Breast cancer is the leading cause of cancer death in women worldwide. Because being a woman and advancing age are the most significant risk factors for breast cancer, screening is considered an essential part of women's health care.

The goal of screening for cancer is to detect preclinical disease in healthy, asymptomatic patients to prevent adverse outcomes, improve survival, and avoid the need for more intensive treatments. Screening tests have both benefits (e.g., improved health outcomes) and adverse consequences (e.g., cost, anxiety, inconvenience, false-positive results, and other test-specific harms such as overdiagnosis and overtreatment).

Mammography screening is the only method presently considered appropriate for mass screening of asymptomatic women. Screening modalities include imaging, a physical examination completed by a health care provider, and self-examination. Imaging modalities may include mammography, sonography, magnetic resonance imaging (MRI), and most recently, tomosynthesis and contrast-enhanced mammography

 The ACS (American Cancer Society) recommends annual screening for women ages 45 to 54, biennial or annual screening for women ages 55 and older, and the opportunity to begin annual screening at age 40. Current NCCN guidelines also recommend that women at average risk for developing breast cancer begin screening mammography at age 40

Limitations of Mammograms

Overall, the sensitivity for breast cancer detection by mammography is 85%. However, in women with dense breast tissue it is reduced to 47-64%. Mammograms are the best breast cancer screening tests we have but have their limits. For example, they aren’t 100% accurate in showing if a woman has breast cancer: 

• A false-negative mammogram looks normal even though breast cancer is present.
• A false-positive mammogram looks abnormal even though there’s no cancer in the breast.

A false-negative mammogram looks normal even though breast cancer is present. Women with dense breasts have more false-negative results which is the case in younger women. It gives a sense of security even though cancer is there.
A false-positive mammogram looks abnormal even though no cancer is actually present and which is more commonly observed in younger women with dense breast. Abnormal mammograms require extra testing (diagnostic mammograms, ultrasound, and sometimes MRI or even a breast biopsy) to find out if the change is cancer and it can cause anxiety too.

Mammograms can pick up cancers which needs to be treated but it’s possible that some of the cancers would never grow or spread. Finding and treating cancers that would never cause problems is called overdiagnosis. These cancers are not life-threatening, and never would have been found or treated if the woman had not gotten a mammogram. Overdiagnosis leads to some women getting treatment that’s not really needed which is called overtreatment. Doctors don’t know which women fall into this group when the cancer is found because they can’t tell which cancers will be life-threatening and which won’t ever cause problems. Because of this, all cases are treated. Because mammograms are x-ray tests, they expose the breasts to radiation. The amount of radiation from each mammogram is low, (0.4msv) but it can still add up over time.

Nevertheless, mammography is an impactful tool and is effective in all women but women with high breast density(younger women) are often screened with ultrasound, because mammograms of women with dense breast tissue (younger women) tend to be harder to interpret. For this reason, ultrasound is frequently a diagnostic imaging method for women under 35.

The usual indications for breast ultrasound would be a suspicious finding on mammography or for further diagnostic evaluation of a palpable lesion felt on a clinical breast exam.

Breast MRI is not recommended as a routine screening tool for all women at average risk of developing breast cancer. However, it is recommended for screening women who are at high risk for breast cancer, usually due to a strong family history and/or a mutation in genes such as BRCA1 or BRCA2. If you are considered high-risk, you would have breast MRI in addition to your annual mammograms.

Breast MRI is more sensitive than mammograms but a major disadvantage is that breast MRI screening results in more false positives — in other words, the test finds something that initially looks suspicious but turns out not to be cancer. If breast MRI were adopted as a screening tool for everyone, many women would end up having unnecessary biopsies and other tests. That is why current recommendations reserve breast MRI screening for high-risk women only. MRI is also more expensive than mammography, and dedicated breast MRI screening equipment is not widely available.

Despite the potential drawbacks of mammography, it remains the gold standard and continues to be the only method of breast cancer screening proven to reduce mortality.

Cervical cancer is one of the most common women cancers in developing countries like India. As we know that women with early-stage cervical cancer who undergo radical hysterectomy show an excellent 5- year disease free survival rates. Over the last few years, there is wider acceptance of minimally invasive hysterectomy over open abdominal approach. This provides a perfect platform for systematic review and meta-analyses comparing the risk of recurrence and death between patients who underwent minimally invasive vs open radical hysterectomy for early stage cervical cancer.

