AIBU to consider not attending mammogram appointment

[SuperMoonIsKeepingMeUpToo]

Obviously if I decide not to attend I'll let them know but I'm interested in hearing opinions on this. I take my health seriously and normally attend everything going but this one I'm just not sure about as the accompanying leaflet informs me that:

'Screening saves about one life from breast cancer for every 200 women who are screened. This adds up to about 1300 lives saved from breast cancer'.

Great. But...

'About 3 in every 200 women screened every 3 years from the age of 50 to 70 are diagnosed with a cancer that would never have been found without screening and would never have become life-threatening. This adds up to about 4000 women each year in the UK who are offered treatment they did not need.

'Overall, for every 1 woman who has her life saved from breast cancer, about 3 women are diagnosed with a cancer that would never have become life-threatening. '

It is this risk of them finding and treating a cancer that would never become a problem I struggle with.

I'm 48 - our local authority is trialling extending the age range of women called for breast screening. No breast cancer in my family.

limitedperiod so you're going to judge me? Judge away! I'm entitled to have an opinion and to express it. The OP has asked for opinions - I've given mine.

"Sometimes I envy my cat.." Inserts [bonkers] emoji....

ignore the PPs on here who tell you otherwise. They clearly don't know much about screening

How arrogant.

Some DCIS cancers don't become invasive. But some most certainly do, as I know from experience.

Yanbu. I think the GP's advice above is good. Similar concerns apply to the smear testing programme. I decided to have the testing but declined treatment for a mild abnormality as decided to see how things progressed. Over treatment following screening is a real issue.

YANBU - as a patient it is your right (& some would say responsibility) to explore what tests and screening are right for you.

FWIW I would be the same.

YANBU. I work in health research and have been to some very interesting debates on breast screening. One of the professors who was involved in the initiation of the screening is now against it for the very reasons you give OP. But other professors are very much for it. I think you have to look at your own family history and decide on your risks and whether you want to be screened. Its good that you have read the information leaflet and want to make an informed choice.

My mum had it in her 40s and again in her early 50s - and due to size and the fact that I have a large amount of glandular tissue self-exams aren't easy for me. I'd be jumping on any free screening I was offered.

YANBU, not at all, it's your life.

And life is what's it's about isn't it. If you know the risks of spending months/years of your life with cancer treatment for a cancer that would not have otherwise impacted your life outweigh the chances of your health and perhaps even life being saved by finding and treating one that would, that is up to you. I would do everything you can to establish your potential risk or developing such factors as this would be key in your decision.

This is such an emotive topic, of course everyone wants everyone who could have been saved to have been saved. But I strongly believe individuals have the right to make decisions about how they want to spend the precious time we all have on this earth.

But if you go there will be more opportunities to make these decisions further down the line.

Personally I'd go.

I think it is very reasonable to consider this issue - many people go to their screening appointment without even a second thought. It is a big problem - knowing which cancers to treat and which not to, whether to subject people to unnecessary treatment etc. However, the result won't just be cancer or not. It will have information about size, location etc. Then you could have a biopsy to tell you if it is invasive or not (DCIS). If it is invasive, then you would (I assume) want to have treatment to have it removed. If it is DCIS, then THAT is the point to have the discussion about treatment. As someone else says, it may still have an invasive area in so treatment is necessary, or the treatment may be over treatment and you would never have known about it otherwise.
The other thing to consider is the level of treatment needed. If something is picked up at screening, they can be much smaller and earlier than if you find a lump for example. So treatment may well be less (lumpectomy, rather than mastectomy, or surgery without chemo rather than with).
Of course no one can deny the emotional stress of being diagnosed with a cancer than you need not have known about (and this is one of the reasons that we don't screen for prostate cancer for example) but screening is a complex thing and you are right to read about it carefully.

I would still strongly advise you attend the screening.

Many cases of DCIS will never become malignant. Many cases of DCIS present without a palpable lump. However, I was diagnosed with 70 mm DCIS with a palpable lump aged 43. The biopsy also showed that I had clear nodes. When they offered the mastectomy I did pain over this, having read the research that DCIS is often over treated. I was assured that DCIS could not spread and that the mastectomy was just to prevent any further changes. Because my DCIS was high grade, I'm relatively young and have children I went for the surgery.

