Thursday, 28 October 2010

29/10/10 is 'Wear it Pink Today!'

October is Breast Awareness Month.

One of the tiny little problems of being a nurse is that some folk think you have the knowledge base of a doctor - which of course you don't!

They will show you lumps and bumps and ask your opinion - or ask you this and that and expect an answer.  I can't give them one and suggest they see their doctor.  I have often been asked about mammograms and until earlier this year - would always suggest it made good sense to go ahead.

I have had one myself which proves I am ancient!  Of late, I have been swayed by medical opinion that it is perhaps not a good idea.  Or is it?

October is Breast Cancer Awareness Month.  Astra Zenaca, who manufacture Arimidex and Tamoxifen, founded the Awareness Month in 1995, its aim being to promote mammograms as the most effective weapon in detecting breast cancer.

Is this Big Pharma serving their best interests, directing medical care or just a nice thing to do; maybe the latter?

Although hearing similar stories last year, the seeds of doubt were sown in my mind in January, when I read reports such as this in The Telegraph.  It suggested that, despite a reported 1,400 lives saved per year - there is no evidence that the breast screening programme has saved lives and in fact, women have wrongly been told that they have breast cancer and undergo unnecessary surgery on tumours that would not progress to being harmful.

This article was based on this at the Nordic Cochrane Centre and was swiftly refuted by NHS choices who claimed that the research was a narrative review critiquing the 2008 Annual Review of the NHS Breast Screening Programme (NHS BSP), which reported on twenty years of mammogram screening in the UK.  See here for further details.

In March this year this article appeared in The Telegraph stating that two lives are saved 'for every woman unnecessarily treated'.  It is interesting reading.  It is admitted here that leaflets supplied did not inform of potential risks of screening.

Adverse effects of mammographic breast screening include:

Psychological and physical morbidity - mainly associated with false-positives.

False negatives - approximately 5% of cancers in women over the age of fifty are mammographically invisible.

A diagnosis of cancer that would not have become symptomatic during a woman's lifetime.

Radiation risk - an estimate that one extra breast cancer develops every year in women over fifty, after a latent period of up to ten years, for each million women screened.

There is undoubtedly harm related to breast screening - but there must be some good!?  A detection rate of 6.2 cancers - although some would be of the 'no harm' kind (?) - per 1000 women screened; of these, invasive cancers accounted for 1.4 per 1000.  This reported 1.4 - to me - suggests the risk is worthwhile?  However, if you visit NNT it seems that breast screening is a harmful waste of time.

Furthermore, regular self-examination is a waste of time too!  See here!

There is so much conflicting information, I am left a little confused!  I think I shall probably attend my next, unless something more robust convinces me otherwise.  I will still recommend that other women do too.  But should I?  Should I say - "Look at the evidence and make your own decision"?

What are your thoughts?

Anna :o]

PS We must (as girlies) take some responsibility for our health!  Poor diet, obesity and binge drinking may lead to breast cancer!

10 comments:

Alcoholic Daze (ADDY) said...

That suggests you don't recommend mammograms now. Am I right, and if, so, I would love to know why? I still make myself go for checks every three years, although I find it a very painful experience.

HyperCRYPTICal said...

Gosh! You were quick ADDY - how did you do that(?) - and thanks for your comment.

I have ammended the above as you are correct in your observation. Until convinced otherwise, as said, I will probably attend my next screening amd would suggest (if asked) that others do too.

Anna :o]

Sam said...

Hi Anna :-)

I have ever had just the one smear ... and absolutely hated it! Never again, no mamograms either ... or anything else

Why?

Because I am 'not' sick and I don't like the pain, or the discomfort, the indignity, or the scare that may follow ... and I have no 'family history' for me to panic. If I still get that thing despite it not running in the family, well, tough! I will die ... but 'naturally', not through fear induced illness. Because that alone may well invite the monsters in ... and I have better things to do with my time ... and with my life

Naughty girl? ... maybe ... but it suits 'me' .... as always ;-)

blackdog said...