Brief overview of this meta-analysis

Roni Nitecki at al. reviewed and analysed various observational studies from multiple data sources that used survival analyses to compare outcomes after minimally invasive and open radical hysterectomy in patients with early-stage cervical cancer. All relevant studies related to this topic were searched in various search engines like ovid medline, ovid embase, pubmed, scopus and web of science (from inception to march 2020)

Studies fulfilling following criteria were included in analysis

1. Enrolled adult (18 years) with stage IA1 to II A as per FIGO 2009 (irrespective of histologic type)
2. Studies which compared overall survival or disease-free survival or disease-free progression.
3. Studies which used a survival analyses method
4. Reported median follow up of at least 24 months
5. Had New castle Ottawa scale score of 7 points or higher and was interpreted as being of good quality.

 Studies fulfilling these above criteria were thoroughly analyzed which was approximately 1428 in number, to which inclusion and exclusion criteria were applied and 863 studies were excluded and 49 articles were retrieved. Finally, 15 articles were selected after excluding confounding factors, poor quality studies and duplicated populations.

Pros and cons of the meta-analysis

Pros

1. Present meta-analysis is a large analysis conducted so far and included studies that were not included in prior meta analyses
2. Study addressed to minimize confounding factors by demographic factors and tumor characters like stage and size.

Cons

1. Low to moderate heterogeneity was found in estimates of hazard of recurrence and mortality associated with minimally invasive surgery.
2. Many studies included laparoscopic and robotic as minimally invasive surgeries which greatly depends on various factors like surgeons learning curve, selection of cases, operative techniques which were not analyzed in studies.

Conclusion

Data from 9499 patients who underwent radical hysterectomy were included in the meta-analyses. Of these 49% of patients received minimally invasive surgery. Of these patients who received minimally invasive surgery, 57% received robot-assisted laparoscopy. The total recorded recurrences in all the studies included is 530 and death in 450. It was observed that pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery. No association was found between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death or all-cause mortality.

Finally, the systematic review and meta-analyses concluded that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence of and death compared with open surgery.

COVID -19 is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and spreads through human-to-human transmission first emerged in Wuhan, China, in December 2019. On March 11, 2020, the World Health Organization (WHO) declared that COVID-19 has become a global pandemic which means that disease spread widened and cases were present in multiple countries.

The pandemic has created a number of challenges for healthcare professionals across the globe. From doctors to nurses, the last seven months have been extremely difficult for those involved in delivering treatment and care. Social distancing norms, lockdowns, fear of contracting the virus have added to the stress and anxiety of patients. This is more severe in the case of cancer patients. Over the last few months many cancer patients have delayed their treatment due to the fear of contracting the virus. On the other hand, oncologists have faced challenges in delivering treatment due to changed protocols, social distancing norms, travel restrictions and many other changes. This pandemic has posed many challenges to the routine delivery of safe oncological treatment to all cancer patients including screening, diagnosis, treatment, follow ups and supportive care.

Breast cancer is one of the most common cancers and most of the patients are facing challenges at various steps of their treatment. One of the key challenges that patients and oncologists face is when a patient gets diagnosed with COVID. For instance, a young 29-year-old girl was diagnosed with rapidly growing breast sarcoma (type of malignant tumor). We were planning for a simple procedure without any flap (plastic surgery) cover so as to start her adjuvant treatment as early as possible. Unfortunately, her preoperative COVID-19 test turned out to be positive and we had to postpone her surgery till she became negative. After two weeks when she was taken up for surgery her tumor had almost doubled in size and we had to take plastic surgical help to provide necessary cover post resection. This not only delayed her entire cancer treatment but also had become difficult to manage as the cancer had progressed. This also creates severe psychological trauma for the patient. Same was the cause with another 64 year patient who had to delay her chemotherapy treatment when she tested positive for the disease.

Some of the main problems faced are as below

Delay or avoidance of hospital visit: A number of times even if patients notice a lump on the breast, they tend to ignore it and delay seeking consultation. This is mainly due to the fear of contracting COVID infection by visiting a hospital. Due to the delay in seeking consultation, there is an increasing number of locally advanced and metastatic breast cancer as compared to early breast cancer being diagnosed these days. Unless the lump is quite large with significant symptoms, patients tend to avoid visiting hospitals. According to a recent survey, almost half of breast cancer patients experienced delays in cancer care and treatment as a result of the present pandemic due to various reasons.