The histology from the mastectomy told a very different story. Hidden among the large area of DCIS was grade 3 multifocal invasive cancer, with positive nodes as well, so a similar story to Maudd. Maybe if I had been screened earlier the DCIS would have been picked up before it turned invasive. DCIS can and does change to become invasive, just not always. I'm not sure if being a younger woman increases this risk. Maybe if only a few mm of low grade DCIS was detected the risks would be different.

My DM's cancer was also discovered this way - she had no suspicions at all. It was an aggressive form, and they caught it just in time. She had the full works in treatment, including some lymph nodes removed. She was only 53 when diagnosed - she has made a full recovery.

It's up to you of course, but DM very nearly didn't go to that screening, because it was mildly inconvenient on the day. She's bloody glad she did now - it saved her life.

Zombie's most recent breast cancer was picked up by a routine mammogram. She had annual mammograms as she had already needed one mastectomy followed by chemotherapy, radiotherapy, hormone therapy and 18 cycles of Herceptin. Her previous mammogram (done while she was still receiving the Herceptin) was absolutely clear. In the month preceding her last mammogram she had physical exams done by her surgeon and her oncologist during routine appointments. There was nothing that could be detected on physical exam. The mammogram showed a suspicious area. Further scans and biopsies revealed that the cancer had already spread to her lymph nodes. She had a mastectomy and full node clearance. Post op CT and MRI scans showed the cancer had also spread to her liver.

Until a suspicous area is investigated and a biopsy done it's impossible to know if a particular cancer is likely to be well behaved (slow growing and staying within the breast where it originated) or badly behaved (aggressive and spreading to distant parts of the body).

Zombie cannot be cured. Her cancer can only be controlled. Cancer confined to the breast does not kill. Cancer which has spread will kill eventually. Zombie has already outlived her use by date solely because of the treatments now available.

In the absence of symptoms detectable on a physical exam a mammogram is the best way to learn whether or not there is a potential problem.

Well.... I've just finished a year's worthof treatment; threw the whole lot at it. Chemo, surgery, rads and now tamoxifen. I was 41 at diagnosis, and it was clear on the mammogram. However they don't diagnose on mammogram alone, that leads to biopsy, ultrasound and then a chain of events is triggered such as CT and bone scans to findout the precise nature of a cancer, which will then define the treatment. It can be hormone positive or negative, they can track the growth rate, there is so much information to gather when deciding on a treatment plan, and you have a say throughout. DCIS can progress to IDC, i had both. The mammogram is just a tiny part of it yet crucial - personally after what i've just been through i think it's just bonkers to not go?

I don't think it's ever U to consider whether or not it is in one's interest to attend a routine screening appt., and I find it sad and concerning that women are pressurising and insulting other women for doing just that.

It's your body.

I was invited at 47 & chose not to go, probably not for another 9 yrs, for types of reasons OP mentions & other reasons. I work in public health & you'd be surprised how deviant me & some colleagues are about some of these health choices!! Because we believe more than anyone in principle of individual choice.

I can take full responsibility for whatever happens. But it will be very annoying when GP pesters about it in future. Maybe I will unregister (muse).

I have recently had an appointment letter for my 1st mammogram and also had that leaflet. I decided to go to the appointment even though there is no history of breast cancer in my family. One of the things I was told at the appointment is that because everyones breast are different it is often difficult to tell accurately from the 1st pictures what is normal and what isn't, so you have a higher chance of being recalled. However, if you then attend subsequent screenings, they can pick up any changes easily as they know what is normal for you.

Thankfully my letter came through a few days ago saying all was clear.

It is a very personal decision OP. No right or wrong answer.

