A diagnosis of breast cancer almost always comes like a shock. But when Patricia Copestake was told that she had the disease, she had every reason to be more stunned than most.
Only a few months earlier had the 57-year-old mother-Van-Seven attended a routine-Mammogram-an X-ray scan that was offered every three years from 50 to 70 years every three years to detect breast cancer at an early stage and had received the all-clear.
Then, when she had seen her doctor about a part of her left breast that felt firmer than the rest, she was reassured by the doctor, it was nothing serious.
Patricia was not completely convinced, insisted on further tests and was referred to a breast clinic.
Another mammogram was clear – but as a standard practice she got an ultrasound.
“The sonographer placed the machine on my chest and then reached for the button to call in the consultant,” Patricia recalls. “I knew they had found something.”
Amazingly enough, the tumor was the size of a golf ball. Patricia was immediately booked for surgery and underwent other cancer treatments. She says, “When I was diagnosed, I started thinking to myself – how did they miss this?”
Patricia Copestake with her husband, Graham
Desperate to answers, Patricia sent her earlier mammograms to a private doctor, who pointed to a small note at the bottom of the X -rays: ’75 percent closed tissue. ‘
She adds: “I felt stupid because I didn’t know what that meant.”
Breast density refers to the ratio from fat to gland and connective tissue – the less fat, the closer the chest. And while breast tissue appears white on a mammogram – just like tumors – the more tissue, the less effective the scan.
Patricia says: ‘The consultant explained what closed breasts were and why they were the reason that my mammogram had not collected the tumor.
‘I have had four mammograms over the years. Suddenly I realized that this had been known for years, but nobody had informed me. I was shocked. ‘
More than 40 percent of women have dense breasts – but in Britain, in contrast to the US and most of Europe, she is simply not told.
A recent study by the British care provider Genesiscare showed that 92 percent of British women are not aware of the density of their breast tissue or the increased risk it bears.
Last year the post on Sunday was one of the first to raise the alarm about the outdated screening practice of the NHS, which neither informs women about their breast density nor additional scans.
Campaigners warn that women with dense breasts slide through the net. Now a milestone study has concluded that the NHS screening program of Breast Cancer needs urgent reform.
Researchers from the University of Cambridge and the Hospital of Addenbrooke estimate that more than 3,500 cancers are unnoticed every year by mammograms, but the addition of extra screening methods can triple the detection percentages. Experts say that the solution is cheap, does not require new equipment and can save hundreds of lives annually.
“There is always a balance – we must be aware of both the benefits and possible damage when making changes to the screening,” says Dr. Fiona Gilbert, professor of radiology at the University of Cambridge and the main author of the study. ‘But we are now at a point where the evidence clearly shows that we have to do more for women with dense breasts. Women must be informed. ‘
About 56,000 women are diagnosed every year with breast cancer in Britain, making it the most common cancer in the country. While nine out of ten survival, the disease still claims more than 11,000 lives every year.
Breast screening is a cornerstone in the fight against the disease, aimed at the early detection of tumors when they are easier to treat.
But for women with dense breasts, the program falls short.
Close breasts are not only more difficult to scan – masking tumors on mammograms – they also wear a higher risk of developing cancer.
For the third of women with moderately closed breasts, the risk is four times higher. For the 10 percent with the closest breast tissue, it can rise to six -fold.
Nevertheless, if a woman is found during a routine scan to have closed breasts, it is not even included in her medical notes.
Campaigners claim that informing women about their breast density is vital – help them understand their general risk and take action to reduce it.
This can be maintaining a healthy weight, limiting alcohol or choosing extra scans – measures that can help catch cancer earlier and improve survival.
Campaigner Ceryl Crawys, 58, says that, despite the fact that it has been known for years, women with dense breasts would benefit from better screening, women still come to her with a diagnosis of cancer and the same desperate complaint: “If only it were to know.”
