Consultant Surgeon & Surgical Director
Gilmore Groin and Hernia Clinic & 108 Harley Street Breast Clinic
108 Harley Street
What to do about delayed screening?
It is sobering to think that, in this day and age, we still don’t really know the causes of breast cancer: the problem is that there just isn’t a single cause. There are likely to be many, interacting, factors causing the fundamental change that turns a normal breast cell into a cancerous one. These will include genetic and environmental influences, as well as lifestyle choices (most importantly smoking, obesity and drinking excess alcohol).
On top of that, every breast cancer is different and within any breast cancer there will be many different types of cell. It’s not a single disease, it’s many different diseases that happen to occur in the breast. Hence the push for “individualised care”, where analysing a cancer’s genes can guide the treatment, all of which we embrace at The London Breast clinic, here at 108 Harley Street.
Early bird catches the worm
So, if you can’t prevent it, it’s important to make sure that it is detected early. Breast screening plays a role, but also you need to be aware of, and report, any changes. Breast screening uses low dose x-rays of the breast (mammograms) to detect small breast cancers, before they are big enough to feel, and pre-cancerous changes (referred to as ductal carcinoma in situ). Treating early breast cancers gives a much higher chance of cure. Organisations such as Breast Cancer Now and Breast Cancer Care publish helpful guides on what to look out for.
It takes (more than) two to tango
Once a breast cancer has been diagnosed treatment should be carried by a “Multidisciplinary Team”, including breast cancer surgeons, x-ray specialists (radiologists), cancer specialists (oncologists) and pathologists, as well as specialist nurses, plastic surgeons, physiotherapists and councilors. The team will meet weekly to discuss each patient and to make sure that the best treatment is being offered without delay. Without doubt, this team approach, along with early detection, has helped improve the outcome for breast cancer patients in the United Kingdom.
The COVID 19 barricade
The comfortable “normality” to which we have all grown accustomed, of seeing the GP with potential problems and being referred to the appropriate consultant, has been overturned by the current, unprecedented, COVID 19 pandemic. It has affected everyone in one way or another. While the NHS has been magnificent in coping with this health emergency, having to set aside so much of its resources has, unfortunately, had a knock-on effect on other services, with the investigation and treatment of many other conditions being delayed or deferred.
A recent article issued by the Cancer Research UK (link to: https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-trea tments/) revealed how COVID-19 has had a significant impact on cancer care, with over 2 million people estimated to be waiting for their cancer screening and treatments because of the pandemic. In addition to the lack of resources, it is also possible that some vulnerable patients, and those with chronic conditions, are reluctant to visit their GP because of concerns around contracting COVID 19. With so many GP interactions now being done remotely it may not be possible to get all of the important information to know whether a patient needs referring. Potentially this means that some patients who should be referred will not be, whilst many who do not need to visit a hospital (and risk contracting the virus) may be sent for, ultimately, unnecessary investigations.
Reality kicks in
Those concerned about breast cancer may have found their clinic appointments postponed, and almost everywhere the NHS Breast Screening Service has been suspended. The inevitable result of this is that some women will have their cancer diagnosis delayed. No one knows how long it will take to catch up again, but it is likely to be at least 6 months. There could be up to 10 million people waiting for NHS treatment because of the pandemic. Now, it could be argued that a delay in diagnosis of 6 months for an early breast cancer will not affect the outcome, but that may still leave many people anxious, and, of course, we can never be sure. Even when the NHS Breast Screening Programme resumes there will not only be a backlog but there will also need to be changes in how it is carried out. To meet with social distancing requirements, the capacity of mobile screening units may fall to one third of normal, increasing the delays, and the potential anxiety, for women.
Having a mammogram privately could be a route that some women might want to explore, but even that may not be so simple. Most private hospitals are under contract to the NHS during the pandemic to help treat NHS patients, and so capacity for private care is limited. Many of these contracts are being extended so that, in many places, the provision of “normal” private services may not resume until the Autumn. Although all private hospitals have taken measures to try and avoid NHS patients with the virus these steps are unlikely to have been 100% successful. The so called “silent spreaders” are difficult to detect.
Setting us apart
Here at The London Breast Clinic, 108 Harley Street, as an Outpatient Diagnostic and Treatment Centre, we have not been treating NHS patients and remain a “clean COVID protected” site. Our expert team of specialist radiologists and surgeons are all back, not only for our old patients, but to help anyone with a new problem and anyone who may be concerned about delays to their diagnosis and treatment. Women can also ask for a mammogram, here at 108 Harley Street, without a doctor’s referral, if their screening has been delayed.
So, to give yourself the best chance of surviving breast cancer (should you develop it), get it diagnosed early (through breast screening or by reporting any changes) and have it managed by a cohesive team of specialists, to ensure that there are no delays in your investigations and treatment.