So you think you’re “breast aware”

Everyone wants to know what led up to my diagnosis of breast cancer, especially the women. They usually ask one of two questions: “Did you find a lump?” or “Did they spot it on a mammogram?”. In my case, the answer to both is no. The questions, however, imply that we’re not as savvy around our breasts and breast cancer as we perhaps think we are.

With me, there was no lump. There was, rather, a hardening in an area of the right breast. Or rather, sometimes it felt hard and  sometimes it didn’t. I do appreciate the literature on being “breast aware” couldn’t be clearer on that point. The NHS leaflet, for example, says: Any lumps, thickening or bumpy areas in one breast or armpit which seem to be different from the same part of the other breast and armpit [are] very important if new. However, it was really only when the right nipple became less prominent than usual that I realised I needed to do something about it.

I’d always prided myself on being breast aware. Indeed, I’d been proactive in arranging to have a mammogram under the NHS breast cancer screening programme after I turned 50 in 2013. Two friends had been diagnosed with breast cancer that same year so, instead of waiting to be called in for a routine mammogram, towards the end of the year I phoned and asked for an appointment. I had my first mammogram January 2014; it was clear. They kept me on the system and nine months later I was called up for what would have been my routine appointment. So I had another mammogram last October; that too was clear.

So what happened with that latest mammogram? Was the cancer there and they missed it? That happens more often than most of you would probably think. Or was there really nothing there at the time? I’ll find out at some point as they review as a matter of course all cases of “interval cancer”, ie cancers that are diagnosed between one scheduled mammogram and the next. Even if it’s the latter, though, it’s worth remembering that a mammogram is really just like a photo – a record of a moment in time – and that, according to a government report from 2011, only around a third of breast cancers are diagnosed through screening.

I was proactive in requesting a mammogram, but what about that thickening? How long had that been going on? I honestly don’t know but the tumour was already big (probably bigger than 5cm) and had spread to at least one axillary lymph node by the time I was diagnosed. Both those factors have huge implications in terms of treatment options and the likelihood of recurrence. In medical terms, my cancer at diagnosis was Stage IIIa. That’s still counted as early-stage and, as I’ve said in previous posts, it’s being treated with curative intent.  But we’re having to use every weapon in the armoury to get rid of it and to reduce the chances of it coming back down the line: chemotherapy, mastectomy, lymph node removal, radiotherapy and long-term hormone therapy.

How much difference would it have made if I’d gone to my GP earlier? By a week or two? By a month or two? We will, of course, never know. It’s impossible to tell with any precision how long a cancer has taken to get to its current stage, although they can tell the type, ie whether it’s slow-, medium- or fast- growing. Mine, as fate would have it, is Grade 3. That’s the highest grade, and it means it’s fast-growing.

So let’s be clear. The stage of the cancer at the time of diagnosis is extremely important in terms of planning treatment and predicting outlook. The earlier it’s detected, the easier it is likely to be to treat it, the better chance of a cure, and the better the long-term prognosis.

Ladies*, I don’t know whether you’re reading this thinking “well done for going when you did” or “what an idiot not to have gone sooner”. Now ask yourself at which point you think you’d have gone to your doctor if you’d been me. Was I breast aware or not? You decide.

Breast cancer is rare in women under 50. That said, whatever age you are, you need to make sure you know what’s normal for you, that you know what changes to look for, that you look for them, and that you report any changes without delay. Early detection can be key to survival. It’s as simple as that.

*Of course breast cancer can affect men too, but those cases account for around 400, ie under 1%, of the almost 55,000 cases diagnosed in the UK every year and most men who get breast cancer are over 60.