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Does Breast Screening help or harm?

 

Does breast screening help or harm? This seems to be one of the headlines today, on the second to last day of breast cancer awareness month.

 

So what is this all about then? The debate about whether an NHS Breast Screening programme is necessary and whether it helps has been hotly debated for a long time now. An Independent Review committee was set up by Cancer Research UK and the Department of Health, and the results were published today in The Lancet.

 

Some facts and results of the review:

  • The evidence and trials including were between 20-30 old, so not new
  • They state that the screening programme that 1 breast cancer death could be prevented from 180 of the women screened. That’s about 1300 deaths per year.
  • They also concluded that screening could result in over-diagnosis. This could be about 1% of women screened could be over-diagnosed.

 

Breast Cancer Care have reported on their website that:

“But importantly, no individual woman (or their doctor) can know if a breast cancer found at screening was over diagnosed (so would have remained undetected throughout her lifetime). Nor will she know if she survives breast cancer, whether it was because of screening.

The review panel recommends breast screening continues but with improved information to better convey to women the benefits and harms.

Breast Cancer Care has responded, together with Breakthrough Breast Cancer and Breast Cancer Campaign. We believe that the review has provided clarity that screening can save lives and we encourage all eligible women to consider attending. However, some may be diagnosed and treated for cancer that would not have caused them harm. We think it’s extremely important that women can access clear and balanced information on the pros and cons of breast screening.”

 

 

What is “Over-diagnosis”?

This is where the medical team detect some cancer cells in the breast. This is often non-invasive cancer cells which may or may not have the ability to develop into invasive cancer or a tumour. If the cells are left alone they may not develop at all and the woman could live a breast cancer free life. However, there is also the risk that the cells could develop at a later date and could develop fast too. Then by the time it’s detected it may be in a far more advanced stage. The problem with over-diagnosis is that the patient could end up having what is considered un-necessary surgery and treatments along with the stress that comes from any cancer diagnosis.

There is a form of breast cancer called Ductal Carcinoma in situ, which I have blogged about earlier.

 

 

The following is from that blog too:

Debate about Screening and DCIS treatment

There is a great debate amongst the experts about whether breast screening is more helpful or more harmful. The diagnosis of DCIS has increased following the introduction of routine mammograms, as most of the time this could not have been seen or felt without the imaging. Once diagnosed it will be dealt with using medical intervention. Some experts feel that this puts many patients through a lot of un-necessary stress and treatments, especially if it proves that there wasn’t a high incidence of DCIS and its low grade. There is always the chance that if left alone the DCIS could just be dealt with by the body or may not get worse so no treatment would have been needed. So the debate is whether routine mammograms are useful in detecting early breast cancer or more harmful by putting some women through unnecessary treatments and stress.

Also, the actual DCIS definition and treatment is in great debate. Does a woman with non-invasive breast cancer really need a mastectomy, a surgery which could lead to a lot of mental anguish and body dysmorphia?

Case study

Below is an outline of what one woman went through. This is roughly her story:

  • Routine mammogram done in December
  • 1 week after mammogram receive a letter asking her to go and see a specialist to discuss results, appointment for 1 week later.
  • Meet with consultant and has an ultrasound. Microcalcifications confirmed in 1 breast and biopsy done
  • 2 weeks later has another consultant appointment where DCIS is confirmed and further imaging and biopsies are done
  • 1 week later has another consultant appointment to discuss treatment. Confirmed that the DCIS is high grade and wide spread.
  • 1st February – wide local excision done using guide wire.
  • 2 weeks later – consultant confirms that the DCIS is more extensive than first thought and was up to the clear margin. In addition a number of invasive cells were detected. Advised to have a further wide local excision
  • 1st March – second wide local excision done.
  • 2 weeks after – histology report shows no more invasive cells but there isn’t a clear margin. Advised to consider a mastectomy due to the size of the area affected, the type and the fact invasive cells were found. Told that a 3rd wide local excision with radiotherapy is also an option
  • 12th April – sentinel lymph node biopsy done where 3 lymph nodes are removed – results were clear, no lymph involvement.
  • 1st May – mastectomy and reconstructive surgery preformed
  • 2 weeks later – histology show the breast tissue was clear

The consultant will review and monitor her every 6 months, as he has to keep an eye on the other breast too as there is a greater chance of the cancer forming in that breast as well.

So after 5 months since the mammogram the main part of the treatment is over. There is a long recovery period with other treatments and appointments.

When I ask her about her feelings about what’s happened to her and if she feels routine mammograms are unnecessary she tells me that even though this has been one of the most stressful periods in her life, she is so thankful that we are offered free routine screenings in this country as it has probably saved her life. She understands that there could be a chance that this may not have developed into an invasive cancer, but she believes that the risk that it could have developed would be worse.

So despite having to undergo 3 surgeries, 1 of which was a very big one, in the course of 3 1/2 months plus various other invasive testing, this lady is absolutely confident that this has been for the best in her case. She is a total advocate for cancer screening and is advising everyone who is eligible to make sure that they go.

 

I also know of another lady who is currently visiting family in the UK. In her country of residence they do not offer routine breast screening and she can’t actually remember when she last had this done. 2 weeks ago she started to get pain in her breast and then following various doctors checks and scans it turns out that she has quite advanced breast cancer in not just one, but both her breasts. Upon discussion with her and her family they also believe that if she had the opportunity to have routine breast screening then this could also have been caught earlier, and they feel that the 1% chance of over-diagnosis is one that they would have been willing to risk.

 

Both Breast Cancer Care and Breakthrough Breast Cancer have set up helplines to assist anyone who may be confused or upset by the news today.

 

2 Comments

  1. margaret on October 23, 2013 at 10:11 am

    Diagnosed with high grade dcis in Feb 2013 after routine mammogram. Underwent mastectomy in April with immediate diep recon. The reconstruction failed after two attempts and had to be removed. Three ops in 3 days. Underwent LD Flap recon in July which went well. Just waiting for symmetrisation op now. Thankfully I didn’t need any other treatment. Even after going through all this I am so thankful that I went for that routine mammogram because if left I think things could have been so much worse.

    • Rima on October 24, 2013 at 11:52 pm

      Thank you so much for your story. I’m pleased the LD flap reconstruction went well and even better that you didn’t need any further treatment. From the discussions I’ve had with the breast cancer surgeons they are all of the belief that high grade DCIS will eventually get worse and as such a routine mammogram helps to catch it at an earlier stage. Hope that you stay well and healthy.

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