Improving early diagnosis rates through heightened cancer screenings
Freelance health journalist Kathy Oxtoby got the news nobody wants to hear; she had cancer. More than 50,000 women are diagnosed with breast cancer each year and this figure is rising, but cancer screening numbers have declined – so what can be done to improve early diagnosis rates?
Freelance health journalist Kathy Oxtoby got the news nobody wants to hear; she had cancer. More than 50,000 women are diagnosed with breast cancer each year and the figure is rising, but cancer screening numbers have declined – so what can be done to improve early diagnosis rates?
They were the three words I had never wanted to hear. ‘You have cancer.’ While I was shocked, it also felt inevitable. Why shouldn’t it happen to me, given cancer’s indiscriminate nature and the number of people I’ve known and loved who have been affected by it?
But it couldn’t be too serious, I thought. It was a tiny lump. A ‘one in a million chance of finding it’, the consultant radiologist said.
‘So I have a small lump?’ I asked. She looked into my eyes and we reflected the emotional pain that goes with giving and receiving bad news. ‘No,’ she said. ‘You have breast cancer.’
I was about to start my education in breast cancer treatment and care. I had a good teacher: the calm and comforting breast care cancer nurse, who talked me through the treatment and care to come.
Deaths prevented in the UK each year by routine mammograms
(Source: National Health Service Breast Screening Programme)
Since my diagnosis in August, I have had a lumpectomy, which showed there had been an invasive ductal carcinoma, and a ductal carcinoma in situ in my right breast. Its total size was 4.5mm. It was grade 1 and oestrogen receptors were positive. The margins were clear. Finding a breast cancer lump so early ‘is the reason we do breast cancer screening’, the consultant surgeon said.
Following my diagnosis and treatment I told friends and family about the value of breast screening. Two friends had screening as a result.
More than 50,000 women are diagnosed with breast cancer each year in the UK, according to the charity Breast Cancer Now. But while cancer diagnoses are on the rise, the number of people being screened has gone down.
Addie Mitchell, clinical nurse specialist in breast awareness and breast screening for Breast Cancer Care, says diagnosis rates are rising because of improved awareness about breast cancer and screening.
She says screening ‘picks up cancers early that would be aggressive once they become palpable lumps, and saves lives’.
She adds: ‘Early diagnosis through screening means less aggressive treatment and less anxiety for women in the long run.’
The decline in screening attendance in England was described in a report by the All-Party Parliamentary Group on Breast Cancer published in March and supported by Breast Cancer Now. In 2016-2017, screening was attended by 71.1% of all eligible women within six months of invitation, down 3.4% from 2006-2007.
of women never check their breasts outside routine mammograms
(Source: Breast Cancer Care)
In the last decade, London was the only region to see an increase in screening attendance. In 2016-2017, screening was attended by 64% of all eligible women within six months of invitation. Although this figure has risen from 60.3% in 2006-2007, London is still failing to hit the national target of 70%.
Jill Hardman-Smith, an advanced nurse practitioner in breast care at University Hospitals of Leicester, says people might not go to be screened because they are ‘frightened of the consequences’. She adds multicultural communities for whom English is not their first language may not understand why they are being called for screening.
Macmillan online digital nurse specialist Ellen McPake says having read about the ‘pros and cons’ of screening some women may choose not to attend, feeling there is ‘potential for over diagnosing’. And ‘some people fear a false negative or a false positive’, she suggests.
Nationwide, there are initiatives to encourage early diagnosis of breast cancer. The NHS Be Clear on Cancer campaign advises women over 70 who are no longer part of the national screening programme to be breast aware and to visit their GP if they notice changes to their breasts. Approximately 60 breast cancer screening centres are trialling screening from ages 47 to 74, rather than 50 to 70, to boost early diagnosis and treatment.
NHS organisations are taking action to raise screening rates and increase breast awareness. Jackie Harris, lead cancer nurse at Kingston Hospital NHS Foundation Trust, where I was treated, says the trust runs breast awareness promotions every October during Breast Cancer Awareness month. Initiatives have included breast cancer nurses handing out leaflets about breast awareness in the lingerie department of the local John Lewis store.
In 2005-2006, Tower Hamlets had one of the lowest uptake rates and poorest survival outcomes in the country. Following innovations – such as text message reminders and pre-appointment phone calls – Tower Hamlets Clinical Commissioning Group saw a 13.6% increase in screening attendance in just three years.
Making positive changes
of women of screening age didn’t know they could request mammograms after the age of 70
(Source: Breast Cancer Care)
Health professionals can also advise people about positive lifestyle choices. ‘We know alcohol and being overweight can increase the risk of getting breast cancer,’ says Ms Mitchell.
'Positive changes to my own lifestyle have come out of my experience. Radiotherapy was gruelling and the side effects continued to cause difficulties months later, such as extreme fatigue and dehydration. But feeling sick forced me to stop smoking, have a healthier diet and take greater care of my body.
'I would advise any woman in her fifties who has not had a mammogram to request one. It could save her life. I believe it saved mine.'
Five years ago, Sarah Styles-Power visited a mobile breast screening unit near her home in Shebbear, Devon, for her first mammogram. It was two days after her 50th birthday.
She was called back for another mammogram and a biopsy at the Royal Devon and Exeter Hospital because a small white dot had been found on her right breast. The following week she had an appointment with the breast cancer nurse who said immediately: ‘I’m sorry, it’s cancer.’
‘I couldn’t believe it,’ Ms Styles-Power says.
Less than a month after her diagnosis she had a lumpectomy. Ten days later, worried her lump had spread, she received the results. The 7mm lump was a grade 2 ductal carcinoma – with clear margins.
‘When I received the news, the breast cancer nurse was there, checking I was okay. I can’t fault the continuity of care I’ve had. Nurses, doctors and receptionists – everyone’s been fantastic,’ she says.
Regularity of care
During five years of regular check-ups and endocrine therapy, breast cancer nurses have been available to call for advice whenever she had concerns. In March, her consultant told her: ‘You’re fine, you’re discharged.’
She believes breast cancer screening saved her life. ‘I regularly checked my breasts. But there was no way with the size of the lump I had I would ever have felt it. If it wasn’t for the mammogram it would have been growing.’