INA Paton is what you might describe as a stoic type. Never one to make a drama out of a crisis, she tells it like it is. So when she says, without a trace of emotion, that a routine mammogram saved her life, you can be certain she’s serious.
The 62-year-old from Irvine always attended her screenings unquestioningly. Then in October 2011, around the time of her 40th wedding anniversary, she was called back. This time the scan had revealed a small abnormality. Further tests confirmed she did, in fact, have breast cancer.
She had felt no lumps. Even her surgeon could detect no external sign of the tumour. There had been no warning signs. Which leaves her in no doubt that, had she not attended that scan, her cancer might have killed her.
As it was, because the tumour was so small – 2cm in diameter – a lumpectomy was recommended rather than a mastectomy. During the operation, the surgeon also found another, even smaller tumour that had not been detected by the mammogram. That was also removed in its entirety. Her cancer, Paton was informed, was an aggressive type, but it had been stopped in its tracks.
“If I’d not had the mammogram and it had been left to a stage where it could be felt, it would have been twice or three times the size. And, given the nature of the cancer, it would have been a lot worse.”
Yet the debate over whether routine testing should be stopped continues on both sides of the Atlantic. A report in the British Medical Journal last month, written by Michael Baum, a professor of surgery at University College London, claimed as many as half the women diagnosed with breast cancer through mammograms are actually diagnosed falsely. Another argument claims that, for each woman in the US whose life is saved through mammogram testing, between one and three die as a result of unnecessary treatment.
“False diagnosis does not give rise just to psychological problems such as stress and anxiety,” says retired doctor and author Theodore Dalrymple. “It results in physical harm and even death. Women who are wrongly diagnosed undergo unnecessary surgery, from which there is always some (if statistically small) danger, both from the surgery itself and the anaesthesia. More importantly, the majority of those who are falsely diagnosed will receive radiotherapy, which itself causes death.”
But while some in the medical establishment claim those false diagnosis figures are wildly exaggerated, should women be worried?
“Yes,” says Dalrymple. But he adds, cautiously, “I wouldn’t like people to either have mammograms because I say they should or not have them because I say they shouldn’t. I’m not sufficiently expert to give that sort of advice. The point is that most of the people who give that advice are not expert either.”
And in attempting to measure results and gain possession of an accurate picture, those people are dealing with a constantly moving target.
“Things are changing all the time,” says Dalrymple. “For example, the accuracy of diagnosis changes. The accuracy and value of treatment changes. Radiotherapy changes – usually for the better. When you’re trying to find out whether things like mammograms work, you’re estimating on how past techniques work because, of course, by the time you have the results for techniques that were used, say, ten years ago, the techniques have changed.
“It’s not only mammograms you have this problem with,” he adds. “Some forms of screening are absolutely fine because they’re very accurate, they don’t have false positives and they don’t really have false negatives. But others, like PSA for prostate cancer, face very similar problems.”
One of the arguments against routine testing is that, since treatment is so much more effective now, women would be better off simply waiting for symptoms to show up before getting any treatment. But Dalrymple adds: “Not doing mammograms would mean we might miss a lot of early cancers.”
So what’s the answer? To be tested or not to be tested? “It’s good this is being debated,” says Jackie Harris, a clinical nurse specialist at Breast Cancer Care, “and I think what’s important for women is to understand what it’s all about; what are the pros and cons? As a screening tool, mammograms are very effective but, as with everything, they have their limitations. They’re not 100 per cent perfect.
“There was an independent review of the screening programme that found it is doing what it was set up to do – it is saving people’s lives, on average 1,300 per year. But with every single breast cancer death prevented you have three breast cancers overdiagnosed and overtreated.”
To anyone facing the decision about attending their screening appointment, she says: “Speak with your GP, speak with friends, organisations like Breast Cancer Care. Then make an informed choice about whether to attend or not. In the meantime, every adult should be breast aware – that’s women and men. Breast cancer is the most common cancer worldwide and a woman’s lifetime risk is one in eight. For men it’s just under one per cent.
“Breast awareness simply means getting to know what your breasts are like at different stages in your life, at different times throughout the year, then should you notice a change, that gives you the confidence to report it early.”
For Paton, though, the decision is a simpler one. “Get tested,” she says. “Without a doubt. It saved my life”
Spoilt Rotten: The Toxic Cult of Sentimentality by Theodore Dalrymple is published by Gibson Square Books, £7.99
Breast Cancer Care (0808 800 6000, www.breastcancercare.org.uk)