Tag Archives: Mammography

Should you have a Mammogram?

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Cancer Screening – have your say

 

English: SAN DIEGO (Sept. 22, 2008) Lead Mammo...

 

There is heated debate in some quarters over benefits or problems caused by Mammograms, with experts taking opposing views.  Recently I attended one debate where world-renowned experts were one step away from an Olympics-style boxing match – it became so heated.

There is an increasing recognition that people should be provided with what they need to make an informed choice themselves about cancer screening, including balanced information about benefits and harms.

Currently, Professor Amanda J Ramirez, National Cancer Action Team  is leading a  review, engaging clinicians, academics and charities, who have helped us develop a proposed approach.  This has been published on http://www.informedchoiceaboutcancerscreening.org/

Ramirez is keen to engage YOU in the debate over the coming months. The website will give members of the public an opportunity to have their say about the approach, the type of information that should be available and how it should be presented.  It is well worth taking this survey, which should take about ten minutes, as the answers will be noted and form  help the Team get the views of the public on the approach.

 Background

More and more research is showing breast screening can possibly cause harm as well as benefit.  Ever since the pan-European cancer charity Europa Donna held a fascinating debate in London on screening pros and cons, people have been asking questions.  And major organisations have typically stood back and offered platitudes rather than action.

Dept. of Health, NHS, Breast Cancer Charities, cancer hospitals, professionals, etc. have done what they do best – sat on the fence.

Brave souls, from cancer patient Mitzi Blennerhasset,  to one of world’s leading breast cancer surgeons, Prof. Michael Baum, have been calling and calling for an investigation – for more information – for the truth to come out – but finally Richards, the ‘Cancer Czar’,  has been goaded in to action, come off his comfy fence, and ordered a review.

Meanwhile Mitzi has posted a string of information on her website,

www.evenstarsexplode.wordpress.com

The debate was aired here first

It takes guts for a pioneer, lauded for his work, to go on looking at facts – then come out and say further research says “do the opposite”.

Basically, this was what Michael Baum has done. 

Over two years ago, on a night when there was thick snow,  enough interested people managed to fight through the drifts to hear a fascinating debate, put on by Europa Donna.

The debate was between various luminaries of the breast cancer world – and got so heated that the snows were well on their way to be melted.  Michael was there to explain why, having set up the NHS Breast Screening programme, he now advocated caution – and was telling people that the programme should provide much more information, and to urge further investigation into the results.

Of course, if the NHS ‘approves’ something, woe betide anyone who sensibly points out that once a programme is rolling, it might throw up anomalies.  The NHS has approved – so you don’t questions this.  Well, not if you don’t want the medical establishment to close ranks.

Michael doesn’t care; his position in the surgical oncology world is so eminent he doesn’t need to worry.  But it took guts for Mitzi to question the medical establishment, and demand better treatment for cancer patients.

It should be OUR personal choice if we want a mammogram, or not.  Not dependent on fighting the system or paying to go privately.  But to make this choice we should be given the facts, and let’s hope Mike Richards pulls his finger out and gets on with the review.

Here is an extract of Mitzi’s research, up on http://evenstarsexplode.wordpress.com/

*COCHRANE LEAFLET: screening for breast cancer with mammography http://www.cochrane.dk/screening/mammography-leaflet.pdf

 

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Europa Donna discusses Breast Cancer and Health Economics

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No Fireworks –

but lots of audience participation

 

Aren’t you getting tired of Cameron, Lansley and all telling us that European healthcare is better?

You want to tell them SHUT UP

- and DO SOMETHING ABOUT IT.

Well, Europa Donna is an organisation that is quietly getting on with doing something about it.

At their latest meeting in London Prof. Karol Sikora of CancerPartnersUK was in fine form, giving an informative, up-to-date and sometimes provocative talk to their packed meeting.

Welcomed by Dr. Margaret Spittle, Chairman of their UK Forum, many of those in the audience remembered that nearly two years ago, Europa Donna were one of the first organisations to come out in the open with a debate on the latest findings on Breast Cancer Screening.

