The experts who want ALL women over 70 screened for breast cancer
NOREEN SpENdlOvE was reassured when the results of her latest mammogram were normal. Noreen, then 68, had the scan as part of the NHS breast cancer screening programme, and as she says: ‘As always, getting the all-clear was a big relief.’
But 18 months later, shortly before her 70th birthday, the mother- of-three from derbyshire developed intermittent pain in her left side, just below her breast.
And although Noreen, a former administrator, wasn’t concerned, her daughter, a radiographer, insisted she see a Gp.
despite finding nothing abnormal, the Gp referred Noreen for a mammogram. This revealed three lumps on her left breast, which were all tumours. Noreen is adamant: ‘That Gp appointment saved my life.’
Breast cancer screening was introduced in 1988, with women aged 50 to 64 invited for a mammogram every three years. In 2000, the upper limit was extended to 70.
‘I didn’t realise it at the time, but at 68 I’d already had my last official mammogram,’ says Noreen. ‘ It’s all the more scary knowing that, because even though I check my breasts regularly, I definitely hadn’t felt any lumps. Without my daughter, I wouldn’t have gone to my Gp.’
Noreen was one of the lucky ones. Mps are warning that women will die as a result of the screening age limit.
In a report published two weeks ago, the All party parliamentary Group on Breast Cancer pointed out that 8,000 women in their 70s are diagnosed and treated for breast cancer. And while more are diagnosed at a younger age — 12,800 in their 60s and 10,600 in their 50s — more than half of the 12,000 women who die from breast cancer every year are over 70.
So, extending the age for routine mammograms would mean earlier diagnosis for those over 70 and more lives saved, the Mps said.
In fact, the upper age limit is due to change. From the end of 2016, all women up to 73 will be invited for screening. But critics argue this is not high enough.
Nat lievesley, a researcher at the Centre for policy on Ageing, says this cut- off point ‘seems arbitrary’, adding: ‘It feels like a decision based on cost rather than what’s best for women.’
And the parliamentary group is concerned at the ‘slow pace of change’. In 2013, they called for the age limit to be raised to at least 76, and possibly to 79.
‘While some progress has been made, there is still a lot of work to do in ensuring that older people with breast cancer receive the care, treatment and support most appropriate to them,’ says Steve Brine, the Conservative Mp for Winchester and co- chair of the parliamentary group.
ANdthis ageism is not limited to access to mammograms. There’s evidence older women are less likely to get certain treatment for breast cancer than younger women.
In 2013, researchers at the University of Sussex said women over 70 in the UK who are diagnosed with the disease have only a onein-seven chance of receiving the chemotherapy that is standard treatment for younger patients.
A study from the london School of Hygiene and Tropical Medicine, published in the British Journal of Cancer, reported that women over 70 are 12 per cent less likely to survive breast cancer after three years than women of the same age in Sweden, where screening in most of the country continues to 74.
Sean duffy, national clinical director for cancer at NHS England, last year warned: ‘Around 2,000 deaths from breast cancer in older women could be avoided each year in England if survival rates matched the best in Europe.’
And lynda Thomas, chief executive of Macmillan Cancer Support adds that ending screening at 73 ‘doesn’t take account of the fact that ageing is changing,’ she adds. ‘It’s no longer a strong indicator of frailty. Just look at the role models for women in their 70s.’
Yet the benefits of extending screening are not clear- cut, for there is a risk of women undergoing unnecessary treatment. A dutch study, published in the BMJ in August 2014, suggested that inviting all women over the age of 70 for screening could result in ‘overdiagnosis and overtreatment’.
Researchers monitored 25,500 women aged 70 to 75 diagnosed with the disease after 1995, when breast cancer screening in the Netherlands was extended from 69 to 75. They found this had led to only a small increase in the discovery of advanced breast cancer, while the number of early-stage tumours detected increased considerably.
For every woman found to have advanced cancer, another 20 would be diagnosed with small, slow-growing tumours that might not affect their life expectancy but would lead to major surgery, chemotherapy and radiotherapy.
lead researcher dr Gerrit Jan-liefers, of leiden University Medical Centre, said: ‘The chances of older women recovering from such severe treatment is far less than for younger women.’ Older women are more likely to suffer from chronic health problems alongside cancer, he pointed out. ‘So it may take them a year, a year and a half before they function normally.’
For Noreen Spendlove, however, there is no question in her mind that screening should be extended.
After her second mammogram in March 2011, she had a needle biopsy the same day, and two weeks later a mastectomy. The cancer had spread to her neck, so she was given six sessions of chemotherapy followed by a fiveweek course of radiotherapy.
‘The treatment was murderous,’ says Noreen. But as she prepares to receive the all-clear next year, she has no regrets about having this treatment. Indeed, her worry is that that, once five years since her treatment have passed, she’ll no longer be automatically invited back for screening as younger cancer survivors would be.
In fact, women are entitled to request mammograms at any age — it’s just the invitations that stop. Cancer charities warn that this gives the message that women no longer need to worry about breast cancer.
An added complication is that older women are likely to be less ‘breast aware’ and more cautious about bothering their Gp, the Allparty parliamentary Group pointed out previously.
Jane Murphy, clinical nurse specialist at Breast Cancer Care, says: ‘It’s clear from calls to our helpline many older women believe that because they aren’t being invited, they are no longer at risk.’ Jackie Woods, 57, a local government officer from Forest Hill, South london, agrees this can be a problem. Her mother, Betty, celebrated her 88th birthday last month after undergoing treatment for breast cancer four years ago.
Betty had diligently booked hers self in for regular mammograms, despite no longer being invited for screening — but she was rare a among her peers in doing so.
DURINGNovember 2011, Jackie was diagnosed with breast cancer after her regular mammogram. The diagnosis reminded Betty to request another scan for herself, a and in June 2012 she was diagnosed with an early form of breast cancer and had a mastectomy.
Rather than simply ending s screening, the dutch researchers who suggested that extending the programme to all older women could do more harm than good, say the decision whether to continue scans should be personalised to each woman. This should be ‘based on remaining life expectancy, breast cancer risk, functional status and patients’ preferences’, says dr Jan-liefers.
Another way forward, says Jane Murphy, is for women to be reminded at their last screening that they are entitled to further ones. ‘They should be given a card that informs them that they can continue to take advantage of regular screening. But it doesn’t always happen.’
Noreen Spendlove was given no such card. ‘It’s terrifying to think that the cancer might not have been picked up,’ she says.
BreAsT Cancer Care helpline: 0808 800 6000 or breastcancercare.org.uk. Macmillan Cancer support: 0808 808 0000 or macmillan.org.uk.