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Turned 50. Mammo appt just came out of the blue.... Would you have it?..

(36 Posts)
Erebus Sun 07-Apr-13 20:57:25

I am interested in knowing whether you'd jump at the chance to go and be 'reassured' or whether you'd wonder whether your lack of risk factors outweighed the risks of the radiation involved, esp as it'll be every 3 (?) years forever.

Did you do some research? Did you uncover that stuff that showed that overall, breast screening doesn't reduce the overall outcome of breast cancer detection across the nation; that a large number of 'detected tumours' transpire to be nothing?

Genuinely interested.

Chucksteak Mon 08-Apr-13 23:43:20

Research by Prof Michael Baum (BMJ, 2013, 346:1385) states that
3.4 per 100,000 screened women avoid dying from breast cancer;
3-9 per 100,000 will die from lung cancer and heart issues after radiotherapy/chemo.

I have not attended any mammogram screenings. I resent being sent an invitation with an appointment without any information in the letter regarding pros or cons or informed consent. Am I just expected to turn up like a good little girl?

CabbageLeaves Tue 09-Apr-13 07:31:07

The National Screening Committee review all research and their job is to assess evidence for and against screening

Screening services own remarks re this issues

Their evidence is a lot older

This leaflet should be sent with every invite so I think 'without any information in the letter' needs addressing Chuck. The screening programme failed there. The leaflet gives an overview of information presented in a way for the general programme to appreciate. Those who wish to research it more will be able to google or look at links on that leaflet.

There's realms of research out there and you could argue that NSC and NHSBSP will trot out the research that best fits their argument but so equally will any other person. So what motivates individuals and NHSBSP arguments?

I'm interested in the motivation behind a huge financial burden of a screening programme. Normally the service would be assessed for cost effectivity. Why spend so much if it isn't saving lives/further treatment

I know from experience that some individuals are sceptical about all healthcare so that's one motivation.

My personal thoughts are as my previous posts. I spoke to a friend about this and said I was thinking of refusing. He didn't think it was that wild a decision of mine and he's a radiologist. There definitely is evidence for and against.

I will probably go however.

CabbageLeaves Tue 09-Apr-13 07:38:57

Frome the BMj regarding the controversy

When the Marmot report on breast cancer screening was published in November last year, many will have hoped for an end to this particular controversy. Prompted by calls in the BMJ for more honest information on the harms of screening (BMJ 2010;340:c3106, BMJ 2011;343:d6894), Marmot and his committee were charged with asking whether the screening programme should continue, and if so, what women should be told about the risks of overdiagnosis.

As nicely summarised by Nigel Hawkes at the time (BMJ 2012;345:e7330), the committee concluded that the programme should continue because it did prevent deaths—43 deaths from breast cancer prevented for every 10 000 women invited for screening. The downside was an estimated 19% rate of overdiagnosis: 129 of the 681 cancers detected in those 10 000 women would not have caused symptoms or death during the patient’s lifetime.

But despite this higher than previous estimate of overdiagnosis, the critics of breast screening have not been mollified. Michael Baum is one of them. In an article this week he takes the Marmot report to task (doi:10.1136/bmj.f385). Its estimate of harms was based on three old and shortish randomised trials, and the analysis takes no account of the improvements in treatment since these trials were done, which will reduce the benefits of screening. Nor does it make use of more recent observational data. With these data included, estimated rates of overdiagnosis as a result of screening increase to up to 50%.

This matters because it can change the decisions women make when invited for screening. Jolyn Hersch and colleagues explored attitudes to screening in a sample of 50 women in Australia (doi:10.1136/bmj.f158). The first point to note is that most of the women were surprised when they were told about overdiagnosis. As to whether they would attend screening, most said they would if overdiagnosis rates were 30% or lower, but a rate of 50% made most of them reconsider.

Attitudes might also harden if we were less coy about what we mean by overdiagnosis. In almost all cases of screen detected breast cancer, overdiagnosis means overtreatment. And according to Baum, this means that while deaths from breast cancer may be avoided, any benefit will be more than outweighed by deaths due to the cardiopulmonary and other adverse effects of treatment.

