Carcinoembryonic antigen (CEA) was first identified in 1965 by Phil Gold and Samuel O. Freedman in human colon cancer tissue extracts . CEA is a glycoprotein involved in cell adhesion . It is normally produced during fetal development, but the production of CEA stops before birth. Therefore, it is not usually present in the blood of healthy adults, although levels are raised in heavy smokers. It was found that serum from individuals with colorectal carcinoma, gastric carcinoma, pancreatic carcinoma, lung carcinoma and breast carcinoma, as well as individuals with medullary thyroid carcinoma, had higher levels of CEA than healthy individuals [25-27]. Analysis of detection of CEA in breastcancer patients leads to that the CEA blood test is not reliable for diagnosing breastcancer or as a screening test for early detection of the cancer especially due to the lack of sensitivity (54.4% for all grades of the cancer from I to III, 30.3% for the grade I) (Figure 4B and Table 5). If the test is not sensitive, then it may miss cancers. Therefore, the CEA breastcancerscreeningtests miss a large num- ber of patients with breastcancer depicted in Figure 5B. This wrong diagnosis becomes severer in the early- phased patients (grade I) with a sensitivity of 30.3% (Table 5).
This QI project had two distinct but related goals. First, we aimed to identify patients overdue for cervical, breast, and colorectal cancerscreening using data from the provincial cancerscreening registry together with the practice EMR. Second, we aimed to increase these screening rates using an evidence-based QI intervention. The intervention included three main components. Each overdue patient received a personalized reminder letter. Physicians reviewed their patients ’ screening status and indicated who should be contacted. The letter included a message signed by the patient ’ s family phys- ician and brochures about the relevant screeningtests. We modi ﬁ ed this intervention by experimenting with phone calls as an alternative recall method and collect- ing patient feedback on the process. Also, we provided physicians with individualized feedback on their cancerscreening rates and compared these to screening rates among their peers in their clinic and the entire Family Health Team. Finally, we updated charts with accurate data on the FOBT and improved our EMR reminder function. This project was guided by an interdisciplinary team that included students, physicians, health disci- plines, executives, and administrative support.
Death rates for breastcancer have steadily decreased in women due to earlier detection, such as mammography, and improved treatments (4-9). Mammography is the single most effective method of early detection for breastcancer. It can identify the cancer at an early stage, when treatment is more effective (1). The American Cancer Society screening guidelines recommend that average-risk women aged 40 and older receive mammography screening on an annual basis (1). About 38%-54% of women do not maintain annual adherence to screening mammograms (10, 11), and only 49% having received screening when using a biennial schedule (11). Annual mammography with adequate follow-up is estimated to result in reductions in mortality ranging from 25% to 44% (6, 7, 12-15). Mammography is a highly accurate screening tool, but like most medical tests, it does not have perfect sensitivity and specificity. Generally, reported positive predictive values ranges from 78% to 90% (1, 16, 17). One drawback of mammography is the false positive results. One large study found that over a 10-year period of annual mammogram screenings, the chance of having a false positive result was close to 50% (18).
Mutations in BRCA1 and BRCA2 are responsible for 16- 40% of hereditary breast and ovarian cancers and site-specific breastcancer; inTP53 is associated with up to 85% risk of developing breastcancer by age 60; germline mutations in CDH1 and STK11 are associated with 39-52% and 32-54% risk of developing breastcancer, respectively; germline mutations in the PTEN gene promoter are associated with an 85% lifetime risk of breastcancer
A mammogram will be the proposed system for breast malignancy screening for those normal hazard populace. It will be that main screening modality demonstrated to decrease breast malignancy mortal sin. Time permits dangers to incorporate false negative outcomes also a false sense of security that might delay diagnosis; additional tests also tension connected with false sure comes about; and the truth that breast malignancy might be diagnosed for no change in the length or personal satisfaction about existence . Higher the breast thickness will be connected with higher bosom disease danger previously, both premenopausal what’s more postmenopausal ladies . On the other hand, ladies for greatly low densities need to be as of late indicated to hold a fundamentally more awful prognosis regardless of patients’ age, body mass index what’s more menopausal status . Breast malignancy was troublesome and it should be identified through mammograms did ladies for secondary breast thickness in light of practical malignancy thick breast tissues bring a comparable presence ahead of the mammillary body. Likewise a result, higher breast thickness is connected with a higher rate of false negatives (missed cancers) .