They gathered together Prof. Laszlo Tabar, a Hungarian based in Sweden, and carrying out rersearch supported by the American Cancer Society, Prof. Michael Baum, the person who was instrumental in setting up the UK’s Breast Screening programme, then – after reviewing new evidence, now questions this.  The meeting was chaired by another professor, Valerie Beral – who almost needed armour for protection.

Because when Tabar and Baum got going, no punches were pulled.  This made for a fascinating debate – but it has taken almost two years for the UK authorities to come up to speed and start asking questions.  see http://after-cancer.com/cancer-news-latest/breast-screening-is-it-for-you-or-me/

So when Europa Donna’s UK chapter invited me to another debate, I did wonder if I should pack some pink boxing gloves!

But all was well controlled, although cancer guru Sikora produced a lot of audience reaction.

Patient Involvement

With 46 countries in membership, from Finland to Kyrgystan, Europa Donna runs a course for Patient Advocates every year in Milan.  There they gather together patients from all their member countries, to train them how to advocate on behalf of other patients.  The Advocates then go back to their own countries and speak on behalf of fellow patients;  taking part in training, discussing patient’s care and needs with officials, etc.  And guess which country takes little notice of trained advocates?  Britain.

But this may be about to change. Sikora is known to be keen to involve patients, and during the discussions there was comment that if patients were involved, they would be able to point out where money was being wasted.

Another speaker was Baroness Morgan, Chief Executive of Breast Cancer Campaign, talked about ‘Patient and Public Involvement’, a favourite expression of the Dept. Health;  she asked why were these two roles always lumped together by the NHS?

Patients should be taken seriously, and doctors should realise there was no substitute to taking time to talk to patients.   During meetings, if the patient isn’t at the table, how will providers know what is required?

So there was still room for improvement, although she wasn’t sure the much-vaunted offer of choice “is going to benefit all patients”.  Or will it benefit ” patients who shout the loudest?”  Amongst the audience was Professor Lesley Fallowfield, Director of  Cancer Research UK Sussex Psychosocial Oncology Group.  Her work focuses on improving the quality of life for people with cancer, but echoing Baroness Morgan’s question of benefits of choice, she pointed out that one in five patients’ reading level is that of an eleven year old.  She suggested  “we should improve health literacy at school”, and this is where Europa Donna’s Patient Advocates could be usefully employed.

Perhaps, just perhaps, the powers-that-be will think about actually doing something to bring our standards of cancer care up level with European standards – and this meeting left the audience with plenty of points to ponder.

There was no doubt that at the Advocates training course I was invited to attend, there were discussions on what is cost-effective;  as one delegate told me, when asked to imagine what gold-standard mammography services would be, “we only have one machine in my country”.

But involve patients, and not only might services improve in the UK, but the NHS could find sensible ways of saving money.

www.europadonna.org

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Breast Screening – is it for you or me?

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Woman undergoing a mammogram of the right breast

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At last –

Screening is to be reviewed

Ever since I attended a fascinating meeting put on by Europa Donna, where an expert from Scandinavia debated with the Professor who introduced the breast screening programme into Britain -
and nearly came to blows -
the subject has been of enormous interest.
.
First – I must declare an interest.
  • I have decided for the time being to have an annual mammogram
  • I am then seen by my very eminent breast surgeon, and he carefully examines the screen to see my ‘photos’.              This gives me confidence that my mammogram results are being checked by an expert.
But – when Professor Michael Baum, the very eminent surgeon who introduced the breast screening programme to Britain, then opted out and questioned its efficacy – one listens.

According to a recent BBC story,the evidence for breast cancer screening in the UK is being reviewed, amid controversy about the measure’s effectiveness.

The NHS says screening saves lives, but other researchers have argued that it may cause more harm than good.

The national cancer director for England, Prof Mike Richards, announced in the British Medical Journal that he will lead a review.

He said he was taking the “current controversy very seriously”.

When it comes to cancer treatment, earlier is better. Screening programmes for a range of cancers help doctors make a diagnosis sooner. But they also run the risk of false positives, diagnosing someone with cancer when they are healthy.

Life saving

Screening was introduced for breast cancer in 1988 in the UK, and now offers tests to women, over the age of 50, every three years.

