According to recent statistics released by the NHS, only 70% of women who were entitled to a routine mammogram last year actually turned up to their scheduled screening.
That means close to a third of all women in the UK aged between 47 and 73 – somewhere in the region of 90,000 – are likely to be at risk of unknowingly living with breast cancer, not because they failed to show up for a mammogram appointment, but because they haven’t made arrangements to have alternative screening.
I’m a big critic of mammography for all sorts of reasons, not least because it’s been proven to lack effectiveness, often results in false positive or false negative diagnoses and has been shown to risk triggering cell mutation that results in an avoidable cancer diagnosis.
But it has other drawbacks, too.
Even if it were 100% accurate it would only ever be able to confirm you have or don’t have breast cancer at that particular moment. At roughly 65% accuracy – which is what mammography currently delivers – it can’t even do that.
It’s also a very unpleasant and often very painful experience. The breast tissue is crushed under heavy metal plates (this is the physical trauma that research shows can initiate the cell mutation I mentioned earlier).
Mammography also puts women at risk through irradiation. Research from the world-renowned Cochrane Institute showed that for every death mammography prevents, it puts 10 women at unnecessary risk.
Because of the way screening policy is applied by the NHS, there are a great many women who are routinely excluded from the monitoring process due to not being of a qualifying age but who are nevertheless at risk of breast cancer.
Whilst there is less risk the younger you are and younger women also have higher breast tissue density, making it difficult for mammography to identify a tumour, cancer doesn’t play by chronological rules and has no respect for the NHS’s position on patient care.
So, if it’s not effective, not preventative, not completely without risk, excludes a significant proportion of the UK’s adult female population and is painful for many patients, why does the UK health system continue to put its faith in mammography as the sole breast cancer screening tool which is made freely available to women?
It’s a good question and one that other countries have either already asked and answered or are considering.
In the case of Switzerland, mammography has now been abandoned as a screening tool because it is deemed so ineffective as to be of questionable value. Other countries, including France, are weighing up the benefits of taking the same step.
But regardless of the efficacy of the technology, what can’t be ignored is that 30% of the UK’s female population who qualify for screening have such little regard for mammography that they are instead prepared to put themselves at increased risk of contracting breast cancer.
The response to this level of absenteeism from appointments is curious. The problem is not a new one, and each time research brings the issue back into focus the default answer is a PR campaign to urge women to turn up for their scheduled appointment.
There is little evidence that the NHS or Public Health England is looking seriously at an altogether more important question: why are women forsaking their health in such numbers?
If mammography doesn’t have the confidence of the very people it is designed to benefit, then there is a clear responsibility for those who administer our health system and set its policies to find out why.
Only then will they perhaps seriously examine the overwhelming body of evidence that exists in opposition to mammography screening.
Only then, perhaps, will they start to seriously consider the complementary screening tools that are safer, have greater holistic benefit for general breast health and have much greater scope for diagnostic accuracy.
Only then might women in the UK have the opportunity to really take control of the way their breast health is managed.
Are we saying that we should take the Swiss route and abandon screening mammography completely? No – at least, not until there is an alternative in place to succeed it.
But what we are saying is that mammography alone is not up to the job of giving wholesale protection to every woman who needs it and that screening technology such as breast thermography – which uses thermal imaging cameras to monitor changing tissue temperatures to gauge health risks – has its place alongside mammography as an additional complementary check.
When Thermography is done correctly, studies show it has exceptional reliability as a breast health assessment tool even in younger women as it is not affected by breast tissue density.
There are many women who visit us for thermography because they aren’t convinced of either the safety or effectiveness of a mammogram and they simply don’t want to be another statistic in a flawed system.
Not all of the 90,000-odd women who fail to turn up for a mammogram miss their appointment because of a lack of faith in the process. But equally, it’s a huge number that will not be made up simply of people who would have gone but forgot.
While such level of doubt exists over the worth of mammography those who shape the NHS’s cancer screening have an ethical duty to explore and consider other technologies and offer patients the option to choose them as an extra safeguard for their health.
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