Another day and yet another article over the controversy of breast cancer screening. In case you are not aware – and strangely a lot of women are not – the government is currently weighing up whether or not the current programme where all women are invited for screening between the ages of 47 and 73 for a mammogram (an X ray of your breasts) should continue as it is.
At the moment I am researching a piece on this for a national newspaper – hence my own looking into this subject – but I don’t want this post to turn into a medical piece. I apologise also for not including statistics and research but I will put in links for further reading later.
And instead I am going to bullet point why a growing number of doctors say you should not have screening (I have been shocked by the sheer number of studies suggesting we should not be doing mammograms as we are right now). Incidentally, ‘screening’ is different from a ‘diagnostic mammogram’. There are women often commenting articles, “I found a lump and I went for a mammogram and thank goodness it was seen on that.” But the fact is, they found their lump and so they saved their own life – the mammogram did not find it – and it is this issue that is at the crux of this debate. The point is those women knew something was wrong and got it checked out. This is not about ignoring symptoms, which must be checked out (although might have been a good idea still NOT to have had a mammogram diagnose it – read on and you will see why.) The controversy is over screening women who do not have any symptoms at all.
Anyway, back to the bullet pointed concerns!
* Mammograms are an X ray – and radiation is known to cause cancer. They are not like a smear test which although undignified does your cervix no harm at all. Some doctors claim that the four X rays (at least two of each breast) needed can trigger breast cancer. Also, so the radiographer gains a clear picture, your breasts must be flattened like a pancake in the X ray machine. Doctors examining a woman who has found a lump are told to be gentle so as not to spread any potential cancer. So some people believe that squashing the breast this much (which some women might find painful) could potentially spread any cancer cells.
* Mammograms identify ‘suspicious’ areas that are actually harmless or ‘cancers’ that would go away on their own and that the woman might never have known about had she not gone for a screen. Doctors do not know with some of these ‘cancers’ which ones would progress or not so they always treat them. This means you could have radiation and chemotherapy when you don’t need it. Some women might say, “If I have any cancer I’d rather get rid of it.” But having radiation and chemotherapy is not to be taken lightly. It is full of side effects, which are fine if you genuinely have a cancer that needs treating of course but dangerous if you don’t (for example, radiation for early breast cancer has been linked to triggering a type of heart disease.) A woman also might end up having a mastectomy (the rates of mastectomy have risen as screening has become more prevalent) she might go through deep worry – ultimately a cancer diagnosis will change your life.
* Mammograms also miss cancers – especially very aggressive ones. If you have ‘dense breasts’ (which you might not be told you have) they don’t work properly. The internet is full of stories of women who had a clear mammogram only to find a cancerous lump themselves later. A very aggressive cancer will grow so fast that it can appear out of the blue.
* The chance of a mammogram saving your life is say many doctors overstated. Yes, there are some women for whom a mammogram will spot a cancer they will not have noticed. But the real chance of your life actually being ‘saved’ by a mammogram is much smaller than often stated and muddled by the survival rate of women who are treated for a ‘cancer’ that would never progress. In fact, a number of studies now show the way to never get breast cancer is not to have a mammogram. This is because you don’t put yourself at risk of finding some insignificant cancer that you never would have known about. It might also be because you have not subjected your breast tissue to lots of unnecessary X rays.
* It is generally believed it takes years before a cancer is big enough to even be spotted on a mammogram so it is not caught as early as you might think (plus it might not really be a ‘cancer’) and very aggressive cancers will grow very fast.
* Many women are called back for further tests – and even more mammograms (more X rays of healthy breasts then) after their initial mammograms. Often it turns out to be nothing but then you will have subjected yourself to deep stress and more importantly your breasts to more X rays and possibly other intrusive investigations such as biopsies.
* Critics point out the fact more women are surviving cancer is not down to screening but better treatment. In fact estimates show 90 per cent of breast cancer lumps are found by women themselves and these days they have as good a prognosis as if it had been diagnosed from a screen. Added to this, some ‘cancers’ found on a mammogram are not going to kill you anyway so of course treatment is successful (because it was never needed in the first place…) Breast screening in the UK was introduced in 1988 days before a General Election and obviously in over 20 years we are in a completely new medical arena compared to then.
* Some research shows if you have a family history of breast cancer – and particularly if you carry some genes – then your breast tissue could be more sensitive to X rays. Therefore you could trigger cancer by having checks, especially if you have a mammogram earlier in your life (the amount of radiation adds up.)