In 2002, the World Health Organisation’s International Agency for Research on Cancer estimated that screening reduced deaths from breast cancer by about 35%.

The NHS says 1,400 lives are saved through screening in England alone.

Sara Hiom, from Cancer Research UK says, “the decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained”

And currently it is extremely difficult, if not impossible, to get that explanation.

Review

A review of clinical trials involving a total of 600,000 women concluded it was “not clear whether screening does more good than harm”.

It said that for every 2,000 women screened in a 10-year period:

  • one life would be saved
  • 10 healthy women would have unnecessary treatment
  • at least 200 women would face psychological distress for many months because of false positive results.

The authors of that research labelled the NHS Breast Screening Programme’s advice “seriously misleading”.

Should I?  Or shouldn’t I?

Susan Bewley, Professor of complex obstetrics at King’s College London, has turned down screening.

In a letter to Prof Richards last month, she said: “The distress of overdiagnosis and decision making when finding lesions that might, or might not, be cancer that might, or might not, require mutilating surgery is increasingly being exposed.”

In response, Prof Richards said research suggested that up to two and a half lives were saved for every over-diagnosed case.

He added that he would lead a review of the evidence to settle the ongoing controversy.

“Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.

The review will be led jointly by Prof Richards and Cancer Research UK.

The director of health information at the charity, Sara Hiom, said: “Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening.

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

Breakthrough Breast Cancer’s chief executive Chris Askew said: “Breast screening is vital as it can detect breast cancer at the earliest possible stages when no other symptoms are obvious.

“The earlier breast cancer is picked up the better for the one in eight women who are diagnosed every year with this disease, as treatment options are more likely to be less aggressive and have successful outcomes.

MammogramThe value of breast cancer screening has been a source of controversy

So for the moment, I am definitely watching what goes on.  Personally as co-chair of the local LINk cancer group I will be following the official line – BUT to any woman who asks, I will be advising them to weigh up all the evidence, and ensure that the centre where they are screened is entirely transparent and answers questions FULLY.
It is no use the NHS trying to act like a Nanny state – that’s what happened in Communist countries.  We need the eminent medics to stop squabbling and get round the table to discuss fully the pros and cons.
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When will our politicians get off their behinds and improve cancer care in Britain?

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UIC research

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The World Cancer Research Fund confirms poor cancer health

 

But as usual, the boffins blame the poor results  on us – the patient.

 

Am still trying to get my head around this – but their press release shows latest official figures suggest almost a fifth more women in this country develop cancer before the age of 75, compared with those on the continent.

The World Cancer Research Fund, which unearthed the data, fears that the difference could be down to the fact that British women drink and eat too much!!!!!!!  That’s right, we are to blame.

Red Herrings galore

This seems to be yet another red herring, and attempts to put the blame on us.  No-one ever mentions poor care – but then they want to keep politicians happy.  I go on their website and the home page shows three out of the six pictures we can click, take readers through to donations page.

Instead of constantly blaming us, why not stop pontificating and mouthing hot air, and get down to some solid work to improve our treatment options?  My European friends are just as fat, and certainly are used to drinking more.  But their doctors keep an eye on their health, and will give sensible advice.

What’s more, in those countries with better health outcomes I bet you their doctors give more time for appointments.

Doctors say it is often the “Oh – by the way…..” comment from a patient as they are leaving, that actually shows up what the patient has come to see them about.  With the NHS ten minute appointment system – there is no time to take this further.

Last year we were told that our poor survival rate was down to not taking up screening.  Then the WHO (World Health Organisation) came up with research that said Britain had one of the best rates in Europe for screening take up.  So they have to think up another excuse – and come up with obesity and drink.

 Why don’t we undertake our own research?

Having been treated in Europe and Britain, I can say that in Europe I got good, old-fashioned care from doctors who LISTEN to their patients;  giving adequate TIME for a consultation – not TEN MINUTES.

Back to the WCRF research, and Dr. Rachel Thompson, Deputy Head of Science, says,  “On average, women in the UK are more likely to be overweight and to drink more alcohol than the European average, and this is a concern because both these factors increase cancer risk.

