Breast health and 1 in 9 again

There are so many things to say that are wrong about the new Breast Health UK service that I’d need all night to write about them.

Let me concentrate on just one thing: no, not their offer to perform breast examination on the asymptomatic woman and then teach them how to do it (although it’s tempting to point out the evidence being very much against either) but instead their offer of infra red breast scans on asymptomatic women who don’t fall within the age for the UK Breast Screening programme.

They say: “This examination is recommended to all women over the age of 18 including women previously diagnosed with cancer, with implants, and especially women with dense or cystic breasts or family history of breast cancer.”

and “Digital Infrared BreastScan is unique among breast cancer screening, in that it is the only one with prognostic qualities, i.e. predictive ability. That being the case, it is inappropriate to measure specificity, or false positives, except in a very general way.”

Hmm. They also quote this paper as defence saying that it was “A third paper1 recently reported a 97% breast cancer detection rate using Digital Infrared BreastScan.”

This paper did not look at screening well women with no symptoms with their scanner. It took women who were already going to have a breast biopsy on the basis of an ultrasound or mammogram. One cannot take that information and apply it to Asymptomatic women. Indeed, the paper shows that the test was not good for specificity – it was not reliable at detecting a benign lesion well.

They say that ” Digital Infrared BreastScan is completely non-invasive and poses no risks whatsoever to the woman” but don’t mention false positives or false negatives and the fall-out from these.

I can’t resist saying something about the ‘1 in 9 women’ get breast cancer – that’s  LIFETIME risk you get when you are 85. Most women don’t live that long.

11 Responses to “Breast health and 1 in 9 again”

  1. Alan Henness January 30, 2011 at 1:01 am #

    Good grief.

    That could easily be one for the ASA after 1st March.

    I’ll add it to my list.

    The Nightingale Collaboration

  2. Margaret McCartney
    margaretmccartney January 30, 2011 at 1:08 am #

    Great. All I need are some leaflets and it can go to the ASA now.

    What irritates me beyond all is that despite the ASA upholding complaints many companies – especially Lifescan- go on promoting their wares in soft focus and still not giving decent credence to all the negative sides of screening.
    Just as bad, the NHS are left to sort out all the fall out.

  3. Prof. Wishart/T. Jordansen February 1, 2011 at 7:44 am #

    Thank you for featuring an article/blog on BreastHealth UK.

    You write that the evidence is ‘very much’ against clinical breast examination and teaching women to perform self examination. Clinical breast examination is the first examination any woman has when visiting an NHS breast clinic and is a key part of the “triple assessment” of any woman with breast symptoms. In addition, self examination is an important element of any breast awareness programme. At BreastHealth UK we feel that in order for women to identify changes in the breast tissue it is important to be able to carry out self examination but not as the only diagnostic tool.

    You incorrectly state that BreastHealth UK offers Digital Infrared BreastScan for asymptomatic women who fall outside the NHS screening programme. At BreastHealth UK Digital Infrared BreastScan is promoted in combination with mammography, which is offered to clients according to NICE guidelines.
    Digital Infrared BreastScan has been introduced as an adjunct to mammography and is targeted at women under 50 years old where the sensitivity of mammography was less than 50% in a recent study from Cambridge University Hospital (Addenbrookes).

    If anybody would like to discuss in more detail the services offered by BreastHealth UK we would be pleased to receive calls on 01223 845 200.

    Troels Jordansen Prof. Gordon C Wishart
    Managing Director Medical Director
    BreastHealth UK BreastHealth UK

  4. Margaret McCartney
    margaretmccartney February 1, 2011 at 7:50 am #

    This is what it says on your website

    “Digital Infrared BreastScan
    Click here to view a video about Digital Infrared BreastScan

    A state of the art Digital Infrared BreastScan can determine current breast health by measuring temperature changes in the breast during a period of cooling. Unlike mammography, which produces a structural assessment of the breast, Digital Infrared BreastScan produces a physiological assessment of the breast. The test is non-invasive, involves no compression, takes around ten minutes to perform and can be offered to women of any age. As it does not involve any exposure to radiation the test can be performed on a 6 or 12-monthly basis.

    Digital Infrared BreastScan has been shown to have a high sensitivity (chance of detecting breast cancer) in two early studies in North America. Although it may take several years to fully evaluate this harmless test we feel that there is enough evidence to introduce this new technology to our breast screening programme immediately. Your Digital Infrared BreastScan will be interpreted by one of our experienced Clinical Directors, who has undergone specific training and a screening report will be sent to you by letter. Digital Infrared BreastScan (DIB) in combination with mammography can increase the sensitivity of detecting tumours to 89%. Please click here to read the report.

    Click here for frequently asked questions on Digital Infrared BreastScan.

    Digital Infrared BreastScan is suitable for women of all ages but will usually be performed along with mammography.”

    There are women, are there not, who have presented to your clinic, and who fall outwith the breast screening programme ages, and who have been given an infra red scan?

  5. Margaret McCartney
    margaretmccartney February 1, 2011 at 7:54 am #

    Here is a case study from your very own website where you screen an asymptomatic 47 year old with infrared.

    “47-year old Kate* a business owner from Leicestershire, had previously been affected by a breast cancer scare and in May 2009, she decided to visit BreastHealth UK for a Digital Infrared BreastScan (DIB) as a precautionary measure. After the screening, Kate received the all-clear which has given her complete peace of mind.

