Health: How I became a mammogram junkie: OK for now, but come back next year. Annabel Ferriman asks how many women are, like her, addicted to endless breast screenings

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It all began back in 1986. A mobile screening unit, run by the Women's National Cancer Control Campaign, visited my workplace and I conscientiously booked an appointment for a cervical smear and a breast examination. It seemed a responsible thing to do at the time, particularly since, as a health journalist, I was frequently telling everyone else to do so.

When the doctor discovered that I had a breast lump and that I had a family history of breast cancer (my grandmother died from it), she advised me to see my GP and ask for a hospital appointment and mammogram (breast X-ray). Little did I realise that I would end up a mammogram junkie.

My GP agreed that it would be sensible for me to go and see a specialist. As it was in the good old days, before the Government's health reforms, you could go to whichever hospital you chose. So I asked to go to St Bartholomew's, London, which had an open clinic every Wednesday for anyone with a suspicious breast lump.

I was duly given a mammogram, which showed that I had some areas of calcification - calcium deposits in the tissue - appearing as white flecks on the X-ray. These can indicate the presence of a tumour. The hospital also examined my breasts which, as usual, were lumpy. Like many women, I am prone to develop cysts which feel malignant but which are, in fact, benign.

The doctors hummed and hawed. They eventually put off making a decision by suggesting that I should come back in a year for another X-ray.

That started a process which has lasted for eight years. Every year I go for a mammogram; every year they tell me to come back the next. The procedure varies slightly from year to year; sometimes they carry out one or two further procedures, such as sticking in a needle to draw off some liquid for analysis; and sometimes they don't.

Once a junior doctor said I ought to come into hospital for a biopsy, under general anaesthetic, so that they could check out the lump they were concerned about. Then another, more senior, doctor walked into the cubicle and countermanded the instructions, saying it was unnecessary.

Last year, I was invited back for a procedure called stereotactic aspiration cytology, where they stick a needle into your breast under the guidance of an X-ray machine, so that they can remove cells from the exact area of the breast that is worrying them. The results were negative.

All this should be reassuring, but it has left me a nervous wreck. I know some doctors will now be thinking: 'Why is this ungrateful woman complaining? She has obviously had wonderful preventive health care from a brilliant team of specialists at huge cost to the NHS.' And women who have cancer will be saying: 'What has she got to whinge about?'

In many ways, they are right. I have been checked and re-checked by experts at one of the most prestigious medical institutions in the country. But instead of reassuring me, the procedures have left me convinced that it is only a matter of time before I get the bad news. I have been given the impression that although my results are not actually positive, they are not exactly negative either.

Should the health service be regularly screening pre-menopausal women like me? The X-rays are often hard to read and interpret because the breast tissue is denser in younger women. I cannot help wishing that at the beginning of all this, a consultant had said: 'You obviously have lumpy breasts and a slightly increased risk of cancer because of your family history. Why don't you have regular three-yearly mammograms so that we can keep an eye on you?'

It would have saved the NHS money, the doctors a lot of work and me an accelerating dose of radiation. But unfortunately, the NHS is largely staffed by junior doctors who are not experienced enough to make decisions like this. Follow-up patients hardly ever see a consultant.

In fact, two and a half years ago, a senior doctor did suggest that I wait for two years before my next mammogram. But I was already hooked on the system and after 15 months, my nerve cracked. I found another lump and I was convinced something nasty was developing. I rang up and asked for my appointment to be brought forward. The result was the same.

So the saga goes on and I am now back to the annual X-rays. I have made another appointment for my next mammogram, in January 1995.

Can women like me ever be weaned off the screening treadmill? Will the round of X-rays continue endlessly until they finally find that dreaded lump? And how many other women are in the same position?

Breast cancer diagnosis and treatment: some current concerns

THREE days ago the British Medical Journal published a series of articles on breast cancer, its diagnosis and treatment. Two of them were very critical.

In one, Professor Karol Sikora, head of clinical oncology, at the Hammersmith Hospital, London, calls for an independent inquiry into those women who have been injured by radiotherapy given to treat their cancer. The cancer may have been adequately treated but some women have lost the use of an arm as a result. The risk of this type of injury is put at 1 to 4 per cent, he writes. The pressure group Rage (Radiotherapy Action Group Exposure) has found 2,000 women who have been injured and who allege inappropriate treatment.

The second paper shows how, four years after the publication of the 1986 national guidelines for good practice in the treatment of breast cancer, women were still receiving treatments that did not conform to those guidelines. And, although the women were diagnosed in 1990, the researchers from the Thames Cancer Registry believe that the differences were so marked then that the situation will not have improved significantly since.

In particular they point out that only 5 per cent of women being treated for breast cancer were included in clinical trials which would reveal the best possible treatment combinations.

Medical Screening: the Way Forward, a conference organised by the 'British Medical Journal', will take place at the Queen Elizabeth Conference Centre, London SW1, on 26 January.

(Photograph omitted)

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