyze data of public health. In this way it will be possible to acquire health technology with more guarantees about its effectiveness and professionalize profiles, among other aspects.

According to data from the Spanish Society of Medical Oncology (SEOM), breast cancer is the most serious in women and appears to be on the rise among young women. What is the explanation for these statistics?

Breast cancer is a disease of developed countries because now we have a much more sedentary life. The obesity plays a very important role, in addition to not doing physical activity and the tobacco consumption. There is also a genetic factorbut this accounts for only 3-4% of breast cancers.

Although breast cancer survival is very high, it continues to be a major health problem today due to its incidence. What can be done to prevent it?

There is a primary prevention which is: exercise, quit smoking, follow the Mediterranean diet and reduce consumption of processed foods, among others. All this can be done by the patient if he wishes. Then there is a second prevention, which is what we professionals do: try get to the diagnosis sooner. The difference is huge for women because they will receive less aggressive treatments and will improve quality of life and recovery.

Despite all prevention, primary or secondary, breast cancer can develop and the woman is not guilty therefore, she is the victim. You may have done everything very well and it still looks. It’s important that you enter here the investigation, since we need to know why it occurs. After the Covid-19 pandemic and the rapid arrival of vaccines, we learned that research it’s not a luxuryit is a necessity.

What is the profile of the patients in the consultation?

I distinguish two: that of the healthy woman and that of the symptomatic woman. In the latter there can be women of any age who come because his chest hurts, they start with discharge, nodules were noticed, a nipple was retracted, etc. Sometimes they come out of fear because they did family context. For this circuit of symptomatic women we have an infrastructure of professionals with different technologies that will solve the problem, no matter what level it is at. It can be a simple chat, a MRI or biopsyamong others.

With regard to the healthy population, a distinction must be made between reviews and screenings. On the one hand, for healthy women who voluntarily want to be checked and who are under 45, the radiologist must adapt the technology to their age according to established protocols. Population screenings are another thing, where the health authority requires a test to be carried out. As for the latter, one must be very cautious and have sufficient scientific evidence.

Screening must by definition be a more harmless technique possible because the patient cannot receive harm greater than the benefit she gets, because she’s healthy. The technique used must be very reliable, that’s where the concept of sensitivity and specificity of the test and its limitations. Right now the only validated test for early detection of breast cancer is the mammography.

Breast cancer in the 90s was a health issue, when you put the projections you start to reduce mortality. The scientific evidence said we had to call the women for 50 years that was when they benefited the most, but this year the European community advised lowering the age of screening for this cancer at 45 years old.

According to several studies, the pandemic has affected cancer screening programs, how is the pace picking up after these two years that we have lived?

When the showings stopped in those years later we found each other with larger tumors. Therefore, if in at one point he doubted that the screenings weren’t worth it, we saw that it wasn’t. Every community has adapted to the circumstances, but this is the important thing they started again with the best possible technology.

Why is it important to use innovative technology in breast cancer management?

When I first started breast training, I did it in conventional radiology. Suddenly we jumped and started in the field of digitization, the radiologist made a much more proactive role. We went ahead so that the woman could comment on your process and its treatment. Then came artificial intelligence and tomosynthesis. However, in the population screening circuit we have only one test and with that we have to decide whether the woman is healthy or not. Therefore, it is vitally important that this decision is correct to have the top technology possible on the basis of existing evidence. Once we have it, we must measure results. Radiologists are the stewards of this technology, we need to see what contributes and what doesn’t.

“Digital breast tomosynthesis (TDM) allows us to see inside the breasts and that’s a plus, especially in ones that are dense,” says Romero.

What is the digital breast tomosynthesis (TDM) mammographic technique? What are the benefits?

a mammogram compress and extract a photo, but what happens inside we don’t always see it. With the TDM yes and this is an advance, because we can look at the size of the tumor even if it’s small and that makes all the difference. There are mammograms that are very transparent because the breasts are fat, but there are women who have a fibrous breast And it doesn’t look the same. The tomosynthesis sweep and makes small cuts that allow me to see inside. In the case of dense breasts, it offers a great advantage. We have significantly improved the sensitivity, but also the specificity.

There’s a study published in Journal of Medical Screening in which you yourself participated, where you conclude, among other statements, that the introduction of TDM significantly increased the cancer detection rate. What other points would you highlight from this research?

The article collects a 10-year monitoring where we committed to tomosynthesis. The results were that thanks to this technology and early diagnosis helped reduce mortality of breast cancer, especially in the 47-59 age group. Another important aspect is that let’s call women less to other tests to be carried out for the specificity that TDM offers us.

In this research we also describe how decrease in tumor size, where it dropped the most was in the 45- to 50-year-old group who have the densest breasts. We managed to detect it before and reduce neoadjuvant chemotherapy.

The specialist underlines the need to “personalize the diagnosis” and evaluate the particularities of each woman.

Of all the solutions currently available, which do you think is the most complete to contribute to both early diagnosis and diseases like this?

There is no more complete one, there is one for every moment the patient is and here enter the personalization. In breast cancer diagnosis, we now look at the immunohistochemistry, what other prognostic markers it has, and whether the patient will benefit from the chemotherapy treatment. But you also have to do it customize the diagnostic techniques used because it doesn’t make sense that a 65-year-old woman, who has gone through five normal screening cycles and who has completely fat and transparent breasts, should be treated exactly like a 45-year-old woman, who has a mother who has already had breast cancer breasts and that she has dense breasts.

we need access to the technique and see if we have the ability to acquire it. You need to make the investment sensibly and if a technician is advising you to buy a product, you need to listen to them.

We should get used to measuring. We must have some quality and response criteria to a management that is done, and the first thing we should demand in the Administration is that these checks have been carried out or. at least results. This would allow profiles to be professionalised. For example, they have to enter the file engineers in hospitals because they can contribute a lot to our service.

We also have to get used to it teamwork. In addition to measuring, requires feedback by someone who understands the result and gives a certain answer in a short period of time. We have a large amount of data and we do not manage it information potential that there is right now in public health. We must learn to take advantage of it.

Finally, health must have synergies with Education. If young people move in a virtual world, we professionals have to get used to going there with truthful information.

“We have a lot of data in public health that we’re not taking advantage of,” Romero says.