AS I SEE IT
BY MARIANNE HERON
Confronting the possibility that there is a potential killer in your body is not easy, yet it is something that many women do routinely. Being aware of the threat posed by breast cancer, which affects one in seven women, is important. Not something that is on my mind everyday but something that definitely came to the fore when I went for a Breast Check appointment.
There is something about having a tender part of your anatomy clasped by a machine, a bit like being the sandwich in a toast maker, which concentrates the mind. The ‘what if’ element of the experience, where I wondered if something sinister had been found, continued for days until I got notification of the results, especially when I was called back for a repeat test, which happily turned out to be clear. But having the check is a sensible measure which gives routine reassurance for women.
Currently more than 51,000 women are waiting for that reassurance beyond the two-year period for repeat mammogram tests, and 4,455 women aged over 50 have not received their first invitation, it emerged in Dáil question time last week.
Breast Check is a free test available in Ireland for women between 50 to 69. The delays are due to staff shortages, especially radiologists, and to increased demand due to our growing population where the numbers eligible for the check have increased by 19% since 2019.
Sure, there are similar delays in other areas of the health service, but when it comes to breast cancer timing is critical. The earlier the detection the better the chance of recovery and the less invasive the treatment.
Mammography is seen as the cornerstone of breast cancer detection, according to Arnold Hill, consultant breast and general surgeon at Beaumont Hospital and Chair of Breast Cancer Ireland. Breast cancer is the second most common cause of death from cancer in Ireland with up to 3,700 cases detected and 750 deaths annually with women aged over 50 most at risk.
Crucially early detection increases the five-year survival rate by 95%. The test detects cancer in around nine to 10 in every one thousand women. Women themselves can be backward in coming forward, with about 30% not attending for Breast Check.
Somewhere between 25-40% of cases are self-detected when women notice a lump in breast tissue or some other symptom and 18% are found by accident. Reassuringly though most breast lumps – about 90% – turn out to be benign.
The delays for testing are worrying though, particularly given the still raw memories of the cervical cancer scandal where false negative smear test results led to deaths that might have been avoided. The cover-up over the false negatives issued to hundreds of women in 2011 and not uncovered until 2017 was exposed by the late Vicky Phelan who took a High Court Case against the HSE and the Clinical Pathology Laboratories in 2018. Between 209 to 221 women were misdiagnosed and tragically several, including Phelan who died at the age of 48, went on to develop terminal cervical cancer.
It seems as though nothing has been learned about the importance of early detection.
Ironically, though the delays are happening at a time when technology involved in precision oncology is improving detection and treatment rates. Robotics, targeted therapies and new drugs are set to improve outcomes while international trials have found that AI improves detection rates in reading results by as much as 30% while reducing radiologists’ work by almost half.
Mammography, says Arnold Hill, “is a powerful tool, but it’s not perfect. Some cancers can be challenging to spot on a mammogram, especially in patients with dense breast tissue. With increasing demand for screening, many countries, including Ireland, have a shortage of breast radiologists, the highly trained doctors who read mammograms. This outs pressure on the system and can lead to delays in diagnosis”.
Meantime, it is hoped that staff shortages with key vacancies radiologists and radiographers will be filled by the end of the year. Reassuringly, the majority of women who need further appointments after screening have follow up assessment within the target time frame.
It’s the difference that early detection makes to five-year survival rate that really brings home its importance. The overall survival rate is 89% according to the National Cancer Registry, while for those detected early at Stage One the rate is 99%.