Although BSE was the most commonly practised early detection technique in most of the studies in this review, evidence for its effectiveness is disappointing. A Cochrane Review of two large RCTs (in Shanghai and in Russia) found no beneficial effect from BSE screening compared with no intervention, and there were twice as many biop- sies of benign lesions in the BSE group . Based on data from RCTs and observational studies, the IARC has reported that BSE does not seem to have a significant ef- fect on mortality reduction for breastcancer , and the World Health Organization recommends that BSE should not be promoted on a population-wide level . Over-de- tection of benign lumps can lead to unnecessary physician visits and diagnosis-related expenses, which are undesirable in the SSA setting where health facilities and resources are limited. However, Corbex and colleagues  note that the Russia and Shanghai RCT study populations had relatively early clinical stages at diagnosis, and suggest that greater mortality reduction from BSE might be found in populations where later stage disease at diagnosis is more common. While current evidence does not support BSE as a screening approach for breastcancer, teaching BSE at the individual level in countries where most women present with late stage disease could improve awareness of breastcancer and lead to earlier stage at diagnosis.
Further analysis done showed that there was propensity for the uptake of screening for breastcancer to increase as the level of knowledge of symptoms increased. Having more children was associated with the knowledge of symptoms. The level of knowledge was higher among the respondents with two and above children; those who were younger and had worked for less than 10 years in the markets, earned more than Ksh 15,000 and were Catholics. A few selected characteristics were statistically significant with the knowledge of risk factors of cancer of the breast. They were age, marital status, level of education, main sources of income, number of children and being Christian. In this study majority of the younger respondents were more knowledgeable compared the older respondents. Kisiangani et.al (23) similarly found that the younger participants who took part in their qualitative study appeared to have a better understanding of the cancer, its signs and symptoms as well as lifestyle issues that predispose people to breastcancer and screening as opposed to older participants. According to data presented in the Kenya Demographic and Health Survey, (13), most women in Kiambu County (90.2%) have given birth in a hospital where they have been taught on various aspects of breastcancer by healthcare professionals (13).
Another area discussed was training. The panel wanted to incorporate reasons /aims for some of the MLO descriptors to be used as a teaching aid for trainee mammographers and to reduce ambiguity, also to remind radiographers generally why they are using the criteria. There was a highly significant p value (p<.001) in the importance scoring of descriptors across the panel demonstrating enough concordance to continue with the study. This is a small set and there was weak agreement (w=0.35) although good agreement amongst the panel using a level of consensus established as a mean rating of ≥3.5 for all descriptors except for 3e ‘No transparent skin folds or creases’ scored 2.6 and 3f ‘Symmetrical ‘mirror’ L and R images’ scored 2.7. Also just below the 3.5 cut off was 2a’ Breast centrally placed, nipple in midline subject to anatomical presentation’ scored 3.4 and 3g ‘No artefacts’ scored 3.3. Interestingly the lower scores for these were assigned by radiographer panel members who are perhaps professionally more influenced than radiologists by an aesthetically pleasing and technically optimised image rather than looking purely at whether the necessary clinical information is contained within the image 6,23 (5). These professional
Meta-analyses of these trials have suggested that a breastcancer mortality reduction of about 20% could be expected if at least 70% of women aged 40 to 74 years attended two to five rounds of mammography screening . However, studies in Europe that compared changes in breastcancer mortality between areas with similar economic level and access to treatment, but with early or with late (i.e., 10 to 15 years later) implementation of mammography screening found no difference in changes of breastcancer mortality rates over time [7–9]. The progressive introduction of mammography screening in Swedish counties had no impact on breastcancer mortality trends at county level . In the USA, participation to screening ranging from 40 to 90% did not affect rates of breast death after 30 years of screening . No association was found between the timing and magnitude of declining trends in breastcancer mortality and the timing of mammography screening implementation in the various States of the USA . This apparent absence of impact of mammography screening on breastcancer mortality was in sharp contrast with studies that clearly showed quicker and steeper reductions in the risk of cervical and colorectal cancers in areas where screening is widespread, compared to areas where screening is not common [13 – 15].
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breastcancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9 , 976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15 – 25% in trials and 28 – 56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1 – 60 % in trials and 1 – 12 % in studies with a low risk of bias, and cumulative false- positive rates were lower with biennial than annual screening (3 – 17% vs 0.01 – 41%). There is no consistency in the reviews’ conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54 – 84% and 47 – 69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews’ conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.
The data in  were reported in terms of person years of receiving screening. Dividing person years by the length of the time period we obtained the approximate number of persons eligible for screening in each region and group, n iz++ . Using these data, we estimated the change in the average yearly death rate of incident breastcancer among type C subjects ages 40–69 due to receipt of breastcancerscreening as -9 per 100,000 with 95% confidence interval of (-14, -4) per 100,000 for k = 0 and similarly -9 per 100,000 with 95% confidence interval of (-14, -5) per 100,000 when k equaled the fraction screened. See Table 1 and Figure 1. The estimates were similar for the two val- ues of k because only in Vastmanland County was there substantial screening in time period 0, and that was only 14%. We caution that Assumption 2 may not hold due to improvements in available systemic therapy over the peri- ods of interest . Therefore the results must be inter- preted with caution, as they may overestimate the benefit of screening.