Routin mammograms are offered to all women aged 50 to 70 every three years to detect breast cancer at an early stage
While he lived in France in 2016, Cheryl was diagnosed with breast cancer at an early stage and credits the early detection to the standard practice of the country to perform additional screening for dense breast tissue.
Now, she believes, the latest study can mark ‘an important step forward for British women’.
The new study, published in the Lancet Medical Journal last month, was performed on 9,361 women in the United Kingdom who have closed breasts and looked cancer -free on a regular mammogram.
Researchers tested two additional scan methods that were designed to detect cancer in dense breast tissue.
The first contrast -reinforced mammography (CEM) includes injecting a dye to make blood vessels more visible on the scan.
The second, abbreviated magnetic resonance image formation (AB-MRI), offers a faster alternative to standard MRI.
Among the women, CEM detected another 19 cancers per 1,000, while AB-MRI 17 picked up.
A third method – a form of ultrasound – was also tested. Although it had detected extra cases, it was less effective and identified only four extra cancers per 1,000 women.
The researchers concluded that by adding CEM or AB-MRI to the current screening practices, 3500 breast cancer could be detected every year, so that possibly around 700 lives could be saved.
For Professor Zoe Winters, senior consultant breast cancer surgeon at London Breast Health seems to be a no-brainer in light of the new findings in the light of the new findings.
She says that women in her private breast clinic are both aware of their breast density and are automatically given further screening – usually an ultrasound, but she will now probably also try to use CEM.
She adds: ‘I make sure that women with the closed breasts get an ultrasound and 3D mammogram [which uses multiple X-ray images from different angles to create a layered, three-dimensional picture, making it easier to spot hidden tumours] As a matter of routine – but I still miss cancer.
‘In the US it is now mandatory that every woman must be aware of his breast density. It is important that British women also have this knowledge. ‘
Professor Gilbert says it is more to ensure that changes to the scheme do not cause unintended damage. “It must be relatively simple and cost -effective to introduce contrast -reinforced mammograms on the breast screening program,” she says. ‘Many screening centers and breast clinics throughout the country already have contrast equipment, because it comes as an add-on when you buy a mammography machine.
“But it must be balanced against the risk for women – there is always a very small chance that giving intravenous iodine will cause an allergic reaction.”
She points out that policymakers are also concerned about overdiagnosis of tumors that would not have been advanced to a life-threatening stage in the patient’s life: “Some people will rightly claim to detect that by some of these extra tumors, we find clumps that may never have done damage.”
But, she says, the weight of evidence is for screening, especially since finding cancers early gives the most women a much better chance of survival.
And finally, some claim that informing women about their breast density can cause unnecessary concerns, especially if further tests are not available. But at the end of the day, says Prof. Gilbert, women must be able to choose.
Deborah King tells all her friends to request their breast density information when they attend mammograms
“As long as women are well informed about the risks of contrast -reinforced mammograms, it should be their choice to accept the scan or not,” she says.
‘Changes must be made to the breast screening program. We just have to find the best way to roll it out. ‘
For Deborah King, 60, they could not come before. After discovering a tumor of 1.5 inches (4 cm) in her left breast only two months after a completely clear mammogram, they underwent operations and treatment for a debilitating two years.
She says: ‘I could have died. As a single parent with a teenage daughter, that is a frightening thought. I feel that I fell through the net. ‘
Now graphic designer Deborah tells all her friends to request their breast density information when they attend mammograms. “Some are told and some don’t,” she says. “But it’s worth trying.”
If this does not work, Deborah, e -mail your hospital advises an access request to your mammogram results and they must send the scans within 30 days.
She adds: ‘How should we make informed decisions about our health if we are not informed about this? Especially for women in the menopause who decide whether they should take hormone therapy, which can increase the risk of cancer. It costs women their lives. ‘
Patricia agrees, adding. ‘At the time I asked my doctor why they hadn’t told me about my breast density, and they said they didn’t like to worry unnecessarily.
‘But I prefer to worry for a few weeks and I am told that it is good than no worries and die because my cancer is found once it is too late for treatment. In my opinion it is an easy choice. ‘
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