Mammographic screening
Mammographic screening can be termed as a low-dose X-ray examination of a woman’s breast. This examination is used to sense breast cancer when the ailment is too small to be noticed or felt as a lump (“CDC,” 2018). The origin of mammographic screening can be traced as early as 1895 with the discovery of X-ray. In this regard, the first application of mammography was conducted in 1913 by Albert Salomon, a German surgeon. Salomon performed a study on 3,000 mastectomies whereby he evaluated X-rays from human breasts against the actual detached tissues. As such, he observed microcalcification, a consequence that enabled him to comprehend the variations involving cancerous and non-cancerous breast cancers. Seemingly, in 1930, American radiologist, Stafford Warren used X-ray images to examine the changes in breast tissues due to mastitis and pregnancy. In modern-day, the trend has shifted with the introduction of digital mammographic screening, which utilizes digital receptors and computers in place of Xray film (“ESR,” 2016). This outcome allows for additional manipulation of images, meaning radiologists have better chances of viewing results more clearly. Consequently, with further development of digital mammography, the technique was split into two; 2-dimension and 3-dimension. Hence, questions have arisen regarding which procedure is better between the two in terms of the advantages and disadvantages, false positives, and recall rates. Therefore, while people may consider both techniques as effective methods of screening for breast cancer, nevertheless, 3D edges 2D when evaluated against the benefits and shortfalls they both possess, concerning efficiency and timeframe.
Mammography
Mammography is a kind of x-ray imaging done on the breasts. The technique examines breast cancer in individuals who portray no visible signs or indications of the ailment (“CDC,” 2018). It is also used in scenarios where there is a lump scare or other probable signs of breast cancer. Consequently, mammography occurs in two ways; diagnostic and screening. In this regard, screening mammographs are conducted in women with no signs or symptoms of breast cancer. Hence, the first screening mammography is always considered as a baseline against which all subsequent tests will be evaluated against to determine probable changes in breast tissues (“RSNA,” 2020). Alternatively, diagnostic mammography applies to women who have shown symptoms. Examples of some of these symptoms may entail the formation of lumps, altered shape or size of the breasts, unprecedented pain and nipple thickening, or discharge. Seemingly other additional differences include screening usually takes about 10 to minutes to conduct. In contrast, diagnostic takes relatively loner durations, because radiologist may be required to make further X-ray images and zoom in on sections of interest (“CDC,” 2018). Thus, the presence of physicians is not necessary for screening, although in diagnostic, one is required to monitor the process.
Benefits and Harms of Screening
Seemingly, there are notable benefits and harms associated with screening. Firstly, the benefits are enormous and outrightly outweigh the negatives. Regular mammography has proven to save lives. This outcome is a consequence of early detection, which leads to early diagnosis and treatments. Hence, the risk of dying from breast cancer is significantly reduced by more than a third. The potential for less treatment is also improved since early detection means that one requires fewer treatment procedures when compared if it was found in later stages after spreading to the rest of the body (“ESR,” 2016). Alternatively, there exists some risks and harms associated with screening mammography. Examples include overdiagnosis, failure to find all cancers, and pain and worry. Consequently, some tumors may never grow to become harmful during one’s lifetime; however, screening mammography activates their growth, an outcome which makes them dangerous. Also, chances of mammography revealing typical results may manifest even if there is cancer; thus, they are not 100 percent correct, especially in women aged 45 to 69 years (“RSNA,” 2020). Lastly, the technique can be painful and uncomfortable, resulting in anxiety and worry for some women.
Specificity Versus Sensitivity
Sensitivity manifests as a mammograph’s ability to correctly identify individuals with breast cancer (true positive), while specificity correctly recognizes those without the disease (true negative). According to independent studies, mammographic sensitivity ranges from about 75 percent to 90 percent. As such, the positive predictive value for breast cancer ranges for women aged 50 and below stands at 20 percent, while those aged between 50 to 69 are 60 to 80 percent (Safwat et al., 2020). In terms of symptoms, sensitivity is lower by 60 percent when compared to asymptomatic women (75.6 percent) (Miller, 2014). On the other hand, specificity is considerably reduced for individuals showing major indications of the disease (73.7 percent) compared to asymptomatic people (94.9 percent) (Safwat et al., 2020). Women who go for early screening and those with other indicators are more probable to register false-negative outcomes compared to asymptomatic women. Thus, women characterized by lower sensitivity and have other symptoms need further investigation. This explanation is based on the fact that they may have increased breast density and poor image quality.
2-Dimension Versus 3-Dimension
Advantages and Disadvantages of 2D and 3D.
Notably, the majority of the advantages by 3D manifest as disadvantages of 2D. As such, 2D possesses few benefits in comparison to 3D. One significant advantage of synthetic 2D is that it can present some details and information which are typically best witnessed in 2D films like calcifications (“BCO,” 2019). At the same time, it can select features of breast cancer best observed on 3D, in case there is an overlapping of healthy breast parenchyma cells. Alternatively, 3D has various advantages over 2D. Examples of some of these advantages include effective cancer detection. It covers 35 percent better cancer detection and is more comprehensive. Also, the image clarity is enhanced by providing additional angles of the breast tissue (Dang et al., 2014). Importantly, chances of callbacks are reduced, meaning, anxiety that may emanate from false alarms are eliminated. However, the main disadvantages include costs, time, and radiation. The technique consequently costs more than 2D, and insurers may be reluctant to cover it (Safwat et al., 2020). It takes considerable time to perform and interpret, and chances of radiation are higher when integrated with 3D.
Repeats
In most cases, mammography is always done as the first line of investigation in cancer detection and imaging. As such, there is usually a need to conduct repeats to realize optimal quality without necessarily inducing adverse effects on individuals’ health. In this regard, repeats may be done if the skin or fold obscures the visualization of an area of concern. Consequently, the average repeat mammographic rates stand at 46.1 percent, with a confidential interval of 39.4 to 52.8 percent (Miller, 2014). In the US alone, women aged 50 to 54 years subsequently are subjected to repeats a number, which makes up about 14. 4 percent of all mammographic imaging (Nelson, 2016).
Recall
Also termed as callbacks, recalls occur when radiologists are concerned about something, they are not sure about, failure to which potential concerns may be imminent. Such interest may be due to false negatives or false positives (Komen, 2015). Consequently, 10 percent of all women get recalled for further testing and about 0.5 percent end, although the probability of being diagnosed with cancer after a recall is always lower (Long et al., 2016). Concerning the false negative, it is an outcome that results when a mammographic image shows normality although tumor is present. Statistically, 1 in 5 women registers false-negative on screening mammograms (Bernardi et al., 2014). A primary factor leading to such is intertwined with women who possess dense breasts. Alternatively, false-positive results show an abnormal area to be cancer but turn out to be healthy. This outcome is more prevalent in women who are younger, have dense breasts, a family history of cancer, or consuming estrogen. Notably, after ten annually mammograms, women aged between 20 to 30 years have a high probability of recording false positive (Le et al., 2016).
Conclusion
In summary, after its inception in 1895, mammographic screening has gone on to become a very vital aspect of diagnosing breast cancer. It is also used in scenarios where there is a lump scare or other probable signs of breast cancer. The two different types of mammographic techniques include 2D and 3D. Thus, while people may consider both techniques as effective methods of screening for breast cancer, nevertheless, 3D edges 2D when evaluated against the benefits and shortfalls they both possess. However, synthetic 2D can present some details and information which are typically best witnessed in 2D films like calcifications and is also cheaper. Ultimately, it is evident that 3D performs much better, and efforts should be made to utilize it further.