Intended for healthcare professionals

CCBYNC Open access

Rapid response to:

Research

Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g366 (Published 11 February 2014) Cite this as: BMJ 2014;348:g366

Rapid Response:

Re: Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial

Dear Sir/madam,
I note the above recent research paper with interest. In particular I wish to highlight a sentence in the conclusion and policy end paragraph:

"Nevertheless, education, early diagnosis, and excellent clinical care should continue to be provided to women to ensure that as many breast tumours as possible are diagnosed at or less than 2 cm."

I am a gynaecologist in private practice in Hong Kong. My sister, age 49, was diagnosed with breast cancer in the UK on the basis of a mammogram. It was 5 cms. When I asked her had she felt it, she said no, and that no-one had ever advised her to check her breasts. My sister was very lucky to be node negative, but after chemo and a local excision she did need a mastectomy. She received excellent care in the NHS. However had she been doing monthly breast self-examination I believe she would have picked up her “lump” when it was below 2 cms--perhaps 6 months – 1 year before--and she would not have needed the mastectomy.

Regular gynaecological check-ups of women in the UK is limited to a pap smear by a practice nurse every 2 years. I don’t think a bimanual examination to check for adnexal masses is ever done as a screening strategy for ovarian masses in the general practitioners offices. I don’t think a breast examination or advice to do breast self-examination is “routine”. I have asked my British clients here about whether they were ever advised to do, or taught how to do a breast self-examination in the UK, and 50% said no.

I think treatment of women’s cancers can be improved by earlier detection. Not by bumping up mammography numbers, clearly, given this Canadian study. But by improving screening strategy at the general practitioners offices.

Yours faithfully,

Sally Ferguson

Competing interests: No competing interests

14 February 2014
Sally A. Ferguson
Gynaecologist
OT&P,
5/f,Century Sq,D'Aguillar St, Hong Kong