Breast Cancer: Questions & Answers
Following on from our introduction to The Complete Guide to Breast Cancer, Dr Liz O’Riordan and Professor Trish Greenhalgh have answered readers questions:
I would like to know why mammograms are the compulsory test option after turning 40 years old? Why not ultrasound?
Alma Viviana Silva
Breast screening was introduced for women between 50-70 in the UK to pick up breast cancers at a much earlier stage, before a lump could even be felt. For a screening test to work, it has to have a high level of accuracy, with enough capacity to cope with a large number of patients, and it has to be cost-effective. A mammogram is quick and easy to do (regardless of breast size), is reproducible, and is the most accurate screening tool we have. The NHS breast screening programme only starts at 50, because breast cancer is relatively uncommon in younger women.
Ultrasound is great for assessing breast lumps, but it’s not a great screening tool. It might take a good 30-60 minutes to fully scan two large (eg J cup) breasts, and it still might miss things. Also, ultrasound is not good at picking up the very small cancers that a mammogram can.
Anyone under the age of 40 with a change in their breast should have an ultrasound if the person examining them can feel something. If you are over 40, you will generally be offered a mammogram as well. This is because mammograms are less accurate in younger women as their breasts are more dense.
What advice can you offer someone who’s worried about telling their employer about their diagnosis in case of discrimination?
This is a tough one. Not every employer is friendly and it’s easy to imagine that telling them will do more harm than good. Firstly, you don’t have to tell them anything. However, if you don’t and you find it hard going back to your job, they are under no obligation to help you. If you do tell them, then legally they have to make reasonable adjustments to help you get back to work – such as part time hours or reducing your duties. This is because anyone with cancer is classified as disabled under the Disability Discrimination Act. Your employer is not allowed to discriminate against you.
If you have a work / union representative, you could take them to any meeting with your boss. The Macmillan website has lots of great advice for you and your employer, and it helps if you know exactly what your legal rights are before any meeting. Also, make sure that your employer knows they cannot pass on your medical details to anyone without your consent. It might help to prepare a list of people that you do want to be told about your diagnosis, such as Human Resources.
I had an occult breast tumour which wasn’t picked up by a consultant even though you could feel a large mass. Ultrasound, MRI etc didn’t show it. How common are occult tumours and why isn’t more said about them?
Less than 1% of all breast cancers are missed on screening or examination, but it can happen. If you are young with dense breasts, it can be harder to spot a small breast cancer on a mammogram. However, if there is a palpable lump / dimple / skin change, USS and MRI will normally pick up a cancer. If you have a lobular cancer (that comes from the breast tissue instead of the milk ducts) this grows in sheets instead of a cluster, which makes it harder to see on a mammogram, USS and MRI, like Liz’s tumour. Finally, a very small number of women notice lumps in their armpit which turn out to be lymph nodes with breast cancer cells, yet a cancer in the breast is never found.
We strongly advise you to examine your breasts and armpits regularly, so you know what is normal for you. The Breast Cancer Care and Coppa Feel websites have great tips on how to do this. If you do feel anything that isn’t normal, go to your GP to get it checked out
My mother passed away from breast cancer when I was 14. I’m in my 30s now and worry I will get it too, especially as I have a teenage daughter who I want to be around for, but at the same time I keep putting off asking my GP as I have no symptoms. Can you offer any advice for biting the bullet?
Many people worry about getting breast cancer if someone in their family had it. Only 5% of breast cancers are actually due to a faulty gene (BRCA) that has been passed down from a parent. This is more likely if you have 3 or 4 relatives with breast cancer who were diagnosed at a young age.
Most breast cancers happen simply because women are getting older. As a general rule, if you only have one relative with breast cancer and they were over the age of 40 when they were diagnosed, you are not at substantially increased risk. If you have two or more relatives who were in their 40s and 50s (or younger) when they first developed breast cancer, it is worth going to see your GP to see if you might need to be referred to your local breast unit for more advice.
A good tip for anyone who is nervous about approaching their doctor or nurse with a question is write down what you want to say before you go into the consultation, and what your ideal outcome is, and if necessary, just read out what you’ve written.
My emotions have been all over the place since my diagnosis, my family probably think I’m going a bit crazy, how do I deal with these changing feelings and reassure my family?
We’ve been there! Wild emotions are part and parcel of a cancer diagnosis and they can come on even years afterwards. You’re not ‘abnormal’ for reacting in this way.
We don’t have a magic recipe for eliminating the mood swings, but one tip from our own experience is to tell them how you’re really feeling, instead of putting on a brave face. You could say “I’m afraid I’m feeling a bit tearful today”. This will allow your family to interpret your talk and actions in context.
If you feel like you’re having to provide emotional support for other people in the family, ask one family member if they could take on that role – or at least, share it with you. Finally, you could ask your breast care nurse if you could talk to a Macmillan counsellor.
Thank you to everyone who submitted questions, we hope these answers have helped. Each of the questions authors will shortly receive a free copy of The Complete Guide to Breast Cancer.
Further information and support can be found via Breast Cancer Now, Breast Cancer Care, Cancer Research, and Macmillan Cancer Support and you can purchase a copy of The Complete Guide to Breast Cancer below or in eBook format here.
The Complete Guide to Breast Cancer : How to Feel Empowered and Take Control - Professor Trisha Greenhalgh
The book you can trust to support you at every stage of your treatment - and beyondWinner of best 'Popular Medicine' book, BMA Medical Book Awards 2019 Professor Trisha Greenhalgh, an academic GP, and Dr Liz O'Riordan, a Consultant Breast Cancer Surgeon, are not only outstanding doctors, but they have also experienced breast cancer first-hand. The Complete Guide to Breast Cancer brings together...