Changes in hospital experience: Patients who visit the hospital for consultation and treatment often have to follow strict social distancing norms. Not many family members are allowed into the hospitals. This makes the whole experience quite lonely for them. They tend to miss the physical and emotional support of their family and friends during treatment and consultation. Dealing with the treatment, stressing about contracting the infection, the lack of human touch and physical support during hospital visits and a number of other aspects can mentally impact the patients. Now is the time they need more support. Patients must seek help from mental health professionals who can help them talk about what they are going through. Family members must step up and ensure that the patient is eating healthy and talking to their loved ones to overcome anxiety.

Fear of treatment: Due to compromised immunity due to chemotherapy or because of the disease, cancer patients are at high risk of catching the infection. They are inherently immunosuppressed from their malignancy and therapies which they are undergoing. A number of patients delay their treatment and consultation due to fear of visiting the hospital and contracting infection. Patients and their families must understand that treatment cannot be delayed for cancer. It’s important to balance the risk of exposing themselves to COVID-19 with the risk of advancement or progression of disease.

Continuity of consultation and treatment: Oncologists across the country have had to make significant changes in their treatment protocols and consultation procedures in order to meet the changes in the current environment. To ensure continuity of treatment, oncologists are now offering tele consultation services to help patients manage the disease better. Though oncologists have successfully adapted to tele consultation and other modes to interact with their patients, it becomes fairly challenging to ensure continuity of conversation with their patients. The effectiveness of in person consultation can never be replaced with tele consultation. This is a challenge that oncologists have been continuously working to address.

Financial challenges: The pandemic has led to job losses and decreased incomes for many families. Covering the cost of the treatment and consultation, managing insurance in case of job losses, travel expenses for those from other towns all these factors creating financial difficulties for patients and their families.

After having faced pandemic for more than six months most of the cancer centers have initiated recommended cancer treatment as per the guidelines with fewer deviations following all the precautionary measures. Major challenge is if a patient is diagnosed with COVID before or during the treatment which imposes threat of delay in treatment and progression of the disease is unavoidable. Hopefully, with better drugs available and possibly even vaccines, we can give cancer patients a more level playing field to complete their cancer treatment.

Worldwide, obesity has become a major public health crisis. Although smoking is the most common cause of death that can be prevented, obesity is the second most common.

Endometrial cancer is the most common invasive neoplasms of the female reproductive system in most developed countries with increasing incidence in urban India.

Overweight and obesity not only increase the risk of cardiovascular disease and type-2 diabetes, but also are now known risk factors for a variety of cancer types. Among all cancers, increasing body mass index is most strongly associated with endometrial cancer incidence and mortality but lacks the awareness.

The most frequently mentioned risk factors, which are associated with the occurrence of endometrial cancer are obesity, infertility, high blood pressure, diabetes, liver disease, hormone active tumors of the ovary, and the use of external estrogen.

Obesity is not only associated with increased incidence of endometrial cancer but has also been related to ovarian, breast and colon cancers. It may also be linked with other cancers, including esophageal, pancreatic and kidney (renal).

RELATIONSHIP BETWEEN OBESITY AND CANCER; MECHANISM HOW OBESITY FUELS CANCER

Obesity is defined by the World Health Organization as body mass index> 30 kg / m2 (BMI> 30 kg / m 2 ). In obese patients with overweight from 9.5 to 23 kg develops three times more often endometrial cancer compared to women with normal weight, those over 23 kg overweight frequency of occurrence increases tenfold.

Obese women definitely have an increase in estrogen, which is a hormone that makes some cancers grow.

The association between obesity and endometrial cancer begins with visceral fat, a complex endocrine organ whose components secrete an array of adipokines that induce intermediate effects leading to increased endometrial proliferation and promotion of tumorigenesis. Additionally, adipose tissue contains mesenchymal cells that can be recruited to support tumor growth and progression.

In premenopausal women, cyclic ovarian expression of estrogen further stimulates endometrial proliferation. After menopause, peripheral tissues, especially adipose tissue (fat), becomes the principal site of estrogen synthesis.

 Estrogen and it’s metabolites act to interact with DNA to produce an accumulation of double-stranded DNA breaks to contribute to genetic instability which finally leads to tumor formation.

