Breast Screening Importance.

I`m glad you now understand the necessity of compression during mammography but I do still think you should attend the next breast cancer screening programme that you`re invited to.

On average, white Caucasian women living in the US have one of the highest breast cancer risks worldwide and based on the overall `calculated average risk` roughly one in nine of them at some point will develop it. Women eligible for screening are usually between the age of 50-70 due to the accumulation of random mutations of certain genes that can develop into cancer over time, increasing risk with age. Comparing a 50 year olds risk of 2% to your risk at 60 years old of 4.4%, you have more than doubled your chances within 10 years.

The likeliest explanation as to why living in the US could put you at higher risk is the exposure to environmental factors that poorer developing countries don`t have such as high-fat, processed diets and obesity. It has been suggested that even though oestrogen doesn`t cause cancer it encourages cells to multiply at faster rates and that body fat is a contributing source for producing oestrogen. So unfortunately weighing 90kg could be increasing the amount of oestrogen in your body.

One thing that lowers your oestrogen exposure is the fact that you have had children. It is likely that multiple pregnancies have reduced your risk somewhat due to you having fewer menstrual cycles. This decreases the overall time your breasts are exposed to oestrogens that are produced by your ovaries and hence your overall lifetime risk.

I`m aware that after attending two screenings in the past 10 years that on one occasion you received a `false positive` result. Interpreting results can be difficult due to the ambiguity of some of the scan images. A radiologist cannot always determine the cause of abnormalities on your mammogram and normally it`s as simple as a fluid filled cyst, making the likelihood that it is cancer still relatively small. Another reason may be the x-ray machine settings. The more specific the machines setting the more likely it will only respond to obvious signs like more advanced cancers. This is productive for those with advanced cancer or nothing wrong, but someone with smaller, very early cancer might be missed. The solution could be to raise the machines sensitivity. Again too higher sensitivity from the machine could cause the radiologist to assess all abnormalities detected whether they were cancer or not, detecting early cancers but also producing some inaccuracies or `false positives`. This isn`t preferable but it is near impossible to create a system with perfect specificity or sensitivity, as the more specific it gets usually the less sensitive it gets and vice versa.

Sometimes it`s hard deciding whether having a mammogram will be beneficial to you but statistically 75% of women invited (around 1.3 million) get screened and roughly 10 000 breast cancers are diagnosed yearly. It seems that regular screening between the ages of 50 and 70 does reduce mortality rates. 1 in 8 screened women are marginally more likely to have breast cancer diagnosed than unscreened women but as these cancers are smaller due to early detection they are less likely to be treated with mastectomy (breast removal) than when diagnosed without screening.

Mammograms however, can still be dangerous and exposure to X-rays may have serious consequences. Women screened may slightly raise their chance of random mutations or cell death due to DNA damage. If there is any damage to genes involved in cell division, then cells may divide uncontrollably causing radiation-induced breast cancer to develop. It`s worth remembering though, that only one fatal breast cancer will be caused by mammography radiation, for every 14 000 women screened regularly over 10 years.

Also, some women may suffer psychological distress after screening such as anxiety, especially anyone sent for further testing or receiving unnecessary treatment whether they have breast cancer or not. A call back carries an expectation with it that it may be breast cancer even though it is more likely to be nothing causing extreme anxiety until given the all clear.

I realise that breast screening may feel disheartening at times especially after receiving false positive results. Enduring the discomfort of the mammogram and anxiety felt whilst waiting for results can be emotionally and physically stressful but sometimes getting results, good, bad or inaccurate may be necessary and sobering in the realisation that if you had chose not to have a mammogram, any cancer you may have developed could have been fatal if undetected. The sooner breast cancer is treated the more chance you have of surviving and I personally think that breast screening programmes definitely save lives and hopefully you will decide that they are still beneficial to you!

Your loving niece Joanna.