Why are more women not going to breast cancer screenings?
A London GP insists that women should not be put off by the negative aspects of breast cancer screening.
Tuesday 27 February 2018 01:33, UK
As a new report reveals wide variationsin the quality of treatment for breast cancer across the country, Dr Ellie Cannon examines why more women are not making use of screening programmes.
The London-based GP says that although screening is not perfect, it is the first and best line of defence we currently have in the fight against breast cancer.
The decline in breast screening attendance is exceedingly worrying - whilst there may be pitfalls to breast screening, it is still the best tool we have to pick up breast cancer early. And the earlier a breast cancer is picked up, the easier it is to treat successfully.
The most important thing for women is to be given the full knowledge about breast screening and ensure they are making a potentially life-changing decision with all the information that we have.
Mammograms are not pleasant. Some women find them uncomfortable, as the breast is squashed between two metal plates, and of course some women may be embarrassed.
And the national breast screening programme itself is not perfect. For every life saved by breast screening, three women could end up having surgery that turns out to be unnecessary.
That is because as well as cancers, screening will also pick up false positives, lumps that appear to be cancer on screening but when surgically removed are not.
So there is a risk of 'overdiagnosis' and being treated, including possible surgery, when you don't actually need it.
But the UK breast screening programme with mammograms is the best screening we have at the moment and I would urge women to go ahead and have theirs.
It is important to understand there is a risk of overdiagnosis and that has to be weighed up with the benefits, but the benefits of the programme are certainly very substantial.
The numbers speak for themselves. In 2016/17 18,402 breast cancers were picked up by screening mammograms and over 40% of those could not have been found by examination alone.
That means these were all detected and treated earlier because of screening, with a much higher likelihood of success and cure.
There are many reasons women don't attend breast screening that would explain the new figures highlighted.
Some women are simply too busy to fit it into their schedule, and when they miss the appointment, it is not always totally straight forward to reorganise one.
Women who feel well and healthy may not feel motivated, or do not want to be looking for medical problems.
Many women are aware of the risks of overdiagnosis, and opt out, perhaps opting instead for simply being aware of themselves and how their breasts feel normally.
Some do not attend as they assume they are not at risk of breast cancer if it has not affected their family or friends, whilst others actively do not want to know and are afraid of discovering cancer.
Screening attendance can also be affected by past experiences and women may not return for a mammogram if it has been uncomfortable or painful in the past or if they heard it would be from a friend.
From my experience in a London GP practice, there is certainly an understanding now of the risks of screening in terms of overdiagnosis and perhaps this partially goes to explain the poorer rates in London.
There is also a greater cultural and ethnically diverse mix in London. We know that there is variation across ethnic groups in attendance for screening across all screening programmes, not just breast.
Amongst BAME women for example, mammogram uptake can be lower due to cultural health beliefs, embarrassment and barriers to accessing health opportunities such as language and poverty.
It is hard to explain definitively the postcode mix and greater uptake in areas like the East Midlands but this is likely due to a number of features.
For example, if local community breast screening education and uptake has been strong, it filters around families and local populations encouraging everyone in a snowball effect.
It becomes the "norm" and that is very powerful when it comes to people following suit and doing things for their health.
The services in certain postcodes may be particularly good with easily accessible appointments, text message reminder services and consistency of good staff as well as pleasant screening centres.
All of these seemingly trivial factors can impact on numbers attending.
It's worrying in 2018 to see poor numbers for a screening programme which we know saves lives, despite its downsides.
Women must be fully armed with all the support and information they need to make the right decision to protect themselves from breast cancer.