The National Cancer Institute explains its project fro breast cancer screening through a simple blood test
IN AN article on this page a few weeks ago, the National Cancer Institute (NCI) mentioned the work it was carrying out to devise a method to screen for breast cancer through a blood test. The aim is to increase opportunities for Thais to access medical services and reduce mortality from the disease. Wacoal and other private organisations are collaborating with the NCI to make the project a reality.
While a mammogram is highly effective in identifying breast cancer, it is too costly to be included in the state-funded basic health check-up services, explains Dr Somchai Thanasitthichai, head of the NCI’s Research Department.
Women of all reproductive ages have a risk of this disease, so they should regularly look for abnormalities and have their breasts checked. At present, there are two preliminary screening methods – a clinical breast exam by a doctor or nurse and a mammogram.
“However, both methods have their limitations. Clinical breast exams have accuracy issues because they depend on the sense of touch and palpation skills and the results may vary greatly between examiners. The number of qualified personnel is also inadequate. Mammogram is the most effective way to date but it incurs a cost too high for Thailand to provide it for every woman aged 40 or 50 years and older.
Compared to Asians, Western women have less dense breast tissue and their breasts mostly consist of fatty tissue, so abnormal cells or tumours can be clearly detected by mammogram alone. Asian women have denser breast tissue and less fatty tissue, making it more difficult to spot abnormalities. It is why ultrasound examination is also implemented in breast screening in Thailand whereas Western countries use both methods only for specific diagnosis after initial screenings. This adds more cost for Thais to receive breast cancer screening and it requires radiologists, who are already limited in number, to perform the ultrasound exam.
A research on the cost-effectiveness of population-based mammography screening programmes in Asian countries shows that this type of test is suitable for countries with a breast cancer morbidity rate of at least 45 persons in a population of 100,000. The morbidity rates in Western countries such as the UK, USA and Scandinavia are about 100 persons in a population of 100,000, but the rate in Thailand in 2012 was only 28.5 persons in the same population despite an upward trend over the previous 20 years.
This is consistent with a research by the Institute of Medical Research and Technology Assessment under the Department of Medical Services, which found that investment by state on a population-based mammography screening service was not cost-effective and once again pointed to the shortage of relevant equipment and personnel.
To help more Thais to access breast cancer screening at a lower cost, the NCI started a research project in 2015 to develop a new screening method by identifying breast cancer markers in blood. The project has been financed by a number of private organisations, including ICC International and Thai Wacoal, but funding from other sources is welcome.
The NCI research focuses on a different marker to that of the current tumour marker test, which aims to find a large protein with a complex structure that is usually found in large cancerous lumps or terminal cancer. This, however, is very rarely to be found in early stages of cancer and therefore it is more appropriate to tracking cancer recurrence or responsiveness to treatments.
“This is a promising project and now it is in the phase of increasing sample groups and testing the marker’s accuracy. If successful, this project will provide Thailand with a new breast cancer screening method that can be accessed as easily as an annual health check-up. You will have to receive a mammogram and other tests for treatment planning only if the marker test shows abnormalities. This will enable us to use our medical resources more efficiently,” says Dr Somchai.
To support the NCI’s researches financially, please contact the Research and Treatment Fund by Dr Somchai Thanasithichai, National Cancer Institute Foundation on (02) 202 6800 extension 1509.