Professor Arnold Hill:

A woman is diagnosed with breast cancer in the symptomatic service where I work. Every time we diagnose a patient with breast cancer who has had a mammogram in the previous year, be it in the symptomatic programme or the screening programme, we openly discuss that with the patient. We ask if she would like to see her previous mammogram and we will have it reviewed. There is an excellent process in the screening programme whereby if a woman has had a screening mammogram, we contact the service to say that she has been diagnosed. The service will offer to sit down with her and go through the mammograms. Frequently, it may not have been seen on the previous mammogram. That is the nature of this test. There is real openness there.

What I find in my personal practice when I am dealing with a woman who has just been diagnosed with breast cancer and discussing this openly with her is that it is the last thing on her mind. What she wants to know is the plan of treatment, will she have chemotherapy and how long it will take. They are the sort of major issues. There is a policy and all practicing breast surgeons will offer this to women but is very rare for them to take it up. If they do want to, there is a superb service in BreastCheck whereby two independent people will review the mammogram and the clinical leads will meet the patient. It is very rare that women want this. They want to get on with their treatment, be it surgery or chemotherapy.

It takes approximately nine months for a patