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The need to screen

In a personal blog David Standard, head of media relations at Leigh Day describes his wife's diagnosis for breast cancer and Maria Panteli, a partner in the medical negligence team at the firm, calls for more routine screening of women under the age of 50

David handles all the media relations for clients and the firm, ensuring that people get their voices heard. Maria deals with a wide range of clinical negligence claims involving the delayed diagnosis of breast cancer, retinopathy of prematurity, birth injuries – child and maternal, and spinal cases.
My wife Karen is 46. Last week she finished her last session of radiotherapy having had a breast cancer removed in August through major reconstruction surgery. She has just started the drug Tamoxifen, which she will take for the next 5 years to prevent the cancer's return.

Of our close circle of friends, one is currently going through a very tough session of chemotherapy for breast cancer and one has just finished her chemotherapy and radiotherapy for the same disease, they are also, like Karen, both under 50 years of age.

Whilst breast cancer is not as common in younger women and is often thought of as an illness that affects older women, it is still the case that, every year in the UK, around 10,000 women under the age of 50 are diagnosed with breast cancer.

Breast cancer is the most common cancer in women under the age of 40 [Source: Breast Cancer Care] and remains the most common cancer in the UK. In 2014, there were 55,222 new cases of breast cancer in this country, which equates to around 150 cases diagnosed every day, and 11,433 deaths from breast cancer [Source: Cancer Research UK].

Never has it been so important to extend the trial of offering screening to younger women.

The NHS Breast Screening Programme was set up in 1988. It was the first of its kind in the world. The programme currently invites women aged 50 to 70 for screening every 3 years.

The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47 to 73. The programme aims to detect and treat breast cancer early when the tumour is small and before it has had a chance to spread.

My wife caught her cancer as it had dimpled her skin, no apparent lump but the 12mm cancer was pulling at the skin as it grew and therefore a physical anomaly ensured she caught it early, so the prognosis is as good as it could possibly be. She was lucky.

Screening at an early stage ensures action can be taken as soon as possible. For every 180 women who attend screening, it is estimated that one life is saved.

It was found that just under 4,000 women had unnecessary treatment. From the point of view of a single patient, they have a 1% chance of being over-diagnosed if they go for screening.

It is estimated that it currently prevents around 1,300 deaths from breast cancer in the UK every year.

There is debate on the concept of “over-diagnosis”. This is screening which correctly identifies a tumour, but one which would never have caused harm.

It can lead to women who may have lived full and healthy lives without treatment undergoing treatments – such as, surgery, radiotherapy, chemotherapy and hormone therapy – which have considerable side-effects. There is no way of knowing which tumours will be deadly and which could have been left alone.

So all women who have cancers identified through the screening programme are offered further tests and treatment. The prevalence of over diagnosis was diminished following a breast screening review in 2012 which was put into place to weigh up all of the evidence about the pros and cons of breast screening.

The results of this review found that the NHS Breast Screening Programme offers significant benefits and should continue.

With this in mind, I would like to see the programme extended to include younger women.

Younger women are often reassured, sometimes falsely, that they are too young to have breast cancer. When my wife was told she had breast cancer is was a huge shock and left us both in a daze.

We have two young children and we were suddenly left having to realign careers and thinking about the future welfare of our boys. We just didn’t expect it because of Karen’s age.

We are fortunate to have our two boys but the treatment she will now be taking will mean we can have no more children, something we weren’t planning on but it became an enforced stop to any plans for a bigger family because of the Tamoxifen which hit Karen hard.

However, we are both aware of how lucky she has been in having identified it early. She is preparing to go back to work and live the rest of her life with every possibility of being cancer free.
 
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Maria Panteli, a partner in the clinical negligence team at Leigh Day explains:

Women under 50 are not currently offered routine screening. This is because research has shown that routine screening in the 40 to 50 age group is less effective.

As a woman goes through the menopause, the proportion of fat in the breast tissue increases and this makes the mammogram easier to interpret.

However, a study has shown that digital mammography is better for screening younger women and women with denser breasts and is equally as effective as film mammography in older women.

The decision whether to be screened is a personal one and that decision should be made with all of the potential harms and benefits fully explained.

What is imperative is that we increase our awareness, knowledge and understanding of breast cancer so that we know more about how and why cancers spread and, therefore, which cancers need treatment. It is important that we continue to fund breast cancer research.

Although mammography is far from perfect, it saves lives and it is the best tool that we have at the moment. Its efficacy will be increased with the introduction of digital mammography in most screening centres.

Research is advancing at pace and it is hoped that in the future there will be a number of new techniques that can be used alongside the screening programme to make it more sophisticated and reduce the number of women having unnecessary treatment.

More research should be done on whether screening should be offered to younger women, particularly as the disease in younger women is usually more aggressive and early detection and treatment is therefore crucial to the woman’s survival and quality of life.

Screening


Things to consider:
  • Having a mammogram means your breasts are exposed to a small amount of radiation. To put this into context, it is about the same dose a person receives by flying from London to Australia and back.
  • Sometimes a mammogram will look normal, even if a cancer is there.
  • Sometimes a mammogram will not look normal and you will be recalled for more tests, but a cancer is not there. This can lead to unnecessary anxiety and tests.
  • Screening can find cancers which are treated but which may not otherwise have been found or caused you problems during your lifetime.

Benefits of breast screening:
  • Regular screening can prevent deaths from breast cancer.
  • Screening can find cancer early, before you know it is there. The earlier breast cancer is found, the better your chance of surviving it.
  • If a breast cancer is found early, you are less likely to need a radical or aggressive treatment.
  • You need to be aware that breast screening cannot find every cancer. Some cancers do not show up on a mammogram and sometimes a cancer is not spotted.
  • Screening cannot prevent breast cancer. It only finds cancer if it is already there, but it can find cancers at an early stage.

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