Mammo-screening moves on

EH correspondent H-C Pruszinsky reports

Increased general awareness of issues surrounding hormone replacement therapy, and the fact that Austria is currently the only country among the EU-15 without a comprehensive early screening programme for breast cancer, led Health Minister M Rauch-Kallat to have the parameters for comprehensive mammography screening examined. The immediate result of the study, carried out by the Austrian Federal Institute for Healthcare (ÖBIG), is a pilot project that will include mammography screening for 70,000 women, aged between 50 and 69 years, in two Vienna districts and in Vorarlberg. A second research programme is to target women with a genetic disposition for the disease, and a third programme targets women who have undergone hormone replacement therapy for long periods of time.
Around 4,500 women in Austria develop breast cancer annually; 1,600 die from the disease. The objective is to lower the mortality rate by a third through systematic screening programmes. Comparative figures from the EU-15: 220,000 cases of the disease with 75,000 deaths; 25,000 women who might have been saved through screening.
The EU commission, along with the WHO — among other things based on relevant experience gathered in Sweden and Finland — estimate a 30% reduction in the breast cancer mortality rate if all member states introduce high quality mammography screening, including a second opinion for each case and follow-up examinations for conspicuous cases.
The authors of the ÖBIG report Mammography Screening Austria, published in 2004, state that a comprehensive national early screening programme can save 500 lives annually, but that the Austrian healthcare system currently does not have the appropriate, essential framework for a quality-supported screening programme based on EU guidelines (training, technological quality assurance, breast cancer register). The maximum costs (calculated without accounting for possible synergy effects regarding locations, technology and staffing) are estimated to be around ?22 million annually.

A private foundation for breast health
Founded in Vienna in 2002, the private, charitable Foundation for Breast Health, which is funded by sponsors, donations and the organisation of events and charity actions, has since been successfully working towards the following ambitious objectives:
l Saving lives through education about screening and promoting lifestyle changes.
l Promoting research projects aimed at improving the prevention, early detection and treatment of breast cancer, or those that work towards the psycho-oncological and psychosocial care for breast cancer patients and their families.
The Foundation’s Board is made up of opinion leaders from medical, business and political fields in Austria. The Foundation currently supports the following projects:
1. Prevalence of pre-malignant and malignant lesions in prophylactic mastectomy specimens of BRCA1 carriers in a control group comparison
BRCA1 mutation carriers have a high risk of developing breast cancer (BC). Risk management may entail early radiological screening or a prophylactic mastectomy (PM). The operative treatment strategy involving PM compared with surveillance strategy could gain additional importance for the mutation carriers if the histologically examined mastectomy specimens show numerous pre-malignant and malignant changes despite radiologically unremarkable results. This is why the study retrospectively examined how the histological specimens of the PM preparations of the BRCA1 carriers differed from those in the control group.
The study included 24 healthy mutation carriers and 28 BRCA-1 mutation carriers suffering from breast cancer who had undergone a bilateral prophylactic mastectomy (BPM) or a mastectomy of the contralateral breast (CPM) following unremarkable, pre-operative radiological findings. To compare the occurrence of premalignant and malignant lesions a control group was matched to the respective ages and states of the disease. The group comparison was carried out with t-Tests for dependent samples and the Wilcoxon Signed Ranks Test.
The entire group of mutation carriers differed significantly with regards to the occurrence of premalignant or malignant changes from the matched control group (42.3% vs. 5.8%; p < .001). The sub-group comparison of the healthy mutation carriers as well as the carriers who had already developed the disease compared with the members of the matched control group showed a significant difference in the occurrence of premalignant and malignant changes (45.8% vs. 0%; p = .002; 39.3% vs. 10.7%; p = .03). Carcinomas were detected in 5.8% (3/52) of the mutation carriers and premalignant changes in 36.5% (19/52) of the PM specimens.
2. Early detection of breast cancer and ovarian cancer through the identification of new tumour markers via surface-enhanced laser desorption/ionisation (SELDI-) mass spectrometry
New methods for the early detection of breast and ovarian cancers need to be developed. The objective of this project is to find protein patterns that may facilitate the early detection of breast and ovarian cancer. Serum and tissue samples are analysed with the most up-to-date techniques: combined application of a solid-phase extraction of serum proteins and surface enhanced laser desorption/ionisation mass spectrometry (SELDI-MS).
The characterisation of the detected proteins could establish a new generation of tumour markers and contribute towards a better understanding of the pathogenesis of breast and ovarian cancer.
So far the researchers have gathered samples from 356 breast cancer patients and 81 mutation carriers. DNA and serum samples are also available for most of these patients, and with some patients it was possible to obtain tissue samples of the actual tumours. The researchers also set up a database which makes the processing of data and samples easier.


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