You are certainly right in having doubts. The pressure to have a mammogram is considerable, but the benefit is elusive if not negative. The study you refer to was fairly conclusive, in that those not screened had a slightly better mortality rate than those who had. Cochrane has been highly critical of the risks and benefits, both due to the high levels of radiation involved and the liklihood that anyone with cancer will likely cause it to spread due to the squeezing involved, causing dispersion.

Certainly as someone involved with ionising radiation in my working life, I would not go within a long mile of it (if I were a woman). It is down to personal choice, but I do feel that the pressure put upon the cohort of women eligible, is far too biased in favour of what is dubious benefit. Pretty much as has been proven about hrt, which actually causes breast cancer. If one examines the evidence it is likely that it alone was responsible for the escalation in cancer that was observed and its suspension that then showed a significant lowering. When thinking about a dangerous procedure for a healthy cohort, always pose the question 'who gains'. If it's the drug peddlers and machine makers, be afraid, very afraid.

HyperCRYPTICal said...

Hi Sam and Blackdog!

Sam - I know where you're coming from gal(!) as I also have a 'why worry' attitude to life. Nevertheless, I have attended, when requested, for smears and the mammogram.

I have been giving the mammogram 'issue' a lot of thought today - and doubt that I will have a second!

Blackdog - I agree that the study was fairly conclusive - but at times, studies are demolished by a following study(!); but I have been swayed by it.

As said, I have been thinking about mammograms today and will probably not have another!

When I attended the first, I did inform that I had recently had chest Xrays, a CT scan, etc three months before it and asked whether it would be wise to go ahead. I was informed that there would be no proplem.

Did a bit of googling prior to writing this and discovered that over a three month period, I received (at least) a combined 25.6 mSv dose of radiation.

Problems ahead maybe? But why worry - what's done is done!

Your thoughts on HRT and breast cancer make sense, and please be assured I generally question anything related to my health - which overall is pretty good!

Anna :o]

NorthernTeacher said...

I've had 2 breast screening sessions and found both quite painful (due to small boobs was what I was told first time). I gave up self-checking many years ago as I wasn't convinced I was doing it right. I don't think I'll go again. I'm on the same wavelength as Sam - not ill and not nice.

However, what would be said if I were invited for screening, always refused, and then needed NHS services later when it might perhaps have been easier to deal with earlier? Would it be one of those "if you smoke, you shouldn't get free treatment for cancer/heart disease" reactions? I wonder ...

blackdog said...

Well, remember that dose maximum for a non classified person (in controlled areas) is 1mSv. If my dosimeter recorded 25.6 I would be excluded for a long time and an investigation instituted!

You've had a lot in a year, that's for sure!

Witchdoctor said...

One of the things that irks me about breast screening is that it is not really an invitation to attend ....they have already made the appointment for you. I know why they do this, but it really gets under my skin and for no logical reason apart from my own contrariness, it acts as a deterrent.

My feeling is they need to bolster up the information base, so that those who want to can easily read the pros and cons for themselves in an unbiased and meaningful way before they decide to attend. To date breast screening programmes have not been doing this, instead the literature is of the "you miight be barely literate so I'll make it simple for you" variety. Some literature also implies you are letting yourself and your family down if you don't attend. Surely I'm not the only woman who feels this approach is patronising.

Witchdoctor said...

NorthernTeacher,

I'm sure you would never be rejected by the NHS if you developed cancer and had refused screening. Indeed I believe you would get the best of treatment.

I sincerely hope I never have to eat my hat after saying this!

HyperCRYPTICal said...

Thanks for your comments NT and WD.

WD. I can barely remember the literature - but I tend to think it implied that I would be foolish not to attend.

I did question recent Xrays,etc and as to whether it would be wise to progress, but as said, was told it was okay. Perhaps I should have asked the radiographer and not the nurse - but I didn't! Ho Hum!

But I am wiser now!

Anna :o]