Sunday 18 March 2018

The biggest breast cancer risk that women are not aware of

Stock photo
Stock photo

Rosa Silverman

Women and their doctors need a greater understanding of the risks of cancer in dense breasts, a British MP has warned.

A woman with dense breasts  - those with more glandular tissue - could be six times more likely to develop breast cancer.  At the same time, it can also be harder to detect tumours in dense breasts. 

Research in 2016 suggested NHS breast cancer screening was missing up to 3,500 tumours a year because standard checks were not sensitive enough to pick up around one in six cases. Experts said up to half the cases of cancer in dense breasts could be missed via screening.

Two years after the publication of this study of 3,231 women with dense tissue by Italian and Australian researchers, Craig Tracey MP says more awareness of the issue is still needed - and more checks for those at risk.

The member for North Warwickshire and Bedworth, who is Co-Chair of the Parliamentary Group for Breast Cancer, said in a recent Parliamentary debate on cancer: “Issues surrounding breast density have become clear, particularly the increased risk and the masking of cancers in mammography. Mammograms are obviously the main method of national screening and, while considered the gold standard, evidence shows that they are not as effective for women with dense breasts.”

Women at risk should therefore be offered additional screening, he argued. “The challenge is that tumours show up as white on a mammogram, but so does the dense tissue, meaning that the cancer is missed in more than 50% of cases...The answer would be to change screening guidelines and offer further screening to those women at risk.”

Sally Beckerwas one such woman. The mother-of-one from Brighton, dubbed the “Angel of Mostar” after helping save hundreds of lives in war-torn Bosnia in the 90s, was referred for a mammogram and an ultrasound scan around six years ago after noticing a change in her breast size and a small pea-sized lump close to the surface. Although she was given the all-clear, she began to notice changes in her breast shape and by the following year, when she returned to her GP, she knew something was seriously wrong.

After five core biopsies, in which small tissue samples are removed using a needle, and an MRI scan, Ms Becker, now 55, learned she had an invasive lobular carcinoma. She was told that her breasts were very dense for her age, making it hard to detect cancer at an early stage. She chose to have a double mastectomy as there was a small risk of the cancer occurring in the other breast too, and has since been back at work helping sick and injured children in Iraq.

She said: "Since I had major surgery for breast cancer in 2013, I have been fine, but my mother has just been diagnosed with the same type of cancer. She found a small irregular lump in her right breast and was referred for tests. She had two mammograms, which showed nothing, but they also did an ultrasound and core biopsies, which revealed invasive cancer.

"Fortunately it was caught in the early stages so once she’s had the surgery we’re hoping she’ll be fine. It’s clear that mammography is not effective in diagnosing certain types of breast cancer though, particularly in women who have dense breasts. So it’s vital that they change the guidelines now, before more women suffer as a result of misdiagnosis."

Not only women but health professionals, including GPs who are usually “the first port of call for women concerned about their health” need to be further educated about the problem so that cancers can be detected sooner, Mr Tracey said. This would lead to better prognoses, less aggressive treatments and fewer mastectomies and secondary cancers. It would, he said, “ultimately save lives.”

This week, a report by the All-Party Parliamentary Group for Breast Cancer revealed a “postcode lottery” in screening, diagnosis and death rates from the disease. Women were twice as likely to die from breast cancer in some parts of the country than in others amid “alarming” failings by NHS services, experts warned.

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