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Will the real breast screening please stand up?

Friday 1 October, 2010
There is a lot of money in breasts. You need only look at the number of adverts in women's magazines for breast enhancement or bespoke brassieres to know that boobs are big business. Dolly Parton reportedly has hers insured for $600,000 US.


This month is Breast Cancer Awareness Month and the aisles of every supermarket will be awash with pink merchandise. Thousands of people will buy a pink ribbon and across Australia groups of women will gather for a Girls Night In, generously donating the money they usually spend on a night out to help Cancer Council fight women's cancers, including breast.

The fact breast cancer has such a high profile is a very good thing - it means more money for life-saving research and greater community awareness of what symptoms to look out for and the importance of lifestyle and early detection.

Despite continuous improvements in treatment and survival, breast cancer is a serious health concern in Australia, affecting one in eight women. Worryingly, a growing number of private enterprises are clocking onto the fact that there is money to be made from addressing women's anxiety about breast cancer.

In the last year there has been an influx of commercial breast imaging operations in Australia. Many clinics which once offered spray tans and anti-cellulite treatments, now offer breast scanning services based on technologies whose clinical efficacy is either unknown or poorly evaluated. These services are often aggressively marketed towards women as young as 20 and in some cases are promoted as an alternative to mammographic screening. Cancer Council WA released a report earlier this year outlining some of the services currently on the market.

This trend raises a number of issues.

First of all, Australia has a very effective free national breast cancer screening program. All women aged 50 to 69 are invited for a mammogram (breast X-ray) every two years through BreastScreen, and women aged 40 to 49 and 70 or over may attend if they wish. Biennial mammography is not perfect but it is the best available screening method for breast cancer for women 40 and over. It is also the only method for which there is top level evidence that it saves lives.

The danger of this breast scan while-you-wax approach is that women may forego BreastScreen  or being breast aware in favour of what they believe to be legitimate and scientifically based alternative ‘testing' for breast cancer. Our reason for raising these concerns is to avoid a situation whereby a woman relies on unproven methods of breast cancer detection and subsequently develops a tumour which is not detected until it's too late.

So while you may not have the funds nor the inclination to insure your bust for a vast sum of money a la Dolly, being breast aware and having regular mammograms at BreastScreen from the age of 50 (or earlier if you prefer) is the best insurance you can take to protect yourself against breast cancer.

Comments

I always thought I'd have mammograms, it's a common cancer after all. (although be careful of the 1 in 8 statistic, that applies to a woman in old age, the risk goes up with age, a middle aged woman - it's 1 in 68 (roughly) and women under 30...very uncommon. I did some research first and discovered I hadn't received the full story in my screening brochure. I'd urge all women to be very careful with breast screening, it has risks - false positives, over-diagnosis and there is even concern about the health risks of radiation exposure and compressing breast tissue. I don't agree with a recommendation to screen without also giving women risk information and a proper overview of the test - the real and not inflated benefits. The Nordic Cochrane Institute were so concerned at the lack of risk information being given to women and the lack of informed consent, that they produced their own summary, "The risks and benefits of mammograms" - it's at their website. The NCI have criticized the BreastScreen brochures from several countries, including Australia. I hope our brochure has been improved...but I think all women should be given the NCI paper. Gilbert Welch and Professor Michael Baum have also had lots to say about the risks of breast screening, google their articles. Gilbert Welch is about to release a new book called, "Over-diagnosis" in Jan 11 which covers mammograms. I then thought about clinical breast exams, but found no evidence of benefit, they just cause biopsies. Breast self-exams do the same thing. I've decided to be "breast aware" - just taking note of the look and shape of my breasts in the mirror every morning after showering. I believe women should do their own research before agreeing to cancer screening tests, for some reason we rarely get a balanced assessment of the test - we get scant information, skewed/misleading figures (1 in 8 figure) and an order or recommendation to screen. I don't believe that is an appropriate way to treat adults, women are quite capable of assessing the pros and cons and making their own decisions and that decision, to screen or not to screen, must be respected...too often our concerns are dismissed or ridiculed and that is unacceptable and disrespectful. Men often opt out of prostate screening, women are equally entitled to opt out of breast or any other sort of cancer screening.

