Our mammographer colleague Geraldine has a few things to say about the National Breast Screening Information leaflet. Is the leaflet for or against breast screening? Is it helping you decide, or, as Geraldine fears – putting you off by talking about ductal carcinoma in situ?
Am I being controversial?
This might be a slightly controversial blog but I’ve been spurred into writing it by a conversation I had with one of our new assistant practitioners. She told me that her sister had received an appointment for breast screening but had decided not to attend because she had read the accompanying leaflet and decided that she didn’t want to undergo unnecessary surgery for breast cancer.
While I know this is not the message the leaflet is intending to put across, I fear the reality is that many women read it and see the phrase that
“for every 1 woman who has her life saved by breast cancer about 3 are diagnosed with a cancer that would never have become life-threatening”.
I have highlighted the comment because that’s how it appears in the leaflet whereas elsewhere in the leaflet is a small unhighlighted comment which says that
“doctors can’t tell whether non-invasive breast cancers will grow into the surrounding breast or not”.
Ductal carcinoma in situ, or DCIS
The non-invasive breast cancer referred to is a condition called DCIS or ductal carcinoma in situ. It is true that at present no-one knows which of these types of cancer will go on to become an invasive form and therefore the safest option in considered to be to remove these carcinomas although many of them would probably remain within the duct and not become invasive. The problem is that if you don’t remove them, what do you do?
The LORIS trial
Trials are going on at the moment including the LORIS trial which for women with low grade DCIS involves having a mammogram each year for ten years as opposed to having surgery.
I know that in our trust it is proving quite difficult to recruit women to take part in the trial. Hearing that you have been diagnosed with cancer is so emotive that many women will just want to have it removed rather than live with the uncertainty over a number of years and this is perfectly understandable.
However women should be given enough information about their particular diagnosis so that they can make an informed decision about treatment whatever that might be.
Positive or Negative?
My problem with the leaflet is that it seems to concentrate too heavily on the negative aspects of diagnosis and I feel that this is deterring women from attending for breast screening. Most women who come for a mammogram will get the “all-clear” and I feel the leaflet concentrates very heavily on the negative aspects of a breast cancer diagnosis.
I am happy to be proved wrong – what do other people think?