“They are not the only reasons for the differing cancer rates, but there is now very strong evidence that women who drink a lot of alcohol are at increased risk of developing the disease and that excess body fat is also an important risk factor.

“This is why one of the big public health challenges we face today is to reduce the amount of alcohol we drink as a nation and to get a grip on the obesity crisis before it spirals out of control.

“Together with other factors such as being physically active and eating a healthy plant-based diet without too much salt or red and processed meat, these changes could make a real difference to the number of women who develop cancer before the age of 75.

Hang on!

In Britain, the Office for National Statistics reported last month that 130,043 women were newly diagnosed with the disease in England alone in 2009, a rise of 2.6 per cent on the previous year. But if we have such a good record in up-take of breast screening, then it follows that there will be a rise.

And although this is apparently almost 20 per cent more than the average of 21 per cent recorded across Europe, don’t forget Europe includes many countries where mammograms are difficult to obtain.

Two years ago Europa Donna, the European-wide breast cancer charity, selected me to go on one of their excellent advocacy training courses.  During the intensive training, participants from over 40 ‘European’ countries were asked to role playand ‘imagine what their country’s breast screening would be like if it were  ‘Gold Standard’.

Some of the delegates were bemused by this;  one of them telling me it was almost impossible to obtain a mammogram in their country.  ergo – if it is incredibly difficult to obtain this – no wonder breast cancer doesn’t show up in their health statistics.

Skewed evidence

One comment in the WCRF report even says ” a pint of beer raises cancer risk by a fifth”.

Sorree – what?  Where do they get this from?

Then I remember Winston Churchill was quoted as  saying

Statistics are like a drunk using a lamp post – used more for support than illumination.

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Learn the latest about Mammograms

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Naval Medical Clinic Pearl Harbor, Hawaii (Oct...

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What’s behind all the discussions?

 

The debate still goes on, and many women are still not sure if they should have a mammogram – or how often.

When the U.S. Preventive Services Task Force (USPSTF) announced new recommendations for mammography screening in 2009, the ensuing media frenzy generated a lot of heated conversation.

In the midst of that debate, BCAction (Breast Cancer Action) was one of the few breast cancer organizations to acknowledge mammography’s limitations and call for safer, more effective screening methods.

With related studies and legislation currently in the news, they think that it’s a good time to offer a webinar with their comprehensive analysis of screening mammography.

If you haven’t been involved in a webinar before, you sit at your computer, with your telephone by the side.  What’s onscreen prompts you to take the appropriate actions, and within a few minutes you find it is very easy to listen to arguments, and actually have your say.

This webinar will delineate the risks and benefits of breast cancer screening, review the science behind the USPSTF’s recommendations, and provide attendees with tools for understanding media coverage of mammography. Join for an illuminating look at a complex and often confusing issue.

Sorting Out the Confusion: An In-Depth Look at Breast Cancer Screening

Featuring: Tracy Weitz, BCAction Board Chair and Director, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco

BCAction is running the webinar twice:

Tuesday, July 26, 2011

5:00 – 6:00 PM (Pacific Daylight Time)   UK time approx 0100

Click here to register for the 7/26 webinar!https://www3.gotomeeting.com/register/835265614

and

Thursday, July 28, 2011

10:00AM – 11:00AM (Pacific Daylight Time)  UK time approx  1800

Click here to register for 7/28 webinar!  https://www3.gotomeeting.com/register/861809982

After registering, you will receive a confirmation email containing information about joining the webinar.

System Requirements

PC-based attendees
Required: Windows® 7, Vista, XP or 2003 Server

Macintosh®-based attendees
Required: Mac OS® X 10.4.11 (Tiger®) or newer

 

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Kylie, Martina and other celebs say screening is important

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Martina Navratilova, Kylie Minoque and other celebrities send alert on importance of screening

They probably didn’t mean this to happen, but when a celebrity gets cancer it is news.

And when it is someone like Kylie Minogue, who was considered too young to have breast cancer, the story is covered worldwide.  She went on publicly to say that at first she was mis-diagnosed, and was told she was too young – even with so many well-documented cases.

She persisted in her fight to get the diagnosis – but her fight helped thousands of other young women who have breast cancer, but found difficulty in convincing doctors to take them seriously.

