The myth : ‘I’m not medically qualified. I’m no good at breast self examination. Why can’t I get my GP to do this?’
The truth : Self examination of the breast is just another term for ‘knowing your breasts’. There is no wrong way of doing it. I would equate it to knowing perhaps your personal space in the work place or kitchen, dressing table or study. Most of us just ‘know’ when something has been moved. Examine the breasts with a bit of soap on the palms of the hands examining both breasts and axillae while you are in the shower. This should preferably be done a few days following your periods in menstruaters. If you are interested, there are various YouTube videos demonstrating routine st self examination. Any change that has persisted needs a visit to the GP. You are not expected to diagnose the pathology. Even your experienced GP may only be able to go so far as to say – there is a lump palpable. That lump maybe a cyst, a lymph node, a cancer or something else. That can only be decided with further evaluation which includes tests such as mammogram, ultrasound or a combination of the two.
Guidance : The GP should refer patients to a breast unit on an urgent 2 week wait pathway if the patient or they have felt a breast lump.
The myth : ‘I’ve been recalled following a screening mammogram and told I am to undergo an exam called a tomosynthesis. This I’ve been told is a different type of mammogram with a higher radiation dose. This could be dangerous.’
The truth : A tomosynthesis is a 3 dimensional X-ray of the breast (mammogram). It gives more detail and allows the doctor to decide if an area is normal or suspicious, therefore worthy of further investigation.
Guidance : The dose is still smaller than a CT scan and the additional information makes it worth it.
The myth : ‘My friend was recently diagnosed with an aggressive breast cancer. She was told her screening mammogram was normal 18 months ago. Surely this is a case of a cancer missed?’
The truth : The mammogram is a good screening tool but cannot be expected to pick up all cancers. There may be various reasons for this. These reasons include that the cancer may have developed in the interval since the previous mammogram or that the cancer was really subtle and merged with background tissue making it impossible to distinguish. Another reason that a cancer may not be picked up on a mammogram is that it may have been partly hidden by breast implants. Implant density hides the detail on breast tissue during a mammogram. Of course, it is still possible that the cancer was truly ‘missed’.
Guidance : The NHS breast screening programme provides very strict guidance to breast units in the respect of all cancers in screening age women that occur as ‘interval’ cancers. These are reviewed by a panel of breast radiologists who independently assess whether something was missed. There should be open discussion with a patient in whom this may have happened.