Health and Fitness Wellbeing

Breast screening – why I opted out of a routine mammogram

Breast screening, the pros and cons

After I turned 50 I got the ubiquitous call for breast screening and dutifully went along. It hurt like hell. When I got the latest summons, three years later, it a came with a leaflet called NHS Breast Screening, helping you decide. This time round I’ve chosen not to attend. My maternal grandmother died of breast cancer so opting-out of a routine mammogram was not easy. This post explores why I made my decision.

Finding a lump in my breast

It’s important to give you some background. In 1993, when I was 30, I had a lump removed from my left breast. It was not malignant but back then if you had a substantial lump they whipped it out anyway. The theory was that it could mask something else underneath. When I was 42 I had a biopsy on a second lump, which was also benign, but by this time medical opinion had changed and they left it alone. I had always had sensitive and often sore breasts with lumps that would come and go with my menstrual cycle. After menopause these lumps have disappeared altogether and now my breasts are soft and squishy with no pain.

Anyone who has sat waiting for a biopsy result will recognise the feeling of rising panic as you read the posters around the clinic walls. You prepare yourself for bad news. Luckily, for me, the news has been good but for many women it is not. Around 50,000 women are diagnosed with breast cancer each year in the UK. Although survival statistics are good there are still around 1000 deaths from breast cancer every month. Catching any cancer early reduces the risk of mortality. So why on earth would I choose not to have free NHS breast screening?

Breast screening studies

This is the paragraph in the NHS booklet that made me stop and think:

Screening finds breast cancers that would never have caused a woman harm. Some women will be diagnosed and treated for breast cancer that would never otherwise have been found and would not have become life-threatening. This is the main risk of screening. Doctors cannot always tell whether a breast cancer that is diagnosed will go on to be life-threatening or not, so they offer treatment to all women with breast cancer. This means that some women will be offered treatment that they do not need.

If, like me, you’ve been alarmed at the number of women you know who’ve had treatment for breast cancer this paragraph makes sense. Breast screening produces a significant number of women diagnosed with duct carcinoma in situ (DCIS) – something that was rarely found before screening began. DCIS may never develop into a life threatening cancer but once discovered it is treated just-in-case. Like my lump back in 1993. Only this time treatment could include a mastectomy and debilitating chemo or radio therapy. I decided to do a bit more digging on the internet.

Surgical oncologist, Professor Michael Baum, one of the architects of the original breast screening programme, argued in 2016 that ‘mammograms do more harm than good’. His thesis, which you can read in the Hippocratic Post describes screening for breast cancer as ‘a short history of a big mistake’. It is his view that ‘too many healthy women are harmed by breast cancer screening’. He campaigned for the new leaflet which now reads as in invitation rather than a summons to breast screening units.

An article in The Guardian ‘should I have a mammogram?’ reported on a massive 25-year Canadian study. 89,835 women between 40 and 59 were randomly assigned either 5 annual mammograms or taught to examine their breasts themselves. In the mammography group 3,250 women developed breast cancer and 3,133 in the self-examination group. 500 died in the breast screening group and 505 in the self-examination group. In other words it’s just too close to call.

The Pros and Cons of breast screening

This isn’t science (you can find that all over the internet if you need it) it’s my personal for and against list made as simple as possible:

PROS:
• Screening gives you peace of mind when you get the all-clear.
• Breast cancer caught early is more treatable and the survival rate is better.

CONS:
• It hurts – your breast is squashed flat in a vice.
• Mammograms expose fragile breast tissue to radiation which can cause cancer.
• There are false positives which mean you return for further mammograms causing more potential damage and stress.
• Duct carcinoma in situ might never form into a life threatening cancer but if found it will be treated as if it is.
• Some fast growing and aggressive cancers can develop between mammograms and might not be discovered until it is too late.
• Breast screening starts at 50 but many women develop breast cancer before this.

There is no doubt that breast screening increases awareness and that is a good thing. We are hopefully long past the days when women suffered in silence and were too afraid to go to the doctor when something looked or felt amiss. Once you are in a screening unit there are posters about what to look out for. But for many women who develop breast cancer in their 40s or earlier the summons for a mammogram comes far too late. In short the mammogram catches some but not all cancers. I would argue that what we really need is education at teen level, so that women routinely examine their breasts throughout their lives and know how and where to seek help when they need it.

If you want to know how to check your own breasts for signs of cancer here is a very good video screened on ITV’s This Morning.

My choice

I’ve been checking my breasts for decades and that is how I came to have both my previous lumps treated. Self-examination has worked for me so I’ve decided not to let anyone flatten or radiate my breasts again. At the moment my breasts have never felt better, but if I do notice a problem I will ask for either an ultrasound or MRI scan, both of which are safer and more accurate than a mammogram. I may have to pay for this but the cost of a private MRI scan is around £200 which, though not free like breast screening, is not too prohibitive.

This is my decision and I don’t advocate it for anyone else – every woman needs to make up her own mind.  The big news is that there is a choice and we owe it to ourselves to become informed enough to make it.

With love, Avril x

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Breast screening - why I opted out of a routine mammogram

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