Breast cancer kills 15,000 women every year in the UK. But it's been
estimated that more than 2,000 lives could be saved each year if all women
invited to have a mammogram took up the offer.
One in 12 women in the UK will develop breast cancer in their lifetime,
which makes it, after lung cancer, our biggest female cancer killer. The UK
is not unique in this. Statistics show that our incidence of breast cancer
is similar to that of most other developed countries.
Breast cancer begins to develop
when something goes wrong in one of the cells in the breast. As a result,
the cell starts to multiply in an uncontrolled way.
If the immune system fails to recognize that something is wrong and does
not destroy the changed cell, it will go on multiplying until it forms a
tumour, or lump.
At this point, a cancerous tumour is not usually dangerous. But if it is
left untreated, the cancerous cells can break away and spread through the
blood circulation and lymph system to other parts of the body. They may
lodge in vital organs such as the liver and brain, where they will start to
form new tumours. This spreading process is known as metastasis.
If breast cancer is diagnosed and treated early, before metastasis has
taken place, the chances of a cure are very good. But once the cancer has
spread it then becomes much harder to treat.
BENEFIT OF SCREENING
Mammography is a special type of
X-ray which is designed to detect abnormalities like cancer in the soft
tissue of the breasts. It can help to pinpoint suspicious changes well
before you or your doctor might be able to find a lump by physical
examination or notice other signs.
This early detection is vital, as detecting breast cancer at an early
stage increases the chance of a cure. It also means that you might be
treated more conservatively. This means you may only need to have the
cancerous lump removed rather than the entire breast.
Breast cancer becomes much more prevalent from the age of 50 onwards.
This is why in the UK all women between the ages of 50 and 64 should receive
invitations every three years or so to have a free mammogram. It's been
estimated that if every woman invited to have a mammogram accepted the
offer, more than 2,000 lives could be saved in Britain every year.
Women aged 65 and over are no longer sent special invitations, but they
are still entitled to free mammograms. They should still have a mammogram at
least once every three years, as the risk of developing the disease is still
present. These women can arranged to be screened either directly with their
breast screening unit (listed in your local telephone directory), or through
After the age of 64, it's a good idea to keep a note of when your next
mammogram is due, as after this age you will not be getting an invitation or
DURING THE PROCEDURE
When you first attend the breast
screening unit, a specialist breast cancer doctor will take the details of
your medical history.
You will then be asked to remove all the clothing from the top half of
your body. they doctor will then carry out a thorough manual, physical
examination of your breasts. Mammography is always combined with a physical
breast examination. Although it can pick up very minor changes that can
indicate abnormalities, in about five per cent of cases it can miss lumps
that can be felt by a physical examination.
This will be followed by the mammogram itself. You will be asked to place
each breast in turn on an X-ray plate. The breast is then compressed by a
transparent plate while the X-ray is taken.
Although many women say the
compression is uncomfortable and even painful, it only lasts a few seconds.
You are then free to go, and should be notified of the results within about
The more fatty tissue and the larger the breast, the better the quality
of the X-ray picture will be as any abnormalities or lesions will show up
vividly against fatty breast tissue. Mammography is less effective on women
with very small breasts containing little fat.
The mammogram is read by a doctor who is skilled in examining this
specific type of X-ray. In most cases this will be a consultant radiologist,
a specialist trained in using imaging techniques such as X-rays and
ultrasound scanning to diagnose disease.
READING THE X-RAY
When investigating breast X-rays,
the doctor will be checking the mammogram very carefully. He will be looking
for three things - white areas which may be an indication of abnormal lumps,
any distortion of the breast tissue, and calcification or chalky deposits,
which in some instances are linked with breast cancer.
If the mammogram looks in any way suspicious, it will usually be sent off
to another specialist in the field for a second opinion. If he agrees that
it does look suspicious, the woman concerned will be called back for
This usually means a further clinical examination and more detailed
X-rays of the suspect area. These may be magnified views or views taken from
If you are recalled, do not immediately assume that you have breast
cancer. It simply means you may have an abnormality that will require
Most of these results turn out to be what are called 'false positives'.
This means that although the initial mammogram came up positive, on further
checking it is negative. It could be that the mammogram was misleading
because it was difficult to read, or that you have some other benign breast
condition such as a cyst or fibroadenoma, lumps caused by the
overdevelopment of the fibrous tissue of the breast.
About six in every 100 women are
recalled after screening but only one in 10 of these turn out to have
cancer. At this point you will be put in contact with a nurse counsellor to
give information and support at this inevitably worrying time. You will most
likely undergo further X-rays and examinations. Sometimes you will also have
an ultrasound scan to find out more information about a lump, for instance
whether it is solid or filled with fluid.
If there is still doubt about the lump a biopsy may be performed. During
this procedure a small needle will be used to draw off either fluid or cells
from the breast for examination in the laboratory. This is usually no more
painful than having a blood test. You will then be called back to get the
CATCHING CANCER EARLY
Overall only six out of every
1,000 women invited for screening turn out to have breast cancer.
And even if breast cancer is diagnosed, it may be a type of easily
treatable cancer known as carcinoma in situ, which in half of cases is not
Currently in the United States, experts recommend that women start having
regular mammograms from the age of about 40 onwards. However this remains
controversial in both the UK and other western countries for a number of
First, breast cancer is far less common in women under 50, and
mammography may not be very effective at picking up early cancers in younger
In addition, because breast tissue in younger women is much more
glandular and less fatty, they need to be given a higher dose of radiation
for the mammogram to be effective. Even then, it still remains more
difficult to detect breast cancer in this age group from mammography, as the
X-rays can be difficult to interpret correctly.
In addition, there has been no firm evidence to show that giving
mammograms to women under 50 reduces their chances of dying from breast
cancer. But more research is under way to evaluate the effectiveness of the
procedure in women in their forties.
Because of these difficulties, scientists are experimenting to see if
computers can help them enhance and interpret the mammograms of younger
women. Digital mammography, as it's called, should be safer too, as it gives
even lower doses of radiation than conventional breast X-rays.
Like any X-ray, mammography
involves subjecting the body to very small doses of radiation -- a substance
which is well known to cause cancer itself.
However, the amount of radiation that you will receive during a mammogram
is equivalent to what you would get from general background radiation during
a flight from the UK to Australia.
This means that the increased risk of cancer is very small. In fact,
having a mammogram has been likened to the equivalent cancer risk of smoking
only one-third of a cigarette once a year.