Wednesday 13 December 2017

No says Dr Ann O'Doherty

Consultant radiologist and lead clinical director of Breast- Check, Dr Ann O'Doherty, would like to see an increase in the current take-up of breast screening.

BreastCheck began screening in February 2000. By the end of September 2011, the service had provided 800,452 mammograms to 362,701 women and detected 4,917 breast cancers.

Its take-up is currently at around 75pc. Dr O'Doherty believes that its target to reduce breast cancer mortality by 20pc is achievable and she takes issue with the use of the term 'misdiagnosis' in the UK study.

"We are not getting it wrong," said Dr O'Doherty. "There is nothing incorrect about the diagnosis being made. We may be overtreating it but the diagnosis is absolutely correct. Women are horrified at the media coverage of this because they thought doctors were getting it wrong and misdiagnosing which is wrong.

"It's the natural history of the disease that we have correctly diagnosed that we don't know," she said.

Dr O'Doherty described breast cancer as a spectrum.

"We know that some patients present with highly aggressive diseases. We know that some women will do really well and that some are not going to do so well. The trouble is we don't know which ones are going to end up in which category," she said.

She stressed that in the absence of science, the Independent UK panel on BreastCancer Screening could only guess the level of so-called overdiagnosis.

"There was no science behind that particular bit. It was a guesstimate. I would contend they seriously overestimated it.

"My experience of 22 years in breast cancer is that very few cancers stay static – very few. Hindsight is a great thing.

"We take failure to diagnose cancer very seriously," she said.

She agreed that there was a small group of patients that presented with low-grade ductal carcinoma who were definitely overdiagnosed.

"Maybe less of them will go on but we don't know which of them will go on. We don't have the ability to select which patients," she said.

Pointing out that it was early days since the release of the UK study, Dr O'Doherty insisted that she did not want to have any part in telling women not to come for screening because they may be overdiagnosed.

"We are all discussing it and saying what is best. We have to be honest with women and there has to be more honest and frank discussions with women once they are told they have a specific disease that may not progress.

"They are not being incorrectly diagnosed but they may not progress so we may be overtreating.

"However most women in that situation will opt for the treatment. That is the reality of it. The UK report didn't highlight enough the absolute confidence it gives women to have a negative screening mammogram," she said.

A woman attending for breast screening with the BreastCheck programme has a 93pc chance of being told they are normal, and a 7pc chance of being asked to come back for further investigations.

"You have a less than 2pc chance of being told you have cancer so 98pc of women are getting completely reassured," she said.

Dr O'Doherty added that while she would completely respect the decision of a woman not to go for breast screening, she would urge them to take up the offer.

"I would say to them if they want to reduce their risk of dying from breast cancer they should go. We do pick up earlier cancers which means less invasive surgery, less chem- otherapy.

"If you go, you have a 98pc chance of being reassured and you may have your life saved. It's half an hour out of their lives; when you see the tragedy of breast cancer, it is worth it," she said.

She added that it was important breast cancer was not diagnosed earlier if it wouldn't give the woman extra years of life.

Irish Independent

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