What do a prawn sandwich, a pair of Laura Ashley pjamas, crocus bulbs and some raspberry chocolate got in common? You can buy them all in aid of Breast Cancer. This is ‘breast cancer awareness month’. I have been attempting to suggest that perhaps it isn’t such a good idea for the last decade at least, not that it has made any difference. What we have now (with research to show it) are women who believe they are more at risk of breast cancer than they are, less aware that obesity and alcohol are influential risk factors on cancer, who believe that breast lumps are more likely to be breast cancer than they are, and who believe that age is not a risk factor for breast cancer.
In fact age is the biggest risk factor of all, though you wouldn’t know it if you looked through many of the leaflets or adverts produced by breast cancer charities. Almost unbelivably, the breast cancer lobby will blame almost anyone else for the misperceptions (or ‘lack of awareness’) that women have about breast cancer. When it comes down to taking some responsibility for misinformation themselves, the silence is distinct.
Here is, I think, the very biggest problem. Breast cancer charities could actually come out and say that breast cancer rates could be cut very quickly if women stopped going for screening mammography. Let’s be clear – screening is when you don’t have a problem. It is not when you have a lump or pain in your breast – that’s diagnostic mammography, and that isn’t what I’m talking about. I mean the NHS Screening campaign, which invites women, who have no breast lumps and who feel well, along for 3 yearly mammograms when they are aged between 47 and 73. The problem with breast screening is that it picks up a lot of ‘cancers’ that were never going to kill or maim you. Instead, women are treated for a ‘cancer’ that wasn’t going to affect them had they never known about it.
Some women may say that they still want to take that chance, and if so, they should have access to information that isn’t designed to tell them what to do, but which is independent and respects a woman’s autonomy. This information from the Nordic Cochrane centre is robust;
If 2000 women are screened regularly for 10 years, one will benefit from the screening, as she will avoid dying from breast cancer
At the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy
Furthermore, about 200 healthy women will experience a false alarm.
But you would think, would you not, that breast cancer charities would be attuned to the potential for overdiagnosis from screening by now, and might even be thinking about how to raise ‘awareness’ of the dilemmas that breast cancer screening can throw up. Perhaps they might think that they have a duty to protect women from the excesses of screening, or at least inform them about the problems with it.
Not on your life. Here’s Breakthrough Breast Cancer on ‘why is it important to attend my screening?” The answer: “Breast screening can pick up changes to the breast at a very early stage – even before you might see or feel anything. It’s a vital part of early diagnosis. If there is something there, the sooner it is found, the better the chance that you will be successfully treated.” No mention of harms, or uncertainty, or overdiagnosis. Here’s their policy manager responding to (yet another) scientific paper suggesting that breast cancer screening has complex and slender gains: ” We agree that it is extremely important women are given clear, balanced and good quality information about the benefits and risks of breast screening and their treatment options. This will enable them to make informed decisions regarding their breast screening appointments. Breakthrough Breast Cancer believes breast screening saves lives. Rather than discouraging women, more needs to be done to encourage them to attend their breast screening appointments. We want the Government to commit to continual investment in the screening programme to ensure that all eligible women can access this important service.”
So it seems you can have a choice, but only if you choose to have breast cancer screening.
Breast cancer charities should be waking up to the research. It’s not enough to be eager for easy publicity and for funds generated by emotive appeal. This just creates an obstacle to good quality healthcare : women are being treated less as capable citizens and more as subjects requiring herding. Where is the evidence that breast cancer ‘awareness’ has done us any good at all? I can’t see it.
Meantime, I’m off prawn sandwiches.