    After a breast cancer scare which resulted in two investigative mammograms, Kate was perhaps more aware than most women about the importance of her own breast health and early detection of any abnormalities. Fortunately for Kate the scare didn’t prove to be breast cancer but it made her much more committed to looking after her health: “The scare completely changed my perspective on my own health and made me much more breast aware. As such, I decided to take a pro active step to ensure I was in control of the situation and opted for a Digital Infrared BreastScan at a BreastHealth UK clinic.

    Having already received a couple of mammograms in the past, I didn’t want to be exposed to any more radiation (unless it was completely necessary) and so after much research and a number of detailed discussions with the team at BreastHealth UK, the DIB seemed the best option for me. The DIB doesn’t involve any radiation and uses a temperature sensitive camera to detect ‘hot spots’ on the breast which is a characteristic of many impalpable cancers. This state-of-the-art technology has been shown to have a high sensitivity for detecting early breast cancer, especially in younger women.

    The Digital Infrared BreastScan procedure was completely non-invasive and I felt entirely comfortable throughout. Following the procedure I was thankfully given the all clear – my results were normal. I was sent a comprehensive report detailing my results. BreastHealth UK spent a great deal of time talking me through the report and helping with some questions that I had. I couldn’t fault the attention to detail I received throughout the process which in turn gave me huge reassurance.”

  6. Margaret McCartney
    margaretmccartney February 1, 2011 at 7:57 am #

    And just to be clear, women attending an NHS symptomatic breast clinic are ‘triple assessed’ because they have symptoms. Breast self examination in asymptomatic women has shown to be ineffective, and results in more benign breast biopsies. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376382/pdf/88-6600847a.pdf

    “Regular BSE (breast self examination) is not an effective method of reducing breast cancer mortality.”

  7. Margaret McCartney
    margaretmccartney February 1, 2011 at 8:26 am #

    “Notzarina Reevers Opens BreastHealth UK South Bank Clinic
    Actress and singer Notzarina Reevers – star of Dick Whittington at the Swan Theatre, Worcester – officially opened BreastHealth UK’s new clinic at the Spire South Bank Hospital in Worcester, which offers new types of screening to women of all ages.

    “Young women should realise that it’s never too early to check yourself out,” said Notzarina, 26.

    “Although it’s rare, cancer can affect women of any age, and there are things you can do to help protect yourself. Being cautious is not the same as being paranoid.

    “Unfortunately, a close friend of mine has cancer in her family. For someone in her position, who is concerned about breast cancer but doesn’t have any symptoms, it is very reassuring that BreastHealth UK clinics provide facilities for screening younger women.”

    The South Bank clinic will be one of the first to offer Digital Infrared BreastScan, which is a sophisticated non-contact screening technique that identifies ‘hot spots’ in breast tissue. It is particularly suitable for younger women.

    “I’m delighted that BreastHealth UK is offering this service,” said Notzarina. “It can be hard for younger women to come to terms with needing screening, so having this comfortable and non-invasive infrared technology is very welcome.”

    It can be hard for younger women to come to terms with needing screening?

    again, this is from your website.

    “BreastHealth UK offers a comprehensive range of screening and diagnostic techniques, including technologies that are particularly suitable for younger women. These include clinical breast examination, mammography, and Digital Infrared Breastscan, which are available without a GP referral.”

    and

    A state of the art Digital Infrared BreastScan can determine current breast health by measuring temperature changes in the breast during a period of cooling. Unlike mammography, which produces a structural assessment of the breast, Digital Infrared BreastScan produces a physiological assessment of the breast. The test is non-invasive, involves no compression, takes around ten minutes to perform and can be offered to women of any age. As it does not involve any exposure to radiation the test can be performed on a 6 or 12-monthly basis.

    Digital Infrared BreastScan has been shown to have a high sensitivity (chance of detecting breast cancer) in two early studies in North America. Although it may take several years to fully evaluate this harmless test we feel that there is enough evidence to introduce this new technology to our breast screening programme immediately. Your Digital Infrared BreastScan will be interpreted by one of our experienced Clinical Directors, who has undergone specific training and a screening report will be sent to you by letter. Digital Infrared BreastScan (DIB) in combination with mammography can increase the sensitivity of detecting tumours to 89%. Please click here to read the report.”

  8. Shona McGee February 3, 2011 at 12:09 pm #

    Genius, well done Dr McCartney, from Shona a fellow Glasgow GP and Aberdeen Gradute.

  9. NickEdelsten February 3, 2011 at 3:25 pm #

    Thanks for another interesting post.

    Sorry to be pedantic but I think there is a typo in paragraph 6: “One cannot take that information and apply it to symptomatic women”, should read “…asymptomatic”.

  10. Margaret McCartney
    margaretmccartney February 3, 2011 at 4:37 pm #

    not pedantic at all – woops – many thanks

  11. Rob Findlay March 5, 2011 at 11:58 am #

    Apologies if you’ve seen it already, but I thought you might find this talk from TED interesting, about a new gamma ray screening method:

    “Deborah Rhodes: A tool that finds 3x more breast tumors, and why it’s not available to you”
    http://www.ted.com/talks/lang/eng/deborah_rhodes.html

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