Reviewing screening mammograms with newly diagnosed patients is another unnecessary burden

EDITOR—Paterson wrote about the unnecessary burden placed on patients with newly diagnosed cancer in discussing cancer registration.1 Patients are shocked at the diagnosis of cancer and have to work hard to get to grips with the news and its implications. When their participation is appropriate in treatment decisions—for example, in early stage breast cancer—they need to urgently understand the issues as treatment often cannot start until the type of surgery has been chosen. Talking about cancer registration is an irrelevant distraction at this time.

In addition, doctors must also talk to patients who have previously had screening mammography about the already established, routine process of review of the films and ask whether they wish to be informed about the outcome of that review; the discussion and the patient's decision must be documented. This is another unnecessary burden. It has another dimension, as well as being a distraction and a source of misery. If the clinician concerned with diagnosis and treatment has to undertake the exercise, it associates him or her with the issue of failure of the screening process and thereby erodes the confidence the patient needs to develop with her clinician just at the crucial initial stages of their relationship.

Were doctors consulted about this? The instruction seemed to come as a hurried response to adverse publicity about cervical screening, anticipating the knock-on effects on breast screening. Alternative approaches should be considered. For example, the issue could be addressed in writing, at a time separate from the diagnostic and treatment consultations, the letter signed by a representative of the breast screening programme other than the patient's surgeon. We as surgeons are very willing to answer patients' questions about possible or actual missed diagnoses and will continue to answer such queries made during early consultations. Like Paterson, however, we are unwilling to add a further unnecessary burden to patients with newly diagnosed cancer.