* The flowery pink leaflet given to women when they are called for a breast scan has been widely criticised because it does not point out the above potential harms clearly enough, possibly because if it did then women would refuse to be screened. Instead it ‘promotes’ breast screening as it will save your life and you are an irresponsible woman not to have it. It also quotes statistics many doctors believe aren’t only misleading but plainly wrong. It is noteworthy that the breast screening place makes an appointment for you and tells you to attend (it is not like a smear where you are reminded and you ring up and make your own appointment.)
if you decide to opt out the NHS says you must sign a ‘disclaimer’ – some people might say that is a bullying tactic and makes it hard for women to say no. Some doctors also criticise breast cancer charities as well for not being honest enough about the pitfalls. They say a whole industry – from breast cancer charities (with occasional exceptions – see recommended charity below) to radiology vans and all their receptionists, not to mention GP surgeries that might well get some financial incentive to get patients to attend – has been built up from this screening programme. In the US where many doctors advise yearly mammograms from the age of 40, and in a country of private health insurance and private doctors, this is clearly even a bigger business. If we start advising women not to have them so readily then where does it leave this business?
Critics want to see unbiased leaflets that very clearly give pros and cons of breast screening making it clear attending is voluntary. They want to be sure all women to be aware of all the facts and implications so they can make an individual and informed choice. They do not believe breast screening should be presented in a way that makes it odd to opt out if the woman does not feel it’s right for them.
* There are other ways to detect breast cancer. First you can be ‘breast aware‘ and if you find something of concern, you can have an ultrasound (which is regarded as safe as it is not radiation X ray and don’t forget millions of unborn babies are scanned a lot with no reported issues). There are other diagnostic tests if you find a lump such as a biopsy. Yes this is unpleasant but again it is not radiation on what might turn out to be a healthy breast, should your lump be benign. Therefore it might be, on balance, even if you are worried a lump is breast cancer, you still decide the best course of action is not to have a mammogram.
Some women might still choose a mammogram
It might be despite all of the potential risks of having a mammogram, that some women will still decide to go ahead. For example one study says if 2000 women are screened every year for ten years then one woman’s life would be extended due to earlier detection of breast cancer (200 will have false positives and be called back, ten women will be treated for cancer they do not have, some cancers will also be missed.) There will be those women who feel these are risks worth taking if they are the one whom it is believed a mammogram does save their life. They might well accept there is a risk they will be called back for extra tests and be put through worry for nothing, they will accept it might find a ‘cancer’ that will be treated with radiotherapy, chemotherapy and surgery when in fact had they never gone for the mammogram it might never have been found. They also accept even if they are given a clean bill of health, they might still have a cancer anyway as it was missed by the mammogram. And they also realise they must still be breast aware as aggressive cancers can still appear (called ‘interval cancers’).
One doctor has predicted if breast cancer screening was stopped in the UK tomorrow then the breast cancer rate in the UK would be reduced by 25 per cent. Other research scientists back this up by saying the way to avoid a diagnosis of breast cancer is not to go to breast screening.
One woman I have spoken to who has decided not to have a mammogram says: “Just subjecting myself to the radiation of a mammogram would worry me – what if that radiation and the way a breast is squeezed triggered breast cancer itself? I don’t believe in having unnecessary X rays and the very fact I had put my healthy breast tissue at risk in this way is unacceptable.
“Then if I got the all clear I wouldn’t be properly reassured because even in the NHS leaflet now it says some cancers can be missed – and in fact some invasive cancers cannot be detected at all by a mammogram.
“To be called back for something that was ‘suspicious’ but turned out to be nothing would put me under so much strain and I would frankly feel angry to be put through any more tests for nothing. But if I went for breast screening and was told they’d found a cancer, which I couldn’t feel or see, I would always wonder if it was one of those ‘cancers’ revealed by a mammogram that is really never going to cause me any concerns – only now it had been found of course doctors would have to remove it. I am not one of those women who would believe a mammogram had saved my life – I would wonder if I was one of the ten women in 2000 screened over ten years with a false positive diagnosis.
“I am breast aware – which you have to be anyway even if you have screening because screening does not prevent cancer – and if I found a lump or noticed something unusual in my breasts obviously I would have it checked out. At least then I would know I definitely do need treatment and I would not doubt the diagnosis.”
It may be as patients we need to take more responsibility for our own health. We need accept medicine does not have all the answers and there are risks as well as benefits with everything. However, critics say at the moment there is far too much emphasis on breast cancer screening ‘saving lives’ and not enough about potential harms and because of that women are not able to make an informed choice about whether it is right for them.
* I am NOT a doctor – I am a journalist who researches information every day often in great depth – but I would therefore ask that if you want to find out more about any of the above you use the following links:
Breast Cancer screening – Wikipedia
Should you have a mammogram? Leaflet on mammography benefits and harms by the Nordic Cochrane Centre
Do screening mammograms increase your risk of breast cancer?
My life was saved by a mammogram
Why as a GP I say no to cancer screening
Does breast screening do more harm than good?
You are welcome to leave links or views below.
I would like to hear from any woman who has decided not to have a mammogram for any reason for a health feature. Please contact me here: APPLY