Dr C’s check-up:

A new study led to headlines claiming early mammograms could save lives, but Dr C says it’s not as simple as it sounds – there are risks involved and there are better ways to stay safe

“Mammograms aren’t best for young women”

Arecent study led to lots of headlines claiming that giving women mammograms in their forties, rather than waiting until they reach 50, would save lots of lives, but there are some problems with early screenings – and the research. These types of studies come out fairly often, suggesting that, if we were screening younger women, we would be picking up many more cancers – but you need to weigh that against how many more invasive procedures we would be doing in women with no problems at all, as mammograms are much less accurate in younger women and can give all sorts of false results.

BE REALISTIC ABOUT RISKS BY AGE

You may have seen Sarah Harding recently talk about her battle with cancer, but young women having breast cancer is still very unusual – 80 per cent of women diagnosed are aged 50+ and half are 75 and over. The risk of young women dying is even rarer. That’s why, currently, women are offered mammograms every three years aged between 50 and 70. In this trial, 160,000 women aged 40 or 41 either had once-yearly mammograms or the normal screenings. After almost 23 years, there were 83 breast cancer deaths among those who had the extra screenings, and

219 for those in the no-screening group. What we don’t have is figures for the women who had surgery or treatment when there was nothing wrong. That’s the problem with mammograms for younger women – they have denser breast tissue, which isn’t as easy to scan.

That dense tissue – and some abnormal breast changes, like calcifications and tumours – both appear as white areas in the mammogram, so a healthy woman could be mistakenly told she has a tumour, then have to go through surgery. They aren’t the best screening tool for young women, which is why we use an ultrasound instead.

KNOW THE FACTS

Of course, if it were up to women to make that decision, many may feel happy to have an invasive procedure done only to find out there’s nothing wrong, because at least they would know, but many experts also feel it won’t save many more lives than our current screening programme. In this study, there were 16 deaths per 10,000 in the screening group and 21 for those who didn’t get called up for early mammograms. Cancer Research UK, who are the experts, said that, even with this new study, it still isn’t clear that reducing the breast-screening age would give any additional benefit compared to what we do now. It’s also worth pointing out that this study recruited women from as long ago as the late ’90s, when both mammograms and treatments weren’t as effective as today. The technology has changed, so over the last decade, breast cancer deaths have dropped by around a fifth – since thirty years ago, that decrease would be even more significant.

DON’T MISS SCREENINGS

Cancer Research UK also said that, right now, more effort should be devoted to restoring access to the screening programme we already have and to other cancer-related NHS services that have been disrupted by the pandemic. I wholeheartedly agree, and would urge any woman who has missed a screening to get in touch with their doctor to reschedule. If you have symptoms or have missed an appointment, don’t think COVID-19 is more important – you must go. Worryingly, a quarter of women don’t go for their mammograms, but diagnosed at the earliest stage, 98 per cent of people survive breast cancer for five years or more, compared to 26 per cent if it’s picked up at the latest stage, so please go if you are called up.

CHECK FAMILY HISTORY

We don’t have a one-size-fits-all approach to breast cancer now, so all women are only screened from the age of 50, but if you

have a strong family history, where lots of women in your family under the age of 50 have had either breast or ovarian cancer, you will be monitored more carefully. Even then, you may not need a mammogram, as an ultrasound may be better. We treat each case individually, weighing up people’s risks and family histories. It isn’t that women in their forties are sent away and told to come back at 50. We will do everything that needs to be done.

ASK ABOUT LUMPS

Many women understandably feel nervous to see a doctor or attend a screening, but nine out of ten lumps will be benign.

That should hopefully reassure you that, if you have a lump, it doesn’t automatically mean you have cancer. It’s more likely you don’t, but we won’t know unless you get it checked out. Fifty-five thousand women are diagnosed with breast cancer every year in the UK, and eight in ten of them are aged 50 and over, so the older you are, the more at risk you are.

BE BREAST AWARE

The best way to protect yourself, at any age, is to be breast aware. So, know what’s normal for you, and speak up if something changes. That could be how your breasts look or feel, and that’s for the whole breast area, including right up in your armpit. You don’t need to be a breast expert, just check your breasts monthly – put a reminder on your phone – and if you notice something that wasn’t there last time you checked, go and ask your GP.

PREVENT IT HAPPENING

You can also cut your risk of breast cancer by staying at a healthy weight, particularly in your forties and fifties, eating a healthy and colourful diet, exercising regularly, stopping smoking, and making sure you don’t drink excessively. Aside from that, awareness is the best tool, so know what’s normal for you and flag it up with your GP if anything changes.