Breast screening

breast screening 1I had my breasts squeezed, pinched and photographed today.

Women aged 50-70 are invited for screening every three years, and some women aged 47-49 are invited as part of a study of screening older and younger women. I am an atypical subject for such a study, but, well, why not?

That was what the letter said, though the leaflet says something different: from 2012 the screening programme will be extended to women 47-73, this was decided in 2007 and is now being rolled out. Whatever.

How do I feel about medics touching me? My GP, who has a lovely manner, offered to show me how to examine myself, and I fled: the thought of taking my top off and being touched upset me. I stiffened- if she had touched my clothed arm it would have bothered me.

In 2003 Tim, my friendly Endocrinologist, referred me to a gynaecologist whom I saw three times. He was really really lovely. Just nice. I told him how uncomfortable and difficult I found dilation, and wept. I wanted to talk without crying but could not: I could get the words out if I sobbed in between. Then crying opened me: I could feel my hurt and talk, and he was gentle and understanding.

I saw a surgeon when I was considering implants. I thought I could just be examined, but felt shy when it came to it. He offered a female chaperone, and though I had thought I would not need this, I was glad of it. Sitting with my top off- I can’t respond quite as rationally as I might otherwise.

I cycled a mile to the mobile trailer at the outpatients’ clinic. A woman entered me on the system: hello, how are you? How are you? Oh, not many ladies ask that, I’m fine, she said. I sit in a breast screening 2cubicle where I was invited to take off my bra- indeed I would not like a communal waiting space. There are old magazines.

I go into the end room where the Mammographer asks me to take off my top, and shows me the machine. I remember Josie telling how her breast was squeezed between two cold metal plates- but that was last century, this machine uses plastic. Without intending, I go into a half-trance, so that she can place me as she wishes. I go quite passive. I do not want to make eye contact. She takes some time arranging me just so- it is worse, she says, when people try to cooperate. It pinches. It is uncomfortable, though no worse than seeing the dentist. I will get results, she says, in two weeks.

Some women will have treatment for a condition which would never have caused them problems. 3% of women will have the serious worry of needing further tests, but not needing treatment. Lives get saved by early diagnosis.

I asked if she could show me how to examine myself, but she is not trained to do so. I should ask my GP’s practice nurse. What a job, doing that all day.

13 thoughts on “Breast screening

  1. I do understand how you feel Clare having been through a few intimate exams, I have always had a problem with males getting close enough to me so I can feel their breath because of certain events from my childhood, the first exam was the medical for the forces, namely the drop and cough, for the reader who does not know what that is, its a check for a hernia were the the doctor cups your testicle in his hand while you give a short sharp cough, not pleasant, second one when I had suspected appendicitis and the insanely large black Nigerian doctor with hands like shovels asked me to turn on my side and with his strong accent I didn’t understand what he was going to do, before I had time to say anything his huge finger had gone up my rear end, I thought I was going to die, the shock alone nearly had be hanging from the ceiling.
    My newish doctor is fantastic, I have been seeing her for well over a year now ans she is loverly, I wouldn’t be here without her help, she got me on correct pain relief, seen the right specialist, but when I had a penis problem, I talked to her about it but I couldn’t show here, not because she was female but I couldn’t show anyone except my wife. But after the description the doctor was able to deal with it.
    Its not that I am prudish, I just hate the thought of getting my bits out to be poked at lol.
    If I was female I would not be able to have a smear.
    How funny we people are. 🙂

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    • I had the forces medical too, for the Territorials, with whom I lasted two weekends. Completely impersonal. Prodding and poking can be impossible to bear, sometimes. This time it was OK. I think that is me, rather than the prodders.

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    • Interesting. Thank you.

      Macmillan says baldly “Breast screening saves lives”. The current UK NHS leaflet says 1300 lives are saved each year. So, not likely to be mine, but possible. They also say that 4% of women screened need further tests, of whom one will be diagnosed with cancer. For every one woman who has her life saved, three will have a diagnosis of a cancer which would never have become life threatening. If you are over 70 you are more likely to die of other things: perhaps the number of “would not be life threatening” increase thereafter. This is the June 2013 revision.

