Saturday, 10 October 2009

The Mammogram Debate

Following on from the Boobie-thon week and Breast Cancer Awareness month here in the UK and, since I now have the results, I thought this was relevant here.

As part of the rebuilding of Joanna Cake, I decided to get my physical health checked up, as well as continuing to work on my mental attitude with the Counsellor.

I booked an appointment to have my breasts examined at our local specialist Unit, which runs on a charitable basis outside the NHS. I've been having this done on and off since I was 20. The nurse manually palpates your tissue to check for lumps and checks that you do so yourself correctly every month.

This time, when I called, I was told that Unit policy now says that women under 50 should have a mammogram every year and those over 50 every other year. I last had one of these torturous tests over five years ago when I had a lump under my armpit. This turned out to be a hormonal reaction by my breast tissue and the pain and size of the lump in the second half of every month was regulated by using Starflower or Evening Primrose Oil which contains gamma-linolenic acid (GLA). You can imagine that I was not terribly enthusiastic about being told that I had to repeat the process when I didn't actually have a problem, especially as I was concerned about the risks of radiation exposure.

Since that last unpleasant experience, the quality of the specialist performing the mammograms and the improvement in machinery were very obvious as it was a relatively pain free experience. I had two films on each breast, one from the front and one from the side. The view from two angles increases the chance of detection by 25% and I'm relieved to say that all came back clear.

However, I'm still not sure whether I like the idea of one of these tests every year until I'm 50 and then every other year thereafter, so I will continue to examine myself regularly and give it some more thought so that I am more prepared when they call me back again next year.

The national policy for the UK is a mammogram every three years for women over 50.

I found this information at the very helpful site called cancer help who are part of Cancer Research UK.

Research is comparing having mammograms once a year to mammograms every 3 years. With 3 yearly mammograms there is a more of a risk that cancer could develop between tests than there is with yearly mammograms. But with mammograms every year, women are exposed to 3 times the radiation that they would be with 3 yearly screening. And of course it costs 3 times as much. Some studies have found a slight increase in the number of breast cancers detected in women who have annual screening because more women are now attending but more research is needed in this area.

As with all X-rays, having a mammogram exposes you to some radiation, but only a small amount. Scientists have worked out that there is less than a 1 in 25,000 risk of a mammogram causing breast cancer. About 7 breast cancers are found for every 1,000 women screened as part of the UK breast screening programme. And in these women the cancers are generally at an earlier stage, when it is more likely to be curable. So, doctors and researchers generally think the benefits of finding breast cancer early far outweigh the small risk of radiation from screening mammograms.

If you are younger than 50, your risk of breast cancer is very low. And mammograms are more difficult to read in younger women because the breast tissue is denser, so the patterns don't show up as well. There is currently little evidence that regular mammograms for most women under 47 can prevent death from breast cancer. One UK trial is looking at offering yearly mammograms to women from the age of 40 or 41, who will go into the national screening programme when they reach the age of 50. Early analysis of the data from this trial shows that annual mammograms do pick up some cancers in these younger women but it is not clear whether this will save more lives. The results of this research will not be available for many years

About three quarters of women (75%) go for their breast screening appointments. In 2004 to 2005, over 1.7 million women were screened for breast cancer in the UK. Only 5 out of every 100 (5%) were asked to go back for more tests.

If there is the slightest doubt about your mammogram, but no real sign of cancer, you will be asked to come back for another test after 6 to 12 months. 3 out of every 100 women who are asked to do this need to have further tests after their second mammogram.

If you find a breast lump or have any other symptom that is worrying you, always tell your doctor, even if you recently had a normal mammogram.

It is important to make sure that you know how your breasts normally look and feel, even if you are having mammograms regularly. Most breast cancers are still found by women themselves because cancers can show up between mammograms. This is known as an 'interval cancer'. If you notice any symptoms that could be due to breast cancer don’t wait until your next mammogram. See your GP straight away. There is information on how to check your breasts in the early detection section of CancerHelp UK.

Last updated 06 May 2009

CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK is not a substitute for professional care and should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have, a health problem you should consult your doctor.

Copyright Cancer Research UK 2002
Cancer Research UK Charity Number 1089464


phallatio said...

