Interview 17

Age at interview: 69

Brief Outline:

Attended for routine breast screening. Abnormality on mammogram led to excision biopsy. DCIS was discovered. Chooses not to attend for screening mammograms.

Background:

An Independent advocate for quality in research and healthcare, and writer. Widowed with 2 adult children.

Discusses different kinds of cancer screening and their costs.

I think each type of screening has to be looked at very thoroughly in its own context and there's no 2 types of screening that are the same. Angela Raffles described cervical screening so clearly and I think, when you say cervical screening the thing that pops into my head is the economic aspect of it. I can't remember all the figures but millions of women years, certainly to save a life without any doubt, but all those other grades of cancer that have worried the wits out of thousands of women. Again the downside of screening, without adequate initial information so that a woman at the outset can make up her mind whether to go or not. 

That's a whole different set of parameters to judge. And when you think of the money and effort that's been spent on all that, yes, it's produced benefit but how often do we look at the, both the personal cost and the financial cost of doing that? Is it the best of way of tackling that problem? I don't know the answers but I know what the questions are. And then again, I think prostate cancer is the one that intrigues me more than anything because when I think of the shortcomings of the PSA test and the terrible dilemmas it can put both patients and doctors in when they find, let's say a slightly elevated, what does it mean? We don't really know what it means so you've got a whole series of uncertainties and decisions to make which I think is a horrible thing to impose on men.  

And I wish they would look at the economics of it [breast screening], too, because, you know, '57 million I think it is a year, for what?  I'm not quite sure, it's a bit scary. It could be better spent, I feel. 

Had assumed that breast screening was a good thing until her DCIS diagnosis and decided not to...

Well, they sent me the usual leaflet that they send out. I know it's been modified since but, to be honest, not very much. No, because I think I had trust in the notion that they wouldn't be doing this if it wasn't any good. It seemed too preposterous to think that they would summons millions of women to give them a mammogram if there wasn't some benefit in doing it. 

In retrospect, of course, I think quite differently about these things because I am one of the screens where something was found.  

Certainly because it was responsible. It's there; they're offering it. They wouldn't go to all this trouble if they didn't know what they were doing. And I think trust comes into it more than anything else; trust in the profession. 

And since then I haven't, well since, I can't remember which year, but certainly for many years I haven't had another mammogram because do I want to find ductal carcinoma in situ again?

Bearing in mind that most breast cancers are found by the women themselves anyway, and bearing in mind that I know a thing or two now, what is the window of opportunity for finding something that might be significant? I prefer to take a more sort of sane and balanced view about going and looking for trouble. So either I will or I won't, if I get a recurrence, find it in sufficient time. It depends upon the sort of cancer I may or may not get. It might be a tiny, aggressive one, which will be curtains anyway so what good would a screening have done? It might be another ductal carcinoma in situ, which will take another thirty years to get anywhere significant so, bearing in mind how old I am [laughing] does that matter? I think not. 

Discusses why she will have no more screening after her DCIS diagnosis.

Bearing in mind that most breast cancers are found by the women themselves anyway, and bearing in mind that I know a thing or two now, what is the window of opportunity for finding something that might be significant? I prefer to take a more sort of sane and balanced view about going and looking for trouble. 

So either I will or I won't, if I get a recurrence, find it in sufficient time. It depends upon the sort of cancer I may or may not get. It might be a tiny, aggressive one, which will be curtains anyway so what good would a screening have done? It might be another ductal carcinoma in situ, which will take another 30 years to get anywhere significant so, bearing in mind how old I am [laughing] does that matter?  I think not. 

So, and my philosophy is today is the day that matters. You know, be reasonably sensible about what's life but don't go looking for trouble and don't think you can guard against all the uncertainties and quirks that are going to go and flip you round the ear because I'll probably die of double pneumonia or something when it comes to it (laughs).