I received my 3 yearly mammogram invitation in the post back in August.   It can’t be three years since the last one can it?  (see further musings on the nature of Time here.)  Enclosed with the letter was an NHS leaflet entitled ‘Helping you Decide’ (which I didn’t receive the last time) the purpose of which is to give you a balanced view on whether mammograms are actually worth having (wait, the NHS is questioning its own screening programme?)

The first thing to say about this leaflet is that it won’t help you decide; it will instead cause you to spiral downwards in a health anxiety induced panic.  It therefore needs another title and I’m going with:

‘Not only will this leaflet not help you decide it will also scare the pants off you’

The leaflet opens with:

It is your choice whether to have breast screening or not.

Look here, they may as well be saying, you’re on your own here Mrs.  We may have sent you a letter with an appointment date, and a time and everything, looking all official and such like, but us health professionals have no sodding idea whether you should have a mammogram or not, so we’re leaving the whole thing up to you; being that you’re well qualified in all things medical, with access to the latest research papers on mammography – you’re not medically qualified and don’t spend hours trawling the net re: medical matters?  (I do actually, it’s sad I know.)   Well we do, heck we even write the stuff and a fat lot of good it’s done us.

To further leave the ball in our court the leaflet includes a brief description of the mammography process:

The mammographer will first explain what will happen.  She will then place your breast onto the mammogram machine and lower a plastic plate onto it to flatten it.

Flatten it!!!!   You can’t just casually mention the fact that my personal attributes are going to be flattened.  Do you really expect me to go along with all that flattening ?    Just how flat are we talking here?  (The memory of my last mammogram was surprisingly dim and distant thankfully.)  Like a pancake?   Like one of my husband’s jokes when they fall very flat indeed?

The leaflet then confronts us with an image of a kindly looking, middle-aged mammographer, her hand placed protectively on the back of an anonymous woman, as she places her in the correct position to have her whatsits squished.

I spent most of August into early September typing things like: ‘Are mammograms worth the anxiety’, ‘Is it worth having a mammogram’, ‘Do mammograms really save lives’ into omniscient Google.  The non-helpful NHS leaflet tells us that for every life saved via screening 3 women will be over-diagnosed, meaning they will be treated for a cancer, picked up during screening, that would never have caused a problem or killed them; but they’ll be treated as though they have cancer anyway, as the experts can’t tell the difference between ‘good’ and bad cancers.

There are good and bad cancers?

Apparently so, and some breast cancers can just spontaneously go away – but if they’re picked up via screening then you’d be treated with scary drugs for something that would have basically treated itself.

The anti-mammogram lobby have had a field day with these numbers.  Apparently you have to screen thousands of women for quite a lot of years to pick up just a few cases of cancer; current best estimates being that for every 100 women screened between the ages of 50-70, one will have cancer (this 1:100 statistic is markedly different from the alarming 1:8 statistic the Press like to go with) leading to 1300 lives saved a year in the UK.  However 4000 women will be ‘over-diagnosed’ during that same time, causing potentially damaging and unnecessary treatment.  Therefore the anti-screening lot see mammograms as a huge drain on resources for the NHS with very little to show for the money spent.

Indeed some studies (including an infamous Norwegian study in 2012) have shown that there is no difference in death rates between women who turn up for screening and those who don’t.  That whether a woman’s cancer is detected by screening, or if she notices a lump herself, largely makes no difference to the end result, even if the cancer has been supposedly picked up early via screening. That actually it’s the improved treatment that is saving lives, not the screening programme, which has almost become ineffective, like the prostate cancer screening blood test for men.  There’s also a body of opinion that says mammography should only be used as a diagnostic tool for people who have cancer, and to monitor those who are in remission, rather than as a preventative screening tool.  Not to mention the question of x-ray exposure and whether giving yourself a dose of radiation every 3 years is the wisest course of action, when you have no actual symptoms.

What to do?  – when there’s so much contradictory and unhelpful discussion out there, and given that breast cancer has such a high visibility within our culture, making it seem like it’s almost an epidemic and the only disease on the planet.

(Unfortunately, I realised too late, given the subject matter of this post, that I look as though
I’m holding up a couple of weirdly placed boobs here)

Well I went along to the appointment (because I’m that sort of person, the sort of person who doesn’t have the confidence not to go) telling the lovely, non-middle aged mammographer that I really wasn’t sure why I was there and could she make up my mind for me.  To further confuse the issue, and instil further lack of confidence in the medical profession, she replied that she wasn’t allowed to make any comment; so we sat there in companionable silence whilst I mulled things over, and the massive mammogram machine joined in by looming over us in a highly threatening manner.

The lovely mammographer then spoke, saying she had recently had the test, if that helped, and would definitely be going regularly once she hit 50.  That she’d advised her mother to go regularly.  That a team of physicists had inspected this very mammogram machine that morning, for 45 minutes, to check that it was properly calibrated and incapable of giving you a lethal dose of radiation.  The machine also had a squish regulator on it so that it would be absolutely impossible for that plastic plate to squish hard enough to make your average C cup explode.   And furthermore, at least we weren’t like the Americans, who start zapping you every year as soon as you hit 40.

So I chose to go through the undignified process and the absolutely wonderful mammographer stuck her thumbs up at me from behind her protective bit of plastic and said ‘fantastically clear images well done!’    Like I possibly had the best set of knockers bosom on the planet.

Back at home and, what turned out to be a 2 week wait ensued, during which time I imagined a faceless radiographer examining my prints, maybe finding something, maybe not;  imagining that the mammogram itself would trigger cancer and waited anxiously for the post each day, in case I got a call back letter.

A letter arrived 15 days after the test (I counted every one of those days) practically congratulating me on a normal result but that I should not feel all joyful and carefree, just because I’d had a normal mammogram result this time, because the dreaded BC can strike at any time, so they recommended obsessively checking myself until I’m called for the next one.

Is the mental anguish of going through breast screening every 3 years worth it?

If yours is one of the 1300 lives saved every year by breast screening then it’s a no brainer.  And if you’ve had breast cancer, then mammograms must provide you with much needed reassurance that you still have the all clear.   I just wish the invitation letter contained a leaflet which was a bit more positive.  You know, something like:  ‘mammograms are absolutely brilliant and you’d be an idiot not to get one’, rather than the: ‘we’re really not sure about the whole mammogram thing, so we’re afraid it’s up to you to decide’  approach.

Will I continue to take part in the screening programme?  (providing some other disease doesn’t get me first.)  Yes, definitely……….err No, probably not…….oh I don’t know, give me a minute will you..…… Help me someone, please.  I don’t know what to do.