Bleak October for breast awareness

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.

4 Responses to “Bleak October for breast awareness”

  1. Witch Doctor October 9, 2010 at 8:23 pm #

    This is what they think about “Pink Profits” in Canada.

    http://www.ctv.ca/CTVNews/Health/20101008/pinkwashing-pink-ribbon-101009/

  2. Margaret McCartney
    margaretmccartney October 10, 2010 at 9:03 pm #

    thanks for that – maybe we should hope that we’ll catch up in the UK.

  3. Yvonne Bonifas October 13, 2010 at 5:41 am #

    I am a healthy 55 year old woman with no family history of cancer who in the past year has been pressurised into 3 screening/testing procedures which I consider to be entirely over the top. The first was a mammogram which as I take HRT is being pushed hard at me (refused) with strong implications that being on HRT I am almost bound to get breast cancer , the second was a gastroscopy for stress induced indigestion which was responding well to Omeprazole, but apparently not quickly enough for my GP (refused, got better by itself/Omeprazole) , and the third was a colposcopy with biopsy, for mild dysplasia, – eventually gave in after persuasion from consultant, even though a quick web search shows it extraordinarily unlikley to ever become cancer and would in most countries be monitored by yearly smears.

    This may sound ungrateful, but Im convinced the last test was target driven. The consultant was charming and convincing, but the clinic staff when I phoned up to ask questions were extremely bossy and made me very cross, even implying I had no choice in the matter! Contrary to the leaflet I had been sent with the appointment stating if I had any questions to ring and speak to the speciliast nurse, (“Oh , that’s not our leaflet.” I was told). I only realised half way through the conversation I was being given clinical advice from an NHS Admin Assistant, not even a nurse! When they realised I wasnt going to comply with their peremptory orders I was passed to the consultant. I had a month of distress, worry , anger and fear as I find this kind of thing extremely invasive. If this pattern of testing is being repeated for every low risk middle aged woman in the country no wonder the NHS is over spent.

  4. Catfriend October 15, 2010 at 9:00 am #

    I am glad to have this opportunity of thanking Dr. McCartney for her honest approach to breast screening, and for revealing the truth about it. I just wish more women could read her articles. I am 66, healthy apart from high BP which is controlled with medication. I believe my risk may be slightly increased as I am childless due to infertility.

    I began going for routine mammograms as soon as I was called at age 49 (they believe in starting early in my PCT!), and attended regularly, if reluctantly, until on one occasion I was devastated to receive a recall letter. I cannot explain how fearful I was, and when I arrived at the hospital I found myself in the company of other women, equally, if not more terrified than I was. One told me that after she received the letter she began ‘putting her affairs in order’, another said she had gone to sit in the local churchyard thinking it would be the end for her. I believe we all left with relieved smiles – in my case the problem had been benign calcifications. I forgot all about the disease, as far as the media would allow, until my next ‘invitation’ three years later, when I dragged myself off reluctantly to ‘do my duty’. The test was clear, but last year when I received the dreaded invitation I just could not bring myself to go through with it. I did a lot of internet research and discovered that much of the latest research does not support mass breast screening and the conclusions drawn are very clear. Dr. McCartney’s blogs also helped enormously in my decision to decline the test.

    I find the way the media treats this disease to be extremely distasteful, especially where celebrities who contract it are concerned (and there do seem to be rather a lot of them these days, unfortunately). To me, there seems to be an almost gleeful approach in reporting these women’s misfortune, whereas any other illness would be scarcely remarked on. Breast cancer has become big news and not in a good way . I believe this publicity does not alleviate fears, but exacerbates them. Women friends with whom one dares broach the subject all toe the party line and quote the ‘catch it early and cure it’ mantra, so I say nothing. I would like to discuss this with the practice nurse when I next attend for a BP check, but I know she will try to bully me into screening and I am not willing to risk it, so I will keep quiet. Maybe one day I will be lucky enough to meet another like-minded woman but I’m not holding my breath.

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