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      • I appreciate it doesn’t add much to discussion to give a link, but – where to start?! I do object to statements like ‘breast screening saves lives.’ It does not technically save lives. It detects cancers, which may have remained undetected for longer. And unless things have changed significantly in the last ten years, often the most vicious cancers are the ones that hit younger women. For example, I had a friend who died on her 30 something birthday. An amazing woman. If only I could face death with the same calmness and tranquility that she did. The relevance of that is that neither she, nor her friend were included in the programme. (The friend was still fine, last thing I heard) and married her girlfriend a couple of years ago.

        The other issue with screening younger women is the density or whatever it is called of the breast tissue. With younger women false readings are more common.

        OK, I’ve now looked ie read the leaflet. It is making my hair stand on end, and I have long hair. Regardless of the sloppy presentation of statistics and lack of sources, ie the group of sources, it is not well written. Mixed tenses. I still think it is very dangerous to state that screening saves 1300 lives a year. That is an assumption and an extrapolation of certain statistics. If it is looking at survival rates then that is not the same thing, because not everyone with breast cancer had it picked up through the screening programme.

        Anyway, I had better shut up or this reply will be as long as my original post on screening. I enjoyed working in screening, it was intellectual, challenging, and I had great colleagues in both breast and cervical (I chaired both local multi-disciplinary groups), but my bottom line is that 96 mill pounds (prob gone over the 100 mill mark now) could be better spent on essential drugs for women – and men – who DO have breast cancer. But people get passionate about screening, and cancer is a good word to wind up politicians. It would be far better to spend the money on prevention rather than early detection.

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        • Thank you for this. I have not researched in depth, and your professional experience is a useful corrective. Any woman must make her own decision. The bit about younger women having denser tissue may be relevant to me: I am 47, but my breast is younger than that of most women my age.

          There is the radiation dose, and people living on granite- Aberdeen, New York- have high radiation doses. There is the ethical issue of whether to give treatment to a group for the benefit of one of that group: some suggest statins should be prescribed to large swathes of society, where a small percentage would have terrible symptoms. Then there is the vaccination programme: if most people are vaccinated, then the risks to each individual are greater than the benefits.

          Possibly it is a question of being seen to be doing something, even if it is not certain that something achieves anything. Then again, not being able to assess the evidence from primary sources, Macmillan and the NHS are pretty good secondary sources.

          Thank you for putting the other point of view.

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      • My experience is also more than ten years out of date, so bear that in mind. But some things don’t change. What to do about DCIS may have done, there were a lot of unanswered questions about that back in the 90s, ie whether it actually went on to become a very invasive cancer.

        Your basic premise is looking at how the public health function works. ie treat everyone for the benefit of a few. So that includes screening, vaccinations, fluoridation of the water supply, adding folic acid to flour/bread because pregnant women don’t get enough iron and can’t work that one out on their own etc etc. Public health treads a very fine line between state intervention and erosion of personal freedom. Depends which side of the line you fall on.

        As for sources, I always want the primary source because I don’t trust someone else’s interpretation.

        Regardless of any of that, I hope you get a clear result. Well worth you doing some research though. I have no idea about the risk factor for transpeople, we did discuss male breast cancer from time to time, but we were still battling to agree funding for transops, let alone consider them in screening programmes.

        Oh and regarding self-checking. That fell well out of a favour a while ago? Is it back in favour again? How things go round and round again. [bangs head against wall]

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            • On self-checking, Garrison Keillor told of a man who died of cancer. Every two months or so he would notice something which he thought was a strange symptom, worry it was cancer, see the doctor about it and be told to go away. Then one day he found- I dunno, a lump in his testicle, something. He jumped into his car and drove it as fast as it would go to the town- skidded, and crashed into a tree, dying instantly.

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  2. The basic theory of self-checking for women is to check at the same time every month, usually in the shower (?) but breasts change depending on time of month and periods etc etc. Check under arms (lymph node problems) under breasts, and around nipples. But suddenly all that advice was withdrawn via a national circular. Trouble was, national circulars don’t get down to everyone in the field.

    My FiL (who died before I was married) died of a heart attack. When he looked at his notes that said he had colorectal cancer, he promptly went. Pretty similar. My dad was not too different. None of that was self-checking but the eventual diagnosis didn’t go down too well.

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  3. My last mammogram was done by a tech from Scotland. We had each other giggling to where flattening my breasts like pancakes didn’t hurt nearly as much as my face from smiling due to her great humor.

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