Type 2 diabetes, also strongly associated with obesity, results in elevated levels of insulin and insulin-like growth factor (IGF)-1, as well as hyperglycemia, all of which contribute to endometrial cancer pathogenesis. In the endometrium, insulin and IGF-1 are characterized by hyperactivity and increased signaling in pathways associated with the development of endometrial cancer.

Obesity also stimulates production of a variety of pro-inflammatory adipokines and cytokines that increase endometrial cancer risk.

So, molecular mechanism of obesity contributing to increased incidence of cancer is fairly well understood.

WHAT SHALL WE DO?

It is important to realize that a large weight loss will reduce cancer risk.

Life style modifications, dietary changes, regular exercises should be inculcated to maintain healthy body weight. Multiple interventions have demonstrated efficacy to ameliorating obesity and, by extension, associated endometrial cancer risk.

Bariatric surgery has demonstrated the ability to achieve dramatic and sustainable weight loss in obese individuals. More specifically, a recent meta-analysis of six observational studies showed a 60% reduction in endometrial cancer risk among obese women who underwent bariatric surgery.

Progestin medications counteract estrogen's proliferative effects on the endometrium, and progestin-containing oral contraceptives have a well established protective effect against endometrial cancer. Intrauterine devices, including those without embedded progestins, also have shown an ability to reduce the risk of endometrial cancer.

Surgery is a principal component of treatment for endometrial cancer. However, obesity can complicate surgery and other clinical management strategies. Obesity not only directly complicates surgery, but obesity-associated medical comorbidities also increase the risk of perioperative complications.

In the end, the message that should be getting out to women is to avoid sedentary lifestyles and maintain a more appropriate/ideal weight, and to plan weight loss for women who are overweight or obese as a means of overall health maintenance.

Screening mammography is considered to be the most recommended way to detect breast cancer; however when it comes to screening cancer for younger women, this method is not considered to be the best option.

Breast cancer can affect at any age, hence cancer screening even at early age is essential. Usually, younger women, do not consider themselves to be at risk of suffering from breast cancer, so they tend to ignore the symptoms. There are several factors that can put young women at high risk from this disease such as:

1.  Family history of breast cancer,  particularly in a mother, daughter, or sister
2. Women who carry genetic defects are also at great risk
3. History of radiation therapy

Breast cancer is one of the few cancers when detected early and treated appropriately, can be completely cured. Normal life after breast cancer treatment is possible but the pre-requisite is early detection. When detected early, the treatment becomes simpler, shorter and cheaper. And more importantly complete cure is possible.

For the early detection of breast cancer, regular mammograms are not recommended by the doctors for women under 40 because breast tissue tends to be denser in young women, making mammograms less effective as a screening tool. Hence, screening mammograms may be recommended only for younger women with a family history of breast cancer and other risk factors.

To detect this disease early, there are certain guidelines recommend by the medical experts, which can help in detecting cancer early for the timely and effective treatment. Doctors recommend monthly self-breast examination (SBE) and annual clinical examination for >20 years aged women. It has to be done on seventh day of the periods. However, women who have achieved menopause or have undergone hysterectomy or have irregular periods need to do it on a particular date of the month.

 Younger women generally have dense breast tissue making mammogram interpretation challenging; hence other modalities are still being explored.  Contrast enhanced MRI is highly sensitive (99% when combined with mammography) can lead to malignant changes.

 While performing the self-examination, if the person finds a breast lump or an unusual discharge from nipples, must not be ignored. It is essential to seek help immediately but all lumps, skin changes or nipple changes do not necessarily mean it is cancerous.  It is essential to approach the right specialist (Breast oncologist) to detect the right symptoms.

Nowadays new methods are experimented to detect breast cancer among younger women, one of the methods are iBreast Exam (iBE). This instrument is a hand held pre-screening device that can be used in resource constraint area and women with suspicious features can further undergo mammogram. iBE is based on piezoelectric detector, which can be effectively used by non clinician with a sensitivity of 60%.

Breast cancer in men is rare but this is the potential cause of neglecting the symptoms as more priority is given to women than men due to the high risk found among women. Mostly, male breast cancer is detected between the ages of 60 and 70 and they are at higher risk when they are exposed to radiation, has a family history of breast cancer, a genetic mutation, and having high estrogen levels. Early detection can be achieved with MRI or ultrasound.

