October is well known as Breast Cancer Awareness month.
Every year around this time there is talk about a national screening programme for breast cancer, but I know the drill fairly well by now.
There is usually the same plea (often by me) every January which is Cervical Cancer Awareness month, for a national Pap smear screening programme.
Everyone is up in arms about the importance of early detection and treatment and countless lives saved, but in the end, nothing substantial really materialises.
Breast cancer (unlike its poorer relation, gynae cancer) does continue to receive extensive publicity and why not. It is by far the most common cancer in women worldwide both in developed and developing countries and the incidence has been steadily rising in the last few years in both low- and middle-income countries.
So, having a comprehensive breast cancer screening programme ideally as part of a wider national cancer screening and control plan is critical.
My experience here in Trinidad in dealing with breast disease is fairly limited and I tend to defer to the experts. In fact, early on I came to realise that traditionally, women with specific breast complaints initially consult a gynaecologist.
This seems obvious as women depend on their gynaecologist for advice regarding their reproductive organs, including the breasts, and by the very nature of their practice, a gynaecologist has some experience with benign breast problems, either during or outside pregnancy.
However, with increasing specialisation and everyone finding a niche for themselves, there are indeed breast surgeons and oncologists who are specifically trained in dealing with breast cancers. Some of these may have had a background in gynaecology or general surgery but now have become experts in breast cancer management.
Being a specialist in oncology myself, I do indeed subscribe to the notion of leaving the cancer stuff to the experts. I may be a gynae-oncologist after all but by no means a breast oncologist. So, barring the most basic concerns, I tend to refer onwards.
Nevertheless, there are always differences in opinion on who should be doing what. I have learned the hard way that many doctors hold the view of “this is how I have always done it with no major issues so why change now.”
Take mammograms for instance.
There are so many opposing views as to who should have, when should they have it, what is the benefit and is there any benefit at all?
Mammography for breast cancer is still recommended by many international bodies and organisations based on various studies and levels of evidence.
Screening for breast cancer using mammograms on a national basis remains costly and tends to be feasible in countries with good health infrastructure that can afford a sustaining long-term programme.
The need for interpretation of a mammogram by a specialist radiologist not only contributes to this high cost and limited access but adds an element of human error to even the most well-established screening programmes.
Imagine my surprise when I saw a recent study published in the highly regarded Lancet medical journal about the use of artificial intelligence (AI) to report mammograms.
A Swedish team of scientists used an AI computer algorithm to read the mammograms of over 8000 women and found that the AI cancer detection software performed on par with and in some cases better than the radiologists in picking up cancer.
Even more astonishing was that the AI algorithm had no access to previous mammograms or information about patient symptoms or hormonal therapy, unlike the radiologists.
These remarkable results have also been reported in the Journal of the American Medical Association—(JAMA Oncology) which prompted an editorial comment that the “time has come” for further investigation into artificial intelligence models.
If AI technology could eventually differentiate women with breast cancer from those without, this would have the potential for global use, especially for those who have no access to cancer screening.
But for us here in Trinidad and Tobago, the “time has come” to have the conversation once again about national cancer screening programmes and the how crucial they are.
We are still a long way from replacing doctors with computers, but even though AI technology gets more accurate everyday (while we clearly may not), the basics of cancer screening and management still apply.