Screening has failed, the check it yourself breast cancer survival guide

There is growing disquiet in the medical community. The NHS breast-cancer screening programme, which invites all women to have three-yearly X-rays (mammograms) from the age of 50, has been said by some doctors to 'do more harm than good'.

This, coupled with the fact that one woman in eight now develops the disease 5,000 more diagnoses a year than a decade before and reports that many cases are dismissed by GPs who don't recognise symptoms, makes for confusing reading.

What all experts agree on is that early diagnosis is key to successful treatment. 'When a breast cancer is picked up through a routine screening mammogram, it's often cured,' says Lester Barr, a consultant breast cancer surgeon at the Christie Hospital in Manchester.

'When the disease is picked up through discovering a lump, the chances of a cure drop as the cancer is likely to be more advanced.'

Mr Barr admits that screening, which was introduced in 1988, could be improved but women should not be put off having mammograms. 'There is an argument that screening catches tiny tumours that would never have grown, meaning women go through unnecessary worry and treatment. And perhaps we need to better target women who are at risk.

'All women need to make sure they are doing enough themselves to ensure early detection. There are still women who know surprisingly little about how a breast should feel and look.' Here, Britain's leading experts give their essential guide that every woman should read.

LOOK FOR FAMILY PATTERNS
Breast cancer is hereditary in ten per cent of cases so it is vital for a woman to know her family history, says Professor Gareth Evans, consultant in genetic medicine at St Mary's Hospital in Manchester. 'Look for any patterns on one side of the family such as a mother, grandmother, aunt and first cousin who have been diagnosed with breast cancer. If there are at least two first-degree relatives – ie a mother and sister – who have had the disease, the risk is greater,' explains Prof Evans. The younger a woman is diagnosed the more likely it will be that her breast cancer has been caused by an inherited defective gene.

IF THERE IS HISTORY, GET A GENE TEST
The rogue genes, known as BRCA 1, BRCA 2 and P53, can be identified through a blood test. But this can be done only if a woman has a living relative who has had breast cancer and can provide a blood sample. Those who carry the genes have an 85 per cent risk of getting breast cancer. The options for women with a strong family history or who have been identified as carrying the faulty breast-cancer gene include yearly MRI scans and mammograms on the NHS. 'Together these can pick up 90 to 95 per cent of breast cancers early,' explains Prof Evans. 'But some women opt for a pre-emptive strike by having their breasts removed.'

Prof Evans is leading a study into the use of the drug tamoxifen, which may reduce the risk of breast cancer by 40 per cent. 'Do'’t take the contraceptive pill if you have a strong family history as the drug has been linked to an increase in risk,' says Dr Anne Trigg, a consultant medical oncologist at Guy's and St Thomas' Hospital, London.

ALL WOMEN MUST BE BREAST AWARE
Mammograms are not effective for women under the age of 50 as the breast tissue is still too dense. If there have been isolated incidents of breast cancer in the family, you can always consult your GP for an examination. 'Aside from lumps, they are looking for areas of the breast that feel subtly different from the rest  limpness, a harder area or a breast that feels more granular,' explains Mr Richard Sainsbury, consultant breast cancer surgeon.

Unexplained tiredness can be early symptoms of the disease. 'It's not necessary to do constant self-examinations,' says Mr Sainsbury. 'But be aware of any changes – particularly heaviness, distortions, or a change in size or shape.'

A RED RASH IS A RED ALERT
'Inflammatory breast cancer, which accounts for between one and five per cent of breast- cancer cases, can make the skin red and swollen, but it is often misdiagnosed as cellulite or a skin infection,' Dr Trigg says. 'Look out for a new and itchy rash around the nipple, discharge from the nipple or any difference in shape and size. It could be normal but always get it checked by your GP. And always check armpits for lumps.'

CHECK MONTHLY AFTER YOU HIT 30
Dr Trigg says: 'From the age of 30, self-examination should be done once a month, midway through the menstrual cycle.'

Using the pads of the fingers, feel in small circular motions round the breast and then move in smaller concentric circles until you reach the nipples.
Cover the entire breast from top to bottom, side to side.
Do this lying down, and then feel your breasts while you are standing or sitting.

'In the ten years leading up to the menopause, breast tissue begins to turn to fat and this can cause benign cysts,' adds Mr Sainsbury. 'Cancer can be ruled out by mammogram or biopsy. See your GP, who will refer you to a specialist.' Be familiar with the appearance of your breasts, checking that they are their usual shape, size and colour and appear symmetrical.

THE QUESTION: TO HRT OR NOT TO HRT?
At present women of 50 are called for a three-yearly mammogram through the NHS screening programme. But Prof Evans says: 'A third of breast cancers are picked up in the three years between mammograms.'

Self-examination is vital after the age of 50 when breasts may look different. A loss of volume can cause dimpling in the skin and as this can also be a sign of breast cancer, get it checked.
Prof Evans tells menopausal women with a family history to avoid hormone-replacement therapy as artificially raising hormone levels can increase risk of breast cancer. The hormone oestrogen, which can drive some forms of breast cancer, is produced by fatty tissue. So the fatter you are, the bigger the risk.

AFTER SCREENING STOPS . . .
Screening stops at the age of 70. If women wish to continue, then they can request it, explains Barr. He says: 'By the age of 80 any lump is likely to be breast cancer. Women should be aware of any changes.'

By ANGELA EPSTEIN