I've been acutely aware of this month, as there have been millions of pics of cleavage all over Facebook. It's made me think about how often (or not) I check myself. Men never think about checking for prostate, and even though men play with their nuts all the time, they wouldn't know how to check for lumps. Where do I stand on such an important debate? No comment. I've got two problems of my own!

Anonymous said...

Ti begin, I am not a medical doctor though I do have a doctorate. There is a lot of legitimate debate about the value of mass screening for breast cancer and prostate cancer. What the article does not mention is the biggest risk of mass mammogram screening for women who have not other risk factors -- the risk of unnecessary treatment. I will try to find an authoritative article on the topic.

Polar said...

Oh My Lady,
We went through the mammogram in our house, again last month. Mrs. Polar is a year younger than me.
Last fall, as part of the annual physical exam the company pays for, for both of us, the Mrs. had a mammogram that required a closer look. She just shrugged it off until this past spring when the office sent a certified letter reminding her it needed a closer look.
She hid the panic well... but delayed until she was eligible for the Free one again. (she is brilliant with our finances)even though I had offered several times to pay for the Whole thing.
Her panic surfaced about a week before the exam, but held it together to get a Very Clean bill of Health.
Our daughter, the Nurse, won't let her get away with postponing tests like that again.

Anonymous said...

Below is a link to a story in the New York Times about debate in the UK (and elsewhere) the benefits and risks of mass screening for breast cancer. This story gives more thorough discussion of the risk of unnecessary treatment. Now my wife falls into a risk group because her mother had breast cancer, so my wife has had annual screenings since age 40. All are completely clear. Unfortunately, there is not a clear course of action for the average person.

Joanna Cake said...

phallatio - The link that Ben gives further down in the comment box applies to your problem also.

Ben - Thanks for that link. Being very lucky and not having a history of breast cancer in our family, the prospect of exposing myself to the radiation every year does worry me. As I said, I shall continue to examine my breasts regularly (and get Ruf to confirm the examination) and I shall certainly give it a lot of thought when I am called back. My own mother has already said that if she were to discover a lump through her own palpation, she would treat such a thing with natural remedies having little faith in the pharmaceutical toxins. She has a degree in natural medicine so, if it comes to it, might have the knowledge to succeed but it is a very tricky subject with both sides so entrenched in their own opinions that it is almost impossible for us mere mortals to make an informed decision.

Polar, That's exactly what Ben is talking about. Stress is one of the worst factors for contributing to illhealth and the worry in between the two examinations was eventually proved unnecessary, thank goodness for Mrs P x

Ro said...

I've been closely involved with breast-screening and cancer professionals for many years and am all too aware of the debate over mass-screening and frequency of screening. Hell, I've even written a paper on mammography!

I'm very much in favour of a screening programme for those in, say, the 40-60 age group. There seems to be little doubt that screening, for this age group, saves lives; older women, as the article suggests though, gain less benefit as tumours generally develop much less aggressively as you age.

And the radiation risk really is very minor for mammograms, say, every other year.

The real debate is about how often mammograms should be taken and at what age to start and stop them.

What I have no doubt about, though, is that standard cancer treatments (pharmaceutical, surgical and radiotherapeutic) definitely save lives. The evidence is overwhelming. There is, I regret to say, no such evidence for "natural medicine". I'm all in favour of people being allowed to choose the approach to handling their cancers, but I find it hard to see people opting for "natural" treatments as other than a palliative measure from that point when they've ... given up.

Let's hope, in all our cases, it's an academic discussion ...

nitebyrd said...

Here it's every year, I believe at 45. If there is a family history, then even earlier.

I have to say that I'm for the more frequent screening. I also think that statements about lower risk under 50 is probably not very intelligent. My daughter was 28 when she was diagnosed. 85% of women with breast cancer have no family history and more young women are being diagnosed.

Self-exam is very important as well.

I'm also very glad that they have improved the mammogram equipment!

Joanna Cake said...

Hey Ro! Thank you for giving it to us from a more informed viewpoint. My mother has no history of breast disease in her family and is in her 70s. She does, however, have a history of violent allergic reactions to pharmaceuticals. Hence her standpoint, which I probably should have explained more clearly. Certainly I wouldnt advocate her proposed method, other than in conjunction with standard medical intervention.

Nitebyrd - It's the same with cervical cancer for which screening doesnt start here until the age of 25... and yet young women in their early 20s are dying from this disease. Just not enough of them for it to be statistically/financially viable to include them :(