In the United States, one in eight women will be diag- nosed with breastcancer during her lifetime . In 2008, an estimated 182,460 cases of breastcancer will occur, accounting for 26% of all cancer cases in women  Cur- rent consensus screening recommendations divide women into normal and high-risk categories after using physical examination and clinical judgment as a starting point . According to the National Comprehensive Can- cer Network (NCCN) Clinical Practice Guidelines [2,3] women at increased risk of breastcancer include those with (i) a history of thoracic or mantle irradiation, (ii) a strong family history or genetic predisposition, (iii) lobu- lar carcinoma in situ or atypical hyperplasia, (iv) a prior history of breastcancer, and/or (v) those over 35 years of age with a 5-year risk of invasive breastcancer ≥ 1.7% according to the modified Gail Model. This model calcu- lates risk based on current age, age at menarche, age at first live birth, nulliparity, previous breast biopsies, atypical hyperplasia, and race, though it has not been conclusively validated in non-Caucasian women . The 5-year risk of ≥ 1.7% is the average risk of a women at the median age of breastcancer diagnosis in the United States . Women with a strong family history or genetic disposition are defined as those with BRCA1/BRCA2 mutations, or a per- sonal family history of breastcancer and one of several other familial risk categories, including being diagnosed before age 40, or before age 50 with one or more close blood relative with breastcancer, or a close family mem- ber meeting any of the other criteria . It has been esti- mated that the risk of developing breastcancer in those with BRCA1 or BRCA2 mutations is 45% to 65% respec- tively .
The effects of the required authorization form for the transmission of information related to women’s participa- tion in the breastcancerscreening program are unclear. More than half of our respondents were not aware of the authorization form. They also did not realize that by refusing the data transfer, the women would not have their examination data recorded in the information sys- tem and would not receive reminder letters every 2 years. If physicians encouraged women to authorize data trans- mission, their patient follow-up would be more efficient.
Health care should keep in mind that social support within hospitals and clin- ics is an essential component of a clinical encounter . A study by Jensen et al. indicated that a low level of social support was strongly associated with non- participation in and non-adherence to breastcancerscreening , thus posing a major public health concern. The review of literature revealed that there are no published studies about this community issue in Medina, Saudi Arabia. We aimed to further evaluate such conditions for these women in this city and help them become more pragmatic in their own life.
Screening of BreastCancer: Pakistan, being a developing country, scarce resources, needed to develop strategies to reduce the burden of cancer in terms of financial and other losses. National Cancer Control Program (NCCP) should be implemented strictly and WHO, government and other health authorities including private sector NGOs should provide necessary resources to develop strategies for screening, prevention, diagnosis and treatment of breastcancer. Breast cancers can be minimized just by proper screening. The possible strategy, which has been implemented in very few hospitals of Karachi for prevention and early diagnosis of breastcancer is self and clinical examination of breast over age 20, mammography over age 40. The government, NGOs and private sector should design and implement effective awareness campaigns for general public for the age specific symptoms and screening and to emphasize that early diagnosis can not only reduce economic burden but also families emotions and painful treatment. The recommendation of American Cancer Society for early detection of breastcancer in average risk or asymptomatic people is mentioned in Table-I. 
. Carney, P.A.; Miglioretti, D.L.; Yankaskas, B.C.; Kerlikowske, K.; Rosenberg, R.; Rutter, C.M.; Geller, B.M.; Abraham, L.A.; Taplin, S.H.; Dignan, M.; et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann. Intern. Med. 2003, 138, 168–175.
Mammography in women under age 50 is complicated by dense breast tissue that leads to a higher rate of false-positive breastcancer diagnoses, anxiety generated by the positive screenings, and risk of complications engendered by invasive procedures, thus the controversy surrounding routine mammography in this age group. Meta- analyses have reported a 20% reduction in 15-year mortality from breastcancer for women in their 40s. 5 Put another way, the same authors estimated
psychometric properties of the BCSBQ in an Indian women population residing in Australia. The sample size was 242 in their study. The exploratory factor analysis revealed three factors. The breastcancerscreening methods were considerably associated with attitudes towards health check-up. The perception about the breastcancer questionnaire was not considerably associated with clinical breast examinations and mammography. The perceived barriers to mammography were much less evident among women involved in knowledge about breast and clinical breast examinations. The results showed that the BCSBQ had satisfactory validity and internal consistency. Cronbach's alpha in the three subscales, was within the range of 0.81-0.91. 20 Kwok et al., and
Breastcancer mortality rates have decreased substantially over the past 25 years thanks to improvements in treatment and screening programs, but much remains to be done. We must pay more attention to women 50 years of age and younger and women 70 years of age and older in good health, because breastcancer in these populations represents a substantial burden and concrete solutions are available to physicians. For young women who are at risk, we must provide instruction in BSE, perform CBE, prescribe screening mammography, and, where appropriate, refer for genetic counseling. For older women in good health, CBE and prescribing mammography are appropriate. To improve these practices, we must act upon physicians’ attitudes and skills and issue clearer recommendations.