We agree with Dr Yik Keng Yeong's call to improve breast cancer screening ("Improve breast cancer screening to reduce unnecessary treatment"; Oct 19). However, we wish to clarify some of the doubts he raised on the usefulness of mammogram screening.
As pointed out by Dr Yik, mammography is not a perfect screening modality. However, it remains the most widely available and effective screening tool in detecting early breast cancers that do not present with any symptoms in the initial stage.
The benefits of screening still outweigh the drawbacks. This is supported by strong evidence from several large-scale, randomised controlled trials which show a more than 30 per cent reduction in mortality rate in women who participate in screening.
The claim that the benefits of mammograms are exaggerated, based on a recent New England Journal of Medicine report that was cited by Dr Yik, is flawed because the research used wrongly extrapolated data.
While breast cancer treatments have made great strides in recent years, diagnosis of early stage breast cancers provides the best chance for survival.
Unfortunately, the screening participation rate in Singapore is about 30 per cent to 40 per cent, which is relatively low.
Several women here still present with advanced cancers which render a poor prognosis.
While four in five women with breast cancer survive longer than five years in Singapore, there is room for improvement. Boosting the screening participation rate will help significantly.
Dr Yik has said that too much unnecessary, expensive and painful treatment has also been effected by abnormal mammograms when tumours did not need to be treated. On the contrary, the detection of early breast cancers by mammographic screening will result in the reduced need for radical, toxic and costly treatment regimens, as well as lower treatment-related morbidity.
Dr Yik also suggests that the health authorities find a better algorithm for breast cancer screening using mammograms.
There is already ongoing research to determine better screening strategies.
However, we are still currently unable to predict who will or will not develop breast cancer because 90 per cent of breast cancer patients do not have a family history or known genetic risk factors.
While the pros and cons of breast screening should be discussed with women, the benefits of breast screening should not be understated.
All women aged 50 to 69 years old are encouraged to have regular mammograms once every two years, as recommended by the Ministry of Health's guidelines.
Lester Leong (Dr)
Chapter of Diagnostic Radiologists
College of Radiologists, Singapore
Bernard Lim (Dr)
Chapter of General Surgeons
College of Surgeons, Singapore
Tan Puay Hoon (Dr)
Chapter of Pathologists
Academy of Medicine, Singapore