Breast screening advice during coronavirus: What you need to know

According to research, nearly 1 million women in the UK may have missed life-saving treatment after breast screening delays due to the Covid-19 pandemic. Mammographer Johanna Kelsey of One Welbeck in Central London tells us what we need to know…

  1. What is the national breast screening age?

NHS screening is from age 50yrs and takes place every 3yrs (some NHS screening centres are covering from age 47yrs), but privately, screening can be done every year. Breast screening is voluntary, but patients can self-refer for mammograms from the age of 40yrs. 

Some patients like to go for a screening every 18 months, so they go for a private one first and then after 18 months they will be get screened under the NHS to reduce risk even further. 

For extra security, it is very important that patients keep a record of where their imaging was previously done, so that their mammograms and scans can be compared year on year.

  1. Is there a chance that patients could have breast cancer younger than the national screening age bracket?  

Yes, absolutely.  It was recently reported that the NHS is looking to widen the age bracket for breast cancer screenings.   The results of a clinical trial from 23 years ago by researchers from Queen Mary University of London show that screening women aged 40-49yrs led to a 25% reduction in breast cancer mortality in the first 10 years.

The results also revealed that total years of life saved from breast cancer in the intervention group was estimated as 620, which corresponds to 11.5 years saved per 1,000 women invited to earlier screening.  Based on the UK population of women in their 40s, that translates to somewhere between 300 and 400 lives being saved every year if the screening age was lowered and there was a 70% uptake.

  1. How can patients check for symptoms whilst at home whilst waiting for a screening?  

Self-examination. It would be best to check breasts, neck and armpit every month (not every day) to get to know how their breast tissue feels as everyone is different.  Try to get into a routine so you become familiar with your breasts.  Checking whilst showering, or putting on body lotion, with fingers flat – checking in a mirror so that the underside of each breast can be checked. 

It is suggested that all adult women should self once a month, in the same way each time. If a woman is of menstruating age, then around day 15 of the menstrual cycle is the optimal time to self-examine If a woman notices any change that she is concerned about she should request medical advice.

Self-examination tips

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Ensure to use flat fingers together so as not to squeeze the breast tissue. 

Here’s what you should look for:

  • Breasts that are their usual size, shape, and colour
  • Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor’s attention:

  • Dimpling, puckering, or bulging of the skin
  • A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
  • Redness, soreness, rash, or swelling

Step 2: Now, raise your arms and look for the same changes.

Step 3: While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

What to do if you find a lump

Don’t panic if you think you feel a lump in your breast. Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign (not cancer). There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.

  1. What is the likelihood that a missed Cancer diagnosis will continue to develop into a more aggressive cancer if not attended to quickly?  

Very likely – the earlier any cancer is detected, the easier it is to treat.  

According to research published in The Lancet recently, there have been changes in health-seeking behaviour since March 2020, with urgent 2-week-wait cancer referrals decreasing by up to 80% in response to physical distancing and concerns about contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Additionally, some form of physical distancing is expected to continue for up to 12 months, which will probably further affect the number of admissions to health-care services.

The effect of delayed appointments on patients with cancer is not immediate, and premature death as a result might occur up to 5 years later and will differ according to tumour type.

  1.  Are there any other more efficient options for patients who are concerned about a delayed or missed screening for breast cancer?

Self-refer. Breast cancer treatment has evolved significantly over the last 30 years. There are numerous treatments available but each treatment his bespoke to a particular patient and a particular type of breast cancer.

Self-referral for a mammogram and/or ultrasound in the first instance is advised.  The very latest and most advanced breast screening equipment will soon become available at OneWelbeck Women’s Health Suite. 

The latest technology installed at Enhanced Breast Screening offers 3-D capability, meaning it is designed to scan and detect cancer in dense tissue breast, where cancer can go undetected using older mammographic technology.  

The new Digital Breast Tomosynthesis (3D) technology is proven to detect 20 – 65% more invasive breast cancers compared to 2D alone, an average increase of 41%.  It also helps to have a Mammographer of many years of experience to create good diagnostic images along with the expert Consultant Breast Radiologists to read the Mammograms, supported by AI technology.  These Radiologists will also perform the imaging examinations necessary to determine the next path, such as those specially selected at OneWelbeck. 

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