There was a documentary on recently, where a leading (female) authority on breast cancer talked about this, the relative help vs harm of screening. She had decided not to have screening, for just the reason you have mentioned. But she self checks . Her take was that of course if you find a lump, then go and get it checked, but that statistically mammograms harm more women than they help. Of course if you are the person that is helped, then that is wonderful, so it makes the choice very difficult. I haven't had a mammogram yet, and so I'm weighing it up (I'm 52). I may have a baseline one, I am not sure. I lost a friend to breast cancer recently, she was too young for screening and had a type that doesn't always show on mammograms anyway. I also have a close friend who is one of the ones who falls into the "har" stats. Having had multiple biopsies taken for something harmless. Most women are very pro mammograms, but i think it is sensible to weigh up the stats and give it some thought before going (I can see I'm pretty much alone in that though, on this thread). Radiation itself is a cancer risk. So having mammograms annually as they do in the US, seems dangerous to me. Hopefully as technology progresses we will be able to have scans that don't involve radiation, and that give clearer results. Until then we all have to mull over our choices. I think the stats are 9 women harmed for every women helped? So you are far more likely to be harmed, but the help could save your life. Tricky.

A relative is currently having a tumour removed that was / would have only been found with the screening she was offered having turned 50. I'm so glad she went.

I don't think it's ever U to consider whether or not it is in one's interest to attend a routine screening appt., and I find it sad and concerning that women are pressurising and insulting other women for doing just that

This. The OP is not being irresponsible - she is asking a valid question. We should encourage women to make informed decisions that are right for each individual. The irony is that some of the mother and aunts with breast cancer mentioned on this thread as 'proof' that the OP is wrong probably had unnecessary treatment for DCIS that would never have become malignant.

As I said above, I think on balance the OP should attend screening but I absolutely defend her good sense in considering whether any medical intervention with potential harm is right for her.

I'm 48, I went for my screening in Jan, as part of the new scheme.

Tbh, I wouldn't have gone, but my friend has just had her life saved by this scheme, she's had to have both breasts off and is undergoing the rest of the treatment, but she has a excellent chance of survival, which she would't have had, two years from now. No family history, BF, gave birth at the 'right' age (to protect from some Cancers).

I got called back, it was only a build up of tissue, which is usual post Menopause. One woman, my age, BF five children, no family history had a tumour, it's awful, but you're just so grateful that it isn't you.

My Mums life was saved in 1987, by the new Smear policy, she had to have a full hysterectomy, within a couple of years she would have died.

This screening saves lives and health, the Cancer treatments can be very disabling, make your personal decision, but you've no right to suggest that these extended screenings are unnecessary.

I'm 43 and decided not to go on the grounds that there are a lot of false positives and, in my age group, detection rates are higher with mammograms but cancer survival rates are not. I am also breastfeeding which makes it more difficult to interpret the images.

As a breast cancer survivor, whose cancer was in the back of my breast, close to my lung and undectable to touch. I would recommend that everyone has a mammogram, as this was the only way it could be found . My cancer had already spread to my lymph nodes. The only symptoms I had was feeling more tired than usual. I know mammograms are uncomfortable but I wouldn't be here if I hadn't attended that appointment. A mammogram is nothing compared to having a mastectomy, chemotherapy and radiotherapy etc etc . If having a routine mammogram means you avoid all that, as it is a chance to catch it early, then I would say to anyone to make sure that they attend.

My friend's mum volunteered to take part in a cancer screening trial at her local hospital, where she worked. She had no reason to believe she had cancer; IIRC they were training staff in how to do checks.

That check found that she had cancer (not quite sure where as I didn't like to ask, but I know it was in her reproductive system somewhere). Tragically she died of it about 6 years later, but that early discovery gave her a few extra years with her family of pretty good health.

Obviously this is very unusual and sad, and of course it won't be the same for you. But it highlights the value of this type of check and how lucky we are to have it.

YANBU at all. This is a difficult and controversial area and it may well be that in a few years' time we look back at early screening as a huge mistake. As you've seen on this thread, many people's kneejerk reaction is that more testing must be better, but the harm from over diagnosis is just as real as that from under diagnosis (and it isn't "just" stress: there will be people who died from treatment they didn't need, too). You're doing exactly the right thing in looking into it and thinking carefully about it.

What you know about yourself matters too. Are you someone who, if you have screening resulting in a cancer "scare" that turns out not to be cancer, will then be able to go back to normal quickly, or will it hang over you and make you anxious for years? That's the kind of individual variation the trials can't account for, but it may be important in deciding what the right thing is for you.