Lifestyle behaviors have long been identified as risk factors for both the development of, and negative outcomes, from breast cancer.

For example, obesity (body mass index [BMI] of 30 kg·m² or higher) is associated with a 20% to 40% increased risk of breast cancer in postmenopausal women. Combined obesity and physical inactivity account for an estimated 25% to 33% of all breast cancer.

Further, in patients diagnosed with breast cancer, obesity is associated with a 33% increased risk of recurrence.

Factors known to be protective for breast cancer include maintaining a healthy weight and engaging in regular moderate or vigorous exercise. Unfortunately, exercise remains an underused preventive strategy.

It’s a well-established fact that physical activity helps to keep us healthy.

The American Cancer Society (ACS) strongly recommends exercise (alongside eating a balanced diet and maintaining your optimum body weight) as a breast cancer preventive measure.

HOW EXERCISE REDUCES RISK OF BREAST CANCER

1. Exercise decreases body fat percentage and helps maintain a healthy weight.We all know that regular exercise can help lose weight and maintain a slim figure. This is important because fat cells in the body store high levels of estrogen, a hormone which is one of the strongest breast cancer risk factors when levels become too high with high fat percentage.
2. Exercise decreases the levels of estrogen in body.
   It is now believed that exercise can modify the pattern of a woman’s menstrual cycle, causing body to produce less estrogen. This therefore helps to lower breast cancer risk.

• Exercise strengthens immune system.
  Free radicals are highly reactive, unstable molecules which mutate cells and lead to cancer. Free radicals can, themselves, cause damage to the body but this is counter-balanced by production of antioxidants.
• Exercise provides a mental benefit and stress relief.
  Exercise impacts directly upon your mood and emotions. Although it is often suggested and under ongoing investigation, a direct relationship between psychological stress and breast cancer has not been proven. Certainly, for those undergoing treatment or in the recovery phase, exercise is a fantastic stress-relief to help speed recovery and support treatment.

HOW MUCH EXERCISE IS ENOUGH?

You don’t need to an elite athlete to lower your breast cancer risk.

As little as 30 minutes of moderate physical activity per day has been said to significantly reduce susceptibility according to one recent study.

The ACS (American Cancer Society) have published some very clear and helpful guidelines in relation to exercises for breast cancer prevention:

1.To effectively lower breast cancer risk using exercise, adults should aim for a minimum 150 minutes of moderate-intensity or 75 minutes vigorous-intensity activity spaced out across the week.

2.Ideally, a preventative exercise regimen should begin in childhood with 1 hour of activity per day (preferably vigorous-intensity at least 3 days per week)

3.Moderate-intensity exercise covers physical activity such as a brisk walking, gardening or cycling.

4.Vigorous exercise could include running, fast dance classes, soccer or any other exercise which gets your heart beating and works up a sweat.

Being physically active is not only a preventive measure for breast cancer but also helps in reducing the risk of recurrence in diagnosed cancer patients.

Endometrial cancer (cancer of uterus) is the sixth most common cancer in women worldwide. It is mainly a disease of high-income countries, where the highest incidence of endometrial cancer is in North America, and Central and Eastern Europe; and the lowest incidence in Middle and Western Africa.

Cancer of the endometrium is the second most common genital cancer in Indian women, second only to carcinoma of the cervix.

The incidence of ca Endometrium is very low in India but highest being observed in Bangalore and Delhi. There are few factors contributing to increased incidence of carcinoma endometrium in urban areas of our country.

When the balance of progesterone and estrogen shifts at the time of menopause, with a decrease in progesterone production, even small amounts of circulating estrogens may not be adequately counterbalanced, and can lead to the thickening of the endometrium and potential subsequent endometrial cancer. Several studies have demonstrated that unopposed estrogen therapy increased the risk for endometrial hyperplasia and cancer, whereas the addition of a progestogen prevents such risk.

In addition to the use of menopausal hormone therapy (HT), a number of factors may influence a woman's risk of developing endometrial cancer, including certain medications, obesity, diabetes, hypertension, reproductive factors, and diet and exercise.

Endometrial cancer incidence (SEER data of NCI, USA)

Data showed that endometrial cancer rates declined between 1975 and 1992, and then remained relatively constant up to 2002 in women 50 years of age or older. Extracting data further, it’s calculated that the age-adjusted incidence rate per 100,000 people increased 2.5% annually with a 10% increase from 2006 to 2012.

Reasons for this increasing incidence are reviewed here specially in terms of risk factor.

Menopausal HT

Decrease in FDA-approved estrogen and progesterone therapies

Increased risk for endometrial cancer was unequivocally shown in earlier studies of unopposed oral estrogen. Early data also showed that addition of a progestogen prevented the increased risk of endometrial cancer with unopposed estrogens. Currently, women with a uterus taking systemic estrogens (oral/transdermal) are to be prescribed a progestogen to prevent endometrial hyperplasia, and the potential for subsequent endometrial cancer.

Increase in FDA-approved vaginal estrogens

Local vaginal estrogen use has not been associated with increased risk of endometrial cancer and does not result in endometrial hyperplasia rates as reported for systemic unopposed estrogens.

Obesity

Obesity may account for up to 40% of the observed endometrial cancer incidence, with obese women having a twofold to fivefold increased risk of developing endometrial cancer compared with normal weight women. In general, obesity is associated with higher levels of circulating estrogens in postmenopausal women, likely accounting for their increased risk of endometrial cancer. Increasing incidence of obesity is also a factor contributing to increasing incidence of carcinoma endomentrium.

Diabetes

Diabetes has also been associated with a significant increased risk of endometrial cancer. Data suggest that the increase in diabetes observed may have contributed to the increase in endometrial cancer incidence.

Reproductive factors

Certain reproductive factors may also influence the incidence of endometrial cancer by affecting the relative estrogen/progesterone balance. Women with an increased lifetime exposure to estrogens, including women with an early age at menarche, later age at menopause, lower parity, and no history of oral contraceptive use, have been linked to a higher incidence of endometrial cancer

Cancer and cancer-related treatments

Cancer-related treatments, such as the selective estrogen receptor modulator tamoxifen, may also affect endometrial cancer risk. Although effective in reducing breast cancer incidence by acting as an antiestrogen in breast tissue, evidence suggests that tamoxifen acts as an estrogen in the uterus and increases endometrial cancers.

Exercise

Epidemiological evidence has shown that physical activity can lower the risk of endometrial cancer by 20%–40% compared with physical inactivity. In conclusion, an increase in endometrial cancer incidence may be associated with a number of risk factors like obesity, and diabetes, lack of physical activity, as well as decreased use of approved estrogen–progestogen HT.

Mammography is considered to be the gold standard screening modality for early diagnosis of breast cancer.

But it is associated with few drawbacks technologically, like pain due to compression, lower sensitivity for dense breast and performing breast biopsy, which makes females very anxious and avoids getting screened despite being aware of its advantages.

New technology advances and processes are looking to take the anxiety out of mammograms and encourage women to get themselves screened.

“Patient-centered care” is a popular term among those in the healthcare industry in the 21st century.

It actually means that the patient is part of their own healthcare team helping to make decisions, and they are made as comfortable as possible throughout the process.

Patient-centered mammography focuses on managing compression, streamlining or shortening the exam, and making sure the patient is fully informed about the procedure including breast density.

New technological advancements are helping in all three areas so that mammography becomes a pleasant experience for them and alleviates their anxiety.

Taking the Pain Out of Compression

Many women report that compression is the most painful or unpleasant part of the mammography exam. Sufficient compression is required, however, in order to achieve a high-quality image.

Results from various studies indicated that compression pressures in lower ranges led higher false positive rates.

Lack of consistent guidelines for mammographic compression can lead to a wide variation in execution. Both very high and very low mean compression pressure can adversely affect mammography quality. Therefore, it is reasonable to suggest that standardizing to an intermediate compression pressure may lead to better screening outcomes and a better patient experience.

Mammography vendors have started to introduce enhancements to their systems that try to make the exam less painful for patients. One common enhancement is rounding out the hard corners of the system to better mimic the shape of the breast to allow for less pinching.

GE Healthcare literally put compression in the patient’s hands with their newest mammography system, which is launched in the U.S. in early 2017. After the initial launch, GE gained U.S. Food and Drug Administration (FDA) approval for a remote device that allows patients to control their own compression. The technologist does the initial positioning and compression and then hands the remote to the patient for final adjustments.

Overall, women who used the self-compression device tended to apply more force than the technologist. It’s like the difference between you pinching yourself and someone else pinching you.

Answering Breast Density Questions

Physical comfort is just one important element of a patient-centric mammography exam. When it comes to their own healthcare, patients today want to be armed with as much information as possible to make decisions.

Over the last decade, women in particular have become more aware of the need to ask their healthcare providers about fibroglandular breast density and how it impacts screening and breast cancer risk.

The newer computer-aided detection software delivers automated, rapid and reproducible assessments of breast density to help identify patients that may experience reduced sensitivity to digital mammography due to dense breast tissue.

Making Biopsies Easier

While making the exam more comfortable goes a long way toward a patient-centric approach, any opportunity to streamline or shorten the exam should also be top of mind.

If suspicious findings are detected on a mammogram, the next step is to take a biopsy of the tissue in question and analyze whether it is cancerous. Traditionally, this has meant taking the sample — a painful process for the patient — and taking it to another room to be analyzed.

Technology has looked to streamline this process with new mammography system, which features onboard biopsy and specimen analysis tools which offers one-click targeting of suspicious areas in a mammogram, and the integrated specimen scanner completes the tissue analysis. The technologist does not have to leave the room at all during the process, leaving the patient alone to wonder and worry what the results will be.

One-Stop Breast Imaging

The ultimate goal behind all of these technological advancements — whether in compression, density assessment or streamlined biopsy procedures — is to make the mammography experience more amenable to the patient. As long as healthcare continues to move toward a more patient-centered, value-based enterprise, women’s health facilities may look to employ a combination of these and other technologies to make patient’s lives easier.

Health care providers will have to think about how to engage more women in breast cancer screening so as to make their experience as comfortable as possible and keep them actively involved during the entire procedure and also to motivate them to come forward for screening.

What is cervical cancer screening?

The cervix is the opening to the uterus and is located at the top of the vagina.

Cervical cancer doesn't cause any symptoms at first, or only very few, so it is often not detected for a long time.

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer and thereby helping in early detection.

Screening includes cervical cytology (also called the Pap test or Pap smear) and, for some women, testing for human papillomavirus (HPV).

How does cervical cancer occur?

Cancer occurs when cervical cells become abnormal and, over time, grow out of control. The cancer cells invade deeper into the cervical tissue. In advanced cases, cancer cells can spread to other organs of the body.

What causes cervical cancer?

Most cases of cervical cancer are caused by infection with HPV (Human Papilloma Virus). HPV is a virus that enters cells and can cause them to change. Some types of HPV have been linked to cervical cancer as well as cancer of the vulva, vagina, penis, anus, mouth, and throat. Types of HPV that may cause cancer are known as “high-risk types.”

HPV is passed from person to person during sexual activity. It is very common, and most people who are sexually active will get an HPV infection in their lifetime. HPV infection often causes no symptoms. Most HPV infections go away on their own. These short-term infections typically cause only mild (“low-grade”) changes in cervical cells. The cells go back to normal as the HPV infection clears. But in some women, HPV does not go away. If a high-risk type of HPV infection lasts for a long time, it can cause more severe (“high-grade”) changes in cervical cells. High-grade changes in cervix are more likely to lead to cervical cancer.

Why is cervical cancer screening important?

It usually takes 3–7 years for high-grade changes in cervical cells to become cancer. Cervical cancer screening is very important as it may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.

Advantages

Cytologies every 3 years for women between the ages of 21 and 65 reduce the risk of death from cervical cancer.

• Of 1,000 women who do not get screened, 10 could die from cervical cancer.
• Of 1,000 women who do get screened, 2 could die from cervical cancer.

Therefore, there are 8 less cervical-cancer-related deaths in the 1,000 women who get screened.

This is due to the fact that:

• Screening helps detect abnormal cells in the cervix, which can develop into cancer. Surgical Oncologist can remove the parts of the cervix that contain these cells before a cancer develops. In this way, screening reduces the risk of getting cervical cancer.
• If a cancer is already present, early detection due to screening improves the chances of recovery.

How is cervical cancer screening done?

Cervical cancer screening includes the Pap smear test and, for some women, an HPV test. Both tests use cells taken from the cervix. The screening process is simple and fast.

Patient lies on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.

Cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:

• For a Pap test, the sample is examined to see if abnormal cells are present.
• For an HPV test, the sample is tested for the presence of 13–14 of the most common high-risk HPV types.

How often cervical cancer screening is done and which tests should be done?

It depends on age and health history:

• Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.
• Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.

When to stop cervical cancer screening?

 cervical cancer screening should be stopped after age 65 years if

• no history of moderate or severe abnormal cervical cells or cervical cancer, and
•  three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.

Are there any women who should not follow routine cervical cancer screening guidelines?

Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth may require more frequent screening and should not follow these routine guidelines.

Having an HPV vaccination does not change screening recommendations. Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group.

What does it mean if cervical cancer screening test result are abnormal ?

Many women have abnormal cervical cancer screening results. An abnormal result does not mean that they have cervical cancer. Remember that cervical cell changes often go back to normal on their own. And if they do not, it often takes several years for even high-grade changes to become cancer.

If screening test result is abnormal, additional testing is needed to find out whether high-grade changes or cancer actually are present. Sometimes, only repeat testing is needed. In other cases, colposcopy and cervical biopsy may be recommended to find out how severe the changes really are. If results of follow-up tests indicate high-grade changes, it may need treatment to remove the abnormal cells.

How accurate are cervical cancer screening test results?

As with any lab test, cervical cancer screening results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. Cervical cancer screening also may not detect abnormal cells when they are present. This is called a “false-negative” result.

To help prevent false-negative or false-positive results, one should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before the test and also should avoid cervical cancer screening during menstrual period.

When the doctor says you have stage 0 breast cancer, and now you have lots of questions. What does that mean? Is it even really cancer?

Stage 0 cancers are basically pre-cancerous lesions and are also called “carcinoma in situ.”
Carcinoma means cancer and “in situ” means “in the original place.” (i.e. the cancer confined to its original place which is the earliest non- invasive stage of breast cancer)

The five-year survival rate for stage 0 breast cancer is 93-95 percent. This means that almost all women diagnosed with stage 0 disease will live for at least five years after being diagnosed.

 In fact, women diagnosed with stage 0 breast cancer usually live long and healthy lives.

Stage 0 breast cancer is difficult to detect. There’s no known cause, and most people don’t have any symptoms, though you may notice a lump or bloody discharge from your nipple.

 However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.

Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.

Types of stage 0 breast cancer

Three possible types of “in situ carcinoma” of the breast tissue are:

1. Stage 0 ductal carcinoma in situ (DCIS) is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. Ductal Carcinoma in Situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, in about 50 percent of the cases, it can spread into the surrounding breast tissue. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings.
2. Stage 0 Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. These cells are not cancerous and this condition rarely becomes invasive cancer. However, women who develop LCIS may be at increased risk for developing breast cancer in the future. For women who develop LCIS, the risk of getting an invasive cancer is 20 - 25 percent over 15 years after the initial diagnosis. Patients who have been diagnosed with LCIS,  are recommended to have regular clinical breast exams and mammograms. Hormone therapy medication (Tamoxifen) helps prevent cancer cells from growing.
3. Paget’s disease: Carcinoma in-situ arising from the nipple ducts.

Even though Stage 0 breast cancer is considered “non-invasive,” it does require immediate treatment, typically surgery or radiation, or a combination of the two.  Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer but hormonal therapy is a part of the treatment.

Treatment needs to consider the person's history, treatment needs and goals, and other breast cancer risk factors they may or may not have.

Surgery is the main treatment for DCIS. Most women are offered breast-conserving surgery. If there are several areas of DCIS in the breast, doctors may do a mastectomy to make sure that all of the cancer is removed.

 Lymph nodes under the arm (called axillary lymph node dissection) are usually not removed for DCIS because this cancer has not spread outside the duct in the breast.

To lower their risk of developing invasive breast cancer, some women with DCIS/LCIS may choose to have their breasts removed (called a prophylactic mastectomy). (If genetic tests BRCA1&2 positive)

External beam radiation therapy is usually given after breast-conserving surgery for DCIS. It is used to lower the risk that cancer will come back (recur) in the breast, especially if there is high-grade DCIS. LCIS is not treated with radiation therapy.

Hormonal therapy (Tamoxifen) is offered for hormone receptor–positive DCIS. Hormonal therapy is started as soon as the cancer is diagnosed. It is given for up to 10 years to lower the risk that you will develop another breast cancer.

Women with LCIS may be offered tamoxifen to lower the risk that an invasive breast cancer will develop.