Latest Daily Mail article Oct 7th

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1

I am incandescent at the latest Daily Mail article: “Does breast cancer screening do more harm than good?” with opposing opinions from a Professor of Surgery (yes) and a Consultant Radiologist (no).

My cancer was found on my 3rd, 3 yrly breast screening, when I was 58 yrs. I had no symptoms whatsoever and on receiving the recall letter I had to see my GP about another problem and asked her to feel both breasts as I couldn’t detect a lump, no matter how small - neither could she.

To say I was shocked on seeing the original mammo is an understatement. There was a big, black spiculated mass on the x-ray and I knew, absolutely, it was cancer, although I knew nothing about bc. The tumour was non palpable.

I do wonder now, if annual screening was available, whether my cancer may have been picked up before it had spread to my lymph nodes. My friends in the US, as a condition of their medical insurance, must have an annual mammo and are shocked that we only get 3 yrly mammos, and then after 50. They start having mammos at 40 yrs, and perhaps that is why their survival stats are higher than ours.

The other thing that really irks me is that having had bc (stage/grade 2, 2 cm, 3/18 lymph nodes +) at my hospital, we only get mammos 2 yrly, and after 5 yrs from dx, we go back into the national screening programme, for 3 yrly ones. Having had a non-palpable tumour, how would I know if I had a recurrence if that was also non palpable?

However, at my 5 yrly review last February, my surgeon said he really should discharge me, but will see me for a mammo and ultrasound next February - perhaps he feels sorry for me? I am just grateful that he cares. Incidentally, when I had a consultation with him after WLE and total axillary removal, he said: “You will more likely die of your Crohn’s than bc, as we can do so much to treat bc and are still in the dark ages with Crohn’s”. Seems as if his words are coming true, as my gastro can’t seem to get my symptoms under control and I am definitely facing surgery soon on the strictures.

Some of my friends, who live in Northants, have been having private mammos since they were in their early forties, as a result of having friends and relatives die “early” from bc. They pay £85…yet when I enquired last year at our local Nuffield Hospital in Plymouth, I was told I would need a mammo and ultrasound, as I had had bc, and it would be £450. I declined their offer. The Consultant Radiologist quoted in the article says that he would also like to see the time gap reduced from every three years to every two years, bringing the UK in line with other European countries and help catch faster-growing aggressive cancers. Why not every year I would ask, as in the USA?

I think Professor Michael Baum’s comments in this article (he is against screening yet led the research on breast-conserving surgery and tamoxifen) is cavalier in the extreme and if I thought the Daily Mail would print my letter I would write to them. Having read some of the posts on this forum, it is obviously a waste of time.

Dr. Michael Michell, in his comments says that over the past 20 yrs the programme has screened 19 million women and has saved at least 25,000 women from a premature death from bc. He goes on to say that when he started working in Breast Clinics at Kings College Hospital in the Eighties, it was common to see women who had aggressive cancer where the tumour was eroding the skin, and that finger-tip examination alone is not a good way to find early-stage cancers. That alone seems to me to be a good enough reason for screening.

Rant over…
Liz.

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Hi Lizzie

I have known about Michael Baum’s views for some time and have heard him speak at a cancer conference. He is a bit of a maverick but he has much which is interesting to say. I think I agree with him!

The case for screening by mammography is in my view heavily over hyped…it saves relatively few lives but creates many other problems: complacency in those who have had a ‘clear’ mammogram, possibly over diagnosis of early stage DCIS, false negatives, anxiety etc. It annoys me that the breast cancer charities focus so much on screening and ‘early detection’. Early detection mainly finds slow growing tumours which probably wouldn’t have spread anyway.

I’ll try to find this artilce and read…don’t usually read the Mail. Baum has also been reported from time ot time in other papers.

I think we probably all incline to be interested in the views of those whose findings match our our expereince. Screening badly let me down…I had at least 5 mammograms between ages 47 and 54 when I was diagnosed so (wrongly) imagined everything was OK. Even when recalled from one screening mammogram I was still misdiagnosed (though in fairness that wasn’t the fault of the screening programme).

I think the charities focus on screening because there is right now such a dearth of useful new research which is improving the tired old treatments which just aren’t working for the 12000 plus women who die each year in the UK of breast cancer.

Jane

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Hi Jane,

interesting to read your viewpoint, which I always respect. You are right in saying that I am inclined to accept findings that match my own. I can only tell it from my own perspective and believe that screening has allowed me a longer life than if the cancer had spread to major organs…not that it may necessarily have done. I do wonder how many “non palpable tumours” are picked up on screening.