What of the future? In her editorial, Cliona Kirwan sees the benefits of breast cancer screening being eroded by more effective and less harmful treatments (doi:10.1136/bmj.f87). At what stage must we seriously consider whether this screening is a good use of £96m of the NHS budget? ( Since new and better trials are almost certainly out of the question, we must, says Kirwan, be meticulous in collecting and modelling population data to guide women and their medical advisers in this important decision.

It's complex is the summary!!!

It's also a personal choice and there should be no compulsion to attend but I completely appreciate why people feel pressured. The role of the screening service is to encourage uptake. There has been a change to try and make sure women make a considered personal choice.

MaryAnnSingleton Tue 09-Apr-13 07:52:15

I had my first one which revealed breast cancer (no lumps or anything suspicious beforehand) - so I would say yes,go !

tazzle Tue 09-Apr-13 07:56:13

Yes I would go I have done several times already. There are risks associated with every single test, vaccination and procedure we undertake and in the majority of cases for the majority of people the risk is small but the benefits should a cancer or potential cancer be spotted are huge.

Personally I had one scare that proved " negative " but I was so impressed that theyhad managed to see the tiny tangle of abnormal blood vessels on chest wall on the edge of the X ray. had needed ultrasound to tell it from cancer.

meditrina Tue 09-Apr-13 08:00:21

I had one done after I had found a lump and was seen fast-track at the local teaching hospital (where the staff were wonderful, calming and did everything to reduce discomfort).

It proved to be a benign cyst. It's a terrifying thing to go through, even when the all clear comes within days. Choosing to have a screening mammogram would presumably give you some of that fear, but it does also give the opportunity for treatment.

It really is all down to your attitude to risk. I'll never again think 'it couldn't happen to me', so would go for screening. Others may see the risks differently and reach a different decision.

Icedcakeandflower Tue 09-Apr-13 08:11:42

I was called up for a mammogram last year and it didn't occur to me to refuse. When I turned up early for the appointment, the waiting area was empty, and I was seen early. I only mention this because in my experience, hospital eating areas are always busy grin

The nurse (?) who took me into the screening room was pleasant but I was taken aback when she looked at my boobs and asks if they were mine shock. They're perfectly average in case anyone's wondering grin.

The actual screening really hurt, having your breasts squashed between two metal plates. I have a high pain threshold and childbirth was no worse than an episode of IBS.

After 24 hours I was still extremely sore and bruised.

In spite of all that, I was really pleased to receive the all-clear. And I am glad I went just for the reassurance.

Erebus Tue 09-Apr-13 09:24:49

Thanks for all the input, cabbageleaves in particular.

Dahlialover Tue 09-Apr-13 12:59:17

Iced cake - that was my experience, only the lady doing it wasn't all that nice sad I ended up with sore patches, like mastitis that came and went over 4 months.

From what I can work out, they are still not sure whether the statistics really add up as to whether it is worth going or not. I think on the whole it is just about worth doing it for the population. If nothing else, it does make sure people are checked regularly so do not leave it too late to see the doctor if they find a lump.

Screening can be very stressful, as you are looking for something that probably is not there, so introducing the idea of an illness which does not exist. I volunteered for a trial of the triple blood test for Downs/spina bifida many years ago and was so glad when the all clear came after two weeks. The next one was twins, so it was not applicable and I was much happier (although I was frequently scanned for other problems, but they were a real possibility).

I will consider my options next time I get called up. I wish they would find a better way of doing it.

Dahlialover Tue 09-Apr-13 13:01:34

PS Is it normal to have to remove your glasses?

The nurse outside said it was ok to leave necklaces on, so I don't see why I had to be done blind!

Icedcakeandflower Tue 09-Apr-13 13:48:44

I kept my glasses on, and can't see why it would matter unless you wear your glasses on your chest grin

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