It took a bit of time for that to sink in at which point I headed off to investigate where this article had originated and what these people were on when they put the results of their analysis together.
Well darn me if it didn’t date back to 28 July this year when the esteemed British Medical Journal published their findings. In short
‘Objective To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening.
Design Retrospective trend analysis.
Setting Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).
Data sources WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.
Main outcome measures Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.
Results From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10-15 years.
Conclusions The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.’
Who do these people think they’re kidding?
Perhaps their findings would be different if European women were screened at a younger age and more frequently.
Anyone reading this will know at least one person who has died/ recovered from /is currently fighting breast cancer, their stories are legion but most will thank the powers that be that mammograms are available.
I’ve experienced both the USA and European attitudes to mammograms and the differences are startling.
In the USA you have a mammogram at age 40 to establish a baseline and annually thereafter. In the UK/ Netherlands from 50ish (depending if anyone remembers to alert you to screening and that’s a whole other story) every three years.
Over zealous americans? Perhaps you might think so, but their philosophy is sound. The Americans are great believers in preventative medicine as it saves money in the long run, better still, it benefits the patient.
I well remember my surprise when my US doctor sent me for my first mammogram. We had no family history of breast cancer and it all seemed a little over the top, until she said the chilling words, ‘The screening will give you a baseline for any changes that might happen in the future. By the time there’s a lump it will be too late.’
Hearing that makes you focus. Two years later I was recalled with an abnormal mammogram which subsequently turned out to be okay but gave a few sleepless nights all the same.
The first time I was up close and personal with breast cancer was back in 2005 when two girlfriends, both British, one living in the USA and one in the UK
were diagnosed with breast cancer, neither having a family history of the disease. Both were in their mid forties. Their diagnosis, treatment and recovery could not have been more different.
My friend in the US, lets call her Jenny, went for a regular screening around Thanksgiving 2005 – this after the stress of Hurricane Katrina when she was living in Alabama where she’d evacuated with her children.
The mammogram showed several areas of concern, which they’d been watching from previous mammograms, had developed and she was diagnosed with having two very aggressive types of cancer. Neither could be seen without the mammogram – no lumps, no feeling ill. Time was of the essence but having previous mammograms for comparison helped the doctors more accurately asses her prognosis.
Her options were discussed. Treatment and medication for the rest of her life and no guarantee it wouldn’t come back, or double mastectomy and reconstructive surgery.
I remember a long talk with her after she’d been given the options and time to make her own investigations. The thought of treatment, medication and watching her shadow for the rest of her life wasn’t an alluring prospect. If the cancer did come back she’d be undergoing surgery ten or twenty years down the line, older, maybe less healthy. She elected for a double mastectomy, brave woman that she is.
The surgery took place in February 2006, after surgeons had discussed how it would be done to make reconstruction easier. This in New Orleans where breast cancer patients from all over the states were trying to get surgery, despite the post hurricane devastation. The hospital was reputed to have some of the best mastectomy/ reconstruction surgeons in the country.
It was still pretty brutal – home after a few days and nursed by friends. Attached to tubes and drains and in post operative pain, at no time she did she bemoan her fate. Her only comment was. ‘However bad this is, I’m just grateful to be alive. If we’d been at home in England I would have died before they knew I was even ill.’
By June 2006 her reconstructive surgery had taken place. She was pert, pretty and glowing. At our July book club she was radiant, healthy and ready to grab life with both hands.
My friend in the UK, we’ll call her Liz, developed her cancer at exactly the same time.
In her case she’d never had a mammogram, being under 50, but found a small lump, less than the size of a small pea. Well, her husband found it but that’s a different story. She reluctantly headed to her GP who duly and without much concern sent her off for a screening.
The news was devastating. Aggressive cancer, double mastectomy required immediately. Trying to take it all in there was little time for discussion about post operative treatment, options for reconstruction, alternatives. It was made clear the operation was needed within a week or so.
She and her husband discovered their local Health Authority could not schedule a surgery for two months, but if she were to pay to go privately the adjoining Health Authority could do it the following week. Her doctors made it clear two months was too long to wait. They scraped together from family and friends the £8000 required and she headed off to the hospital.
There are no words to describe what happened except to say she was butchered. No thought as to what may or may not be possible for her afterwards. It was assumed she’d be so grateful for being alive that this pretty, vivacious outgoing woman would be happy wearing standard issue bras filled with prosthetics for the rest of her life. Prosthetics which rubbed and chaffed her painful scars.
She dressed and undressed in the dark away from her loving husband, who couldn’t have been more supportive. He wept to see her so distraught when he was just relieved she was still alive. She started not going out, wearing baggy clothes spiraling down into depression. She felt she shouldn’t complain, rather be grateful and deal with it. She’d been told reconstruction would not be possible due to the botched surgery.
Then she found strength from somewhere and started to fight back.
Three years after the initial surgery she had reconstruction work done using new techniques, and phoned me in great excitement to tell me they could make new nipples too.
I saw the end result physically and mentally. Seeing her for the first time after all this was emotional and heartwarming – she glowed, was vibrant, happy and loved every second of her life. As we left and my husband went ahead out to the car Liz stopped me, whipped up her T-shirt and said, ‘What do you think of these then? Pretty good aren’t they? Don’t have to wear a bra or anything!’ That much was obvious and I have to say they looked totally real. I was thrilled for her. At her 50th birthday party she was dancing on tables.
Two women in different countries sharing the same journey.
I’m not here to make political statements or say what should or should not be done when a woman is diagnosed with breast cancer. Health care systems differ in attitude and how they are funded. I’m sure people in the states have had bad experiences and I know people in the UK have had good ones. What seems incredibly sad is that there is so much discrepancy in diagnosis, treatment and mental/ physical support.
What I do know is that if anyone has a wife, mother, grandmother, sister, daughter, granddaughter, aunt, niece, or daughter in law who is diagnosed with breast cancer they will want the best possible care for them.
And in most cases that first line of defence is the mammogram. Period.