I think one of the conundrums with “early/slow growing tumours”, is how they define these…without screening, particularly with non palpable tumours, how would we ever know we had bc?

If you can’t find the article on-line, PM me with your address and I’ll snail mail it to you if you wish.

take care, and hope your voice is improving…nothing wrong with your finger skills thankfully!

Liz.

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Hi Jane
dailymail.co.uk/health/article-1070547/Does-breast-cancer-screening-harm-good.html

is the link to the article

best wishes

Ann

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I also feel the screening programme is overhyped. It certainly did not pick up my lobular cancer which I found myself only 15 months after a routine 2nd mammogram. Yearly mammograms would seem to be the answer but I have been told they are too risky! as you are then being exposed to radiation. Which is worse I ask myself. Of the people I know picked up by mammogram a lot seem to be Grade 1 a lumpectomy and radiotherapy. Would theirs have progressed anyway as the article in the Mail implies. I am certainly considering paying for an annual mammogram when I get through this terrible treatment. I feel that at the end of the day it is up to each individual to look after themselves and do everything they can and find out as much information as they can.

6

I was dx with lobular cancer Jan 07. My lump appeared just over a month after a mammogram which had come back clear. I was on yearly mammos as my sister had bc previously. We weren’t even aware that mammos do not detect all cancers, this info may have been useful as I delayed going a month or 2 as thought it couldn’t be anything sinister, Durr!!! But I believe Starfish is right it is up to the individual.

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I personally will always be grateful for our screening programme. My stage 2 lobular cancer was picked up at my first mammogram when I was fifty. When I was given my diagnosis I said to the consultant that I hadn’t felt a lump, to which he replied “I wouldn’t have expected you to”. I had a WLE, chemo and radiotherapy and five years later have just been discharged from the breast care clinic. Don’t know how big it would have been by the time I could feel it. So I am obviously going to be one of the people who supports screening - I realise that others’ experiences have been different though. Am on 18 monthly screening at present, but after the next one will go back to the normal three-yearly programme, and admit to feeling rather anxious about this. Though I have had a lot of x-rays in my life and try to avoid them now as much as possible.

8

I was referred as a younger woman (33) to the breast screening clinic under the 14 day rule because I was symptomatic (a palpable lump). The Eden breast screening clinic is a one stop clinic so most people who are clear get to leave the same day without worrying about results.

My results from fine needle aspiration were inconclusive, as was the ultrasound, so a biopsy was taken. It showed grade 3 tumour cells but the team I dealt with didn’t tell me that at this point, they asked me to go back for more tests. I then had a mammogram, another ultrasound this time on both breasts and a second tumouor was found this time in my left breast, at this time it came back as negative, NOT cancerous but the experience of my team made them request yet abother set of samples as they told me outright that it looked suspicious. I agreed. 1 week later I was diagnosed with a second grade 3 tumor which led to my full diagnosis and treatment and has undoubtedly saved my life.

I was not part of the standard screening program but would they have had the experience and the tools to save me without it? I personally do not think so?

Angie

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The screening programme does pick up a lot of DCIS which results in mastectomy. This DCIS may or may not develop into invasive cancer. No-one can predict who will or who will not develop it. But many mastectomies are performed to hopefully reduce this chance. If we did not have screening, many women would remain with 2 breasts and not develop cancer. This may be true but in my case, I was diagnosed with invasive cancer with extensive nodal spread at my first routine mammogram. If I had been 6 weeks older, it may have been picked up a year before and i would have a much better prognosis. When people say that increasing the screening has not been proved to reduce deaths significantly, what they mean is, it is not cost effective eg, the number of lives saved does not justify the expense. As my life may well have been saved by the screening, you can see why I do not agree with this.

10

All of my test results came back clear and my tumour was completely hidden by a fibroid. I was actually told I didn’t have to have the fibroid removed, but I said I didn’t want it left there. I saw the surgeon again a week after I was told I had cancer as I had to go back for lymph node surgery. I asked him what would have happened had I said I didn’t want surgery for the removal of the fibroid and he said he would have presented me with all the reasons why it should be removed. However, I have often dreaded to think what could have happened had something not been nagging at me to get it taken out.

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Hi all,

although I don’t exactly understand why Jane had so many problems with misdiagnosis, I still rest on my laurels that the 3 yrly screening did find my stage 2 tumour, and lymph node spread, when I had no symptoms.
Just so wished I had annual mammos…but we didn’t know that then did we?..we should have foresight of hindsight, but guess that is a dichotomy? and still don’t get them unless we go privately. I am still incandescent.

Thanks for caring and sharing.
Liz.

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I am not saying abandon the screening programme. What I am doing though is saying that the arugments of Michael Baum and others about the linitations of screening should be taken seriously. Baum would argue that the probelms with screening…its drawbacks…as well as its benefits should be explained more clearly to women going for screening so that there really is informed consent. He would alos not support an extension in age of routine sreening by mammogram for younger women and neither do I.

I am not ‘blaming’ my own experience on screening as such but just pointing out that for me there were drawbacks. I was falsely reassured by my clear mammograms…I never knew because I wasn’t told that in fact I had very dense bresat tissue so mammograms could easily miss cancer. Nor was I told that having ‘lumpy’ breasts in fact made the chance of bc slightly higher (I kind of imagined having lumpy breasts was an explanation that would mean lumps wouldn’t be cancer.) My finally midiagnosis was just professioanl negiligence (proven by Gneral Medical Council) and so in a snse is irrelevant to my general argument…except beacuse I was so ill informed about breast cancer I didn’t worry when one of my lumpy breast got lumpier.

I think the charities at present focus far too much on screening and not enough on prevention or on campaigning for improvements in treatments…particularly for those breast cancers for which there are no targeted treatments.

Jane

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It is an interesting article, isn’t it? It raises some pertinent ethical issues surrounding screening, not just breast cancer screening, but all screening. If screening guarantees to save lives or reduce incidences of disease, then all well and good. But often screening causes over-treatment which in turn leads to other problems. In dentistry, for example, in the 1960’ and 70’s everyone was encouraged to have an exam twice a year. If the tiniest hole was detected, it was filled. This is turn led to uncessary fillings (high cost, high anxiety) and more importantly, damages the tooth, so it needs redoing every few years until it probably needs extracting. Those who didnt visit a dentist as often may in fact have better teeth. And the found that screening does nothing to reduce the incidence of decay - other factors do that. Okay, teeth are no where near as important as breast cancer, but I hope it highlights my point. On the other hand, cancers that are caught early may be more treatable, but there are others that whenever they are detected will not be cured. Like Jane, I am not opposed to screening , but I think we need to get it into perspective. It isn’t the silver bullet for cancer cure, far from it. It will help to save some women, but for others will enforce them to have treatment that arguably isnt necessary or worse still, not detect cancer and gve someone a false sense of security. If more money was put into finding the cause, stopping cancer happening in the first place, rather than catching someone “downstream”, then surely this is money better spent?? Good debate

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I am puzzled re screening - I am screened annually and I’m 38 - this is because my sister had an aggressive breast cancer at the same age. Why do I get screened and other people don’t appear to? Why does someone who has had breast cancer appear to have less screening than I do who so far has not had it? Do different health authorities have different rules?

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I agree screening is a puzzle. I am the first person is my family to have bc at 56. My sister went to her GP she is 51 to ask for more frequent mammo/checks. He told her she is at no greater risk that anyone else. This is not what I have read. I have read that if you have a first degree relative you are 8 times more likely to get bc.

Too much faith is put on 3 yearly mammos. Little information - as already mentioned is given about the implications of lumpy breasts which I also had. A nurse told me that mammos do not detect all cancers. There should be more education as to physically checking. I have to be honest and say I did not check myself. Was far too scared. Unfortunately I do not feel that stories in the media do much to encourage the average woman to go their GP if they notice something.

Since my dx most women I have spoken to know little if anything about bc and assume a lump and its picked up by mammogram. Most women havent a clue about the different types of bc and even the need for 18 doses of Herceptin afterwards which some of us have to have. There is a great deal of ignorance.

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Hi there

Some of you may find it useful to read the Breast Cancer Care factsheet on familial breast cancer as it includes information and advice about screening when there is a family history:

You can read this on-line by using the following link :-

breastcancercare.org.uk/docs/familial_breast_cancer_updated_may_06_0.pdf

I hope you find this helpful.

Best wishes

Lucy

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my breasts are naturally lumpy, didn’t check them, no tests picked up my breast cancer including four mammograms, I wanted the lump out from day one, tests delayed this by six months. The delay made no difference to my prognosis. Breast screeners claim credit for every life saved since breast screening was introduced, even though 1988 was a bad year for deaths and the death rate and the diagnosis rate had been rising steadily to then. I think deaths have fallen due to greater willingness by women to go to their doctors and to better treatments,screening has a minimal effect as most women detect their own lumps and half of women getting breast cancer are over 65 so most won’t get screened anyway.

Deaths have fallen in all age groups not just the screened ages so it is doubtful whether screening has had a big impact. Use the money saved by not screening to develop cures and preventive measures

Mole