Yes says Dr Patricia Fitzsimons
Published 24/01/2013 | 06:00
After a long and illustrious career promoting breast screening, former radiologist Dr Patricia Fitzsimons has made the personal decision not to go for a breast screening under the BreastCheck programme.
While accepting that she is in a minority, she believes she has made a reasonable decision in the light of the latest research.
"For me, the disadvantages are greater than the benefit of a small reduction in mortality should I get breast cancer," she said.
"I do not want to be a patient who is possibly overdiagnosed and I do not want to expose myself to the risk of being recalled unnecessarily – both of these risks are now known to be quite high. In addition, a third of cancers are diagnosed between screening rounds and usually these are the more aggressive cancers," she explained.
Dr Fitzsimons, who was involved in setting up breast screening in Brisbane, Australia, in the 1980s and advanced the cause for opportunistic breast cancer screening services at Sligo General Hospital when BreastCheck was rolled out nationally, stresses that she is still very much in favour of breast screening for those who choose to go.
"It does reduce mortality, and I would particularly like to see BreastCheck extended to women who are at high risk," she said.
She reviewed her thinking and while doing a Master's Degree in Psycho-Oncology in DCU she worked on a thesis on the overdiagnosis of breast cancer.
"Some cancers do not need to be diagnosed as they will never cause symptoms or death; unfortunately, at present, we cannot differentiate these from ones that cause significant problems."
She stressed that there were many ways of reducing cancer risk.
"People can take certain measures to maintain good health – for example: eating well; not smoking; not drinking to excess; controlling weight; handling stress, and exercising. Until the publication of new research in the last two years, breast screening was another acceptable preventative measure without obvious side-effects.
"There are now more concerns than ever that women are not being given sufficient information to enable them to make an informed decision on whether they should participate in the breast screening programme or not.
"The problem is that, in order to be diagnosed, you have to bring forward the diagnosis, so going for screening increases the risk of becoming a cancer patient. Some women will be diagnosed now instead of in 20 years or maybe never.
"This and other disadvantages of breast screening now need to be balanced against the reduction in mortality for the very small number of women who will die from breast cancer and this is the difficult choice," she said.
As part of the thesis for her recent studies, she interviewed a small number of radiologists involved in the BreastCheck programme to determine the type of information that women receive.
"The way it is presented at the moment, there's no decision to make.
"It is presented to patients as really good, with only benefits. Once you have the mammogram, however, and are diagnosed with breast cancer, it would be very difficult with the present stage of knowledge to refuse treatment even though you may be one of those being overdiagnosed."
Dr Fitzsimons stressed that if people have a lump they should absolutely go for a mammogram and get treatment.
"The 25pc reduction in mortality in the last number of years has been contributed to significantly by excellent radiologic intervention and management," she said.
She added that opting not to go for screening under the BreastCheck programme should be an acceptable choice. "Women should not be made to feel at fault or negligent if they choose not to go," she said.