Dawn Picken: Personal experience leads to review of evidence on routine screening

Some events are so defining, we divide our life into "Before" and "After", writes Dawn Picken. Photo/Getty.

Some events are so defining, we divide our life into "Before" and "After". Before the death of a loved one; after the move to a new country; before the diagnosis...

I was outside the Papamoa Library two Wednesdays ago when I learned whether my fault line would break. I had just answered a call from Unknown.

"Hi, this is R, the breast care nurse..."

Palpitations of the heart. Inhale through the nose. No time to prep for news.

After four months of waiting to learn whether tiny, suspicious-looking specs, or calcifications, found on a routine mammogram last October were cancerous or benign, I might have an answer.

It took three tries to get here. Three tries before the dodgy microscopic bits would surrender for inspection. Attempt number one, using mammography, involved extreme squashing in standing and prone positions, but no view was clear enough to insert a needle.

Attempt number two involved taking six tubes of tissue with a fat needle guided by ultrasound. "I think we got what we needed," said the radiologist after reviewing samples in-office.

He called a week later to say, in fact, he failed to capture the dubious specs. The doc was trying to determine whether I had microcalcifications indicating DCIS, or ductal carcinoma in situ. It's considered a pre-cancer. Most calcifications are a result of ageing or trauma, not malignancy. Yet digital-imaging equipment allowing detection of these itty bitty bits increases the risk of a false positive result.

Studies show especially for women like me, under age 50, routine breast screening carries additional risk of over-detection, which can mean biopsies, surgery, radiation, drugs, time off work, emotional distress and added costs to the healthcare system for a breast condition that wasn't life-threatening in the first place. About four per cent of women who have a mammogram in the Breast Screening Aotearoa programme will be recalled for further assessment. Of those four per cent, 17 per cent will learn they have cancer. By contrast, in Sweden, where only the most suspicious lesions are biopsied, 80 per cent of biopsies turn out to be malignant.

Whether a country whose district health boards are in debt for tens of millions of dollars each can afford to aggressively follow-up each suspicious cancer screening result is a debate we must continue for the health and wellbeing of our people and our economy.

After biopsy #2, the doc said my likelihood of aggressive cancer was low. Even if I had DCIS, I could wait six months for another biopsy.

I chose to rest my sore boob until July.

As with many other plans, life intervened. This time, in a good way. I signed onto a group tour with friends to run the New York City Marathon in November 2019. Deposits were due. Did I want to spend non-refundable cash without knowing my health status? No, I did not.

I called the breast nurse. Within a week-and-a-half, I was booked for my third biopsy attempt using a new-ish procedure involving a probe and a vacuum. Slightly loopy on expired prescription pain medication, I half-jokingly told one of the nurses in the radiology clinic I felt like I was headed to the guillotine. I fretted about pain and the possibility of another inconclusive result.

Once on the table, I was swabbed with iodine and positioned on my side. An injection of local anaesthetic numbed the area, so I wouldn't feel the large probe. Still, I was practicing loud labour breathing as the doctor inserted one sharp thing after the next. A representative of the device manufacturer was in the room, not just to grow the party, but to guide the doctor. I felt like a giant, lipstick-wearing lab rat. "Push the vacuum button," instructed the rep. "Now, push stop." The rumbling of the machine sounded similar to a pod espresso machine as it grunts out coffee.

The procedure was done in about a half hour and my husband met me in the waiting room. "How was it?" he asked. I told him, "Not as bad as I'd imagined. Can we swing through Macca's for a chocolate shake?" It went down easily, but re-emerged about four hours later. So much for my career as a prescription drug addict - nausea is a side effect of the meds I took.

Back to the phone call. "Your biopsy came back benign," said the nurse. I exhaled, and felt my cheeks widen as I smiled. "Really? BENIGN? Really? That's fantastic news. Thanks so much."

I'm grateful for my new favourite word - benign. About 100 New Zealanders each day aren't so lucky - they hear "malignant", instead. As Joan Didion wrote, "Life changes in the instant." The next instant could be mine.

Knowing friends and family who've caught cancer early or walking with them as they fight terminal disease fuels an urge to scan, screen, scrape and poke every part of our bodies - just in case. But every test has risks and failures. If I feel a lump, I'll get it checked. Meanwhile, I'm switching from annual mammograms to scans every two years.

After a 17-year study in Denmark, researchers reported in 2017 that routine breast screening does not prevent advanced cancers or lower breast cancer mortality. "Some types of screening are a good idea — colorectal, for example," said the lead author, Dr Karsten Juhl Jorgensen, deputy director of the Nordic Cochrane Center. "But breast cancer has a biology that doesn't lend itself to screening."

Before multiple biopsies, I belonged to the more-is-better tribe when it came to breast cancer screening. What harm could it do? Today, I'm a believer in less is more.

Dawn Picken also writes for the Bay of Plenty Times Weekend and tutors at Toi Ohomai. She is a former TV journalist and marketing director who lives in Papamoa with her husband, two school-aged children and a dog named Ally