Martina Navratilova is the latest celebrity to discover she has breast cancer, and the news is surprising.  One would have thought with her healthy life-style, exercise and food regime, she would be the last person to get the disease.  Talking to Colin Murray on BBC Radio 5, she says she is exhausted, but is learning “to take care of yourself – both inside and outside”.

Because she knows she is such an iconic figure, she has decided to ‘come clean’ and tell everyone about her diagnosis and treatment. She is hoping this will encourage others to go and be screened.  She warns “not to let these mammograms slide, like I did”, admitting that although she thought it had been two years since her last one, actually it had been four:   “I just figured I could wait”.

As “very much a person who takes charge” and gets on with things, one definite decision she has made is to wait longer than normal to have radiotherapy.  She didn’t say, but obviously her medical team has told her that France is the best country in the world for cancer treatment;  so she is waiting until May, when she will be working  in France at the French Tennis Championships, to have six weeks of radiotherapy.

Martina says she is worried about getting burns” from radiotherapy, but she is lucky.  French hospitals have a battery of clinically-trialled products which they prescribe for patients, and talking to Oncologists at the last Evraux conference (one of the companies that make these products) I was told that the latest thinking is to start patients on a cream such as Evolife before their treatment.  So that the skin is ‘primed’ before radiotherapy starts.  Makes sense.  Then slap on the cream; I did this four times a day and didn’t burn once.

Blood test for Breast Cancer – is this the answer?

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Blood test kit
Image by ? Lee J Haywood via Flickr

Over Easter the papers were running a story on blood tests for Breast Cancer.

They reported that a Harley Street clinic are offering a simple blood test to detect early breast cancers.

After the long-drawn out libel case recently fought so successfully by Simon Singh (author of Trick or Treatment), one hesitates to venture an opinion – but here goes!

This test has been around since 2007, and one wonders why has it taken so long to be publicised?

Is it because NICE are doing their usual ‘heel dragging’ exercise, and taking that long to evaluate the test? One sympathises with Ian Gibson, the MP who did so much for cancer research, when at a cancer conference he questioned “what good is NICE?”

Or is it because currently the test is credited as being 75% effective, so putting it another way, one in four cancers WON’T  be detected.

But for those of you who are worried, the test, allied to a mammogram, could do a lot to alleviate concerns. It is carried out in a private Harley Street clinic, and you can arrange this through your NHS  GP.  If you ask for private treatment, they have to refer you, but you will have to pay the cost of £499, and any extras.

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Will NHS miss breast screening target times yet again?

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Woman undergoing a mammogram of the right breast
Image via Wikipedia

Breakthrough Comment On Breast Screening Annual Review

18 Dec 09

Never backward in giving itself a pat on the back, the NHS has issued a press release titled:  New NHS Breast Screening statistics reveal nearly 2 million women were screened in 2007-08.

Wonderful – but has anyone noticed that their self-set target of improvement to screening times looks like being missed – again?

Dr. Alexis Willett, Head of Policy at Breakthrough Breast Cancer, says:

“We are pleased the NHS Breast Screening Programme is now screening more women than ever before as this vital free service saves lives. However, for all eligible women to receive the best possible screening service, the Government needs to ensure it meets its December 2010 deadline for the roll-out of digital mammography across the UK. While some progress is being made, recent updates show there is still a long way to go to achieve this.

In the States, there is a huge outcry because women are being advised to wait until age 50 for screening – currently they start at age 40 – yet in UK we don’t start until 50.

Then, we are supposed to be seen within “two working weeks” – some NHS Trusts interpret that to be 14 working days i.e.  14 weekdays, spread over almost three weeks.

In Switzerland they consider they need to improve, so have just announced waiting times are to come down from FIVE working days to THREE!

Make sure you DO get what you are entitled to – and jump up and down if you don’t get regular appointments.  And join up with Breakthrough’s campaign to improve target times.  As Breakthrough say, “we recommend that all women attend breast screening when invited because the earlier cancer is detected the better the chances of successful treatment.”

For further information please contact:  Richard Purnell
T: 020 7025 0290
E: richardp@breakthrough.org.uk

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