From: Elizabeth, 15/04/2013

More damning evidence released recently - that the fall in death rates from breast cancer is about better treatments, and not screening. "Scrap breast cancer screening" by Prof Michael Baum appeared in the Guardian recently and there is a link to the research in the BMJ. (in comment 3 or 4) Prof Baum and others are taking legal action against the NHS for failing to obtain informed consent from women. Our brochures are worse than the UK equivalent, yet no one here is warning women about the risks and actual benefits of this testing. I know Breast Screen are pushing to reach a 70% target of women aged 50-69 - this should be about informed consent and our health, not targets and protecting the screening industry. http://www.guardian.co.uk/commentisfree/2011/aug/02/breast-cancer-screening?INTCMP=SRCH

From: Elizabeth, 15/04/2013

I'd urge anyone thinking about breast cancer screening to first listen to an amazing lecture given by Prof Michael Baum at UCL recently, "Breast cancer screening: the inconvenient truths". (on Utube or at Prof Baum's website) We shouldn't have to find out about the risks and actual value of screening for ourselves - why is it acceptable to give women selected and IMO, misleading information and then recommend testing up to a govt-set target? Men are not treated this way and it is equally unacceptable to treat women like children - no one has the right to keep me in the dark and risk my health. Respect informed consent for women!

From: Elizabeth, 15/04/2013

I have been recalled for more tests after a routine screening. I am 57, lead a healthy lifestyle and no cancers of any kind in my family. Three of my grandparents lived to over 90 (one was 100). I am scared of what they might find, that it will be something that I have to have a biopsy for and then turn out to be one of the so called cancers that would never have progressed but I will feel compelled to be treated. I already feel like a breast cancer patient! I didn't know any of this research about screening. If I had I would not have bothered to go. I now feel I am on a no way back path to some sort of diagnosis! Breast screen NSW could not get me in for assessment for a month so I have made an appointment with a private clinic and will pay the gap. The anxiety of waiting is really affecting my life at the moment. I was then rung by a nurse at breast screen asking me did I know the implications of going private. That I could not return to breast screen for this "episode" if I found that the private system took longer to schedule me for a biopsy. She told me how seamless their service was in doing the diagnostic mammogram, the ultrasound and then biopsy on the same day if need be. The reason I don't want to go to breast screen is exactly this over the top approach. They have everyone there and you get a time with the nurse, doctor, radiologist etc and all the time feeling they have already diagnosed you. I just need to know now what they have seen and go privately to get in earlier. The call by breast screen pointing out the need to know the potential consequences of my decision has only stressed me more. I wish I had the strength to just not go to the follow up and never go to screening again.

From: Michelle, 09/11/2014

Hi Michelle, thanks for posting on our website. I’m sorry to hear about your experiences with a follow up screening appointment. This can be a really anxious time and the emotions you are experiencing are not uncommon when you’re asked to undertake further testing. As with all screening tests, screening mammograms are not 100% accurate. This means that sometimes a woman’s screening mammogram may look abnormal and she might be recalled for further tests. Most women who are called back for further tests do not have breast cancer. Unfortunately, we will not know this until you have attended. You may like to speak to your GP about how you are feeling, as they may be able to advise of the best possible course of action for you. Alternatively, you can call Cancer Council 13 11 20 (for the cost of a local call) and speak to an experienced cancer nurse who will be able to provide you with a more personalised service. Our lines are open from 9:00am-5:00pm, Monday to Friday and we welcome your call. Wishing you all the best.

From: Shannon from the Cut Your Cancer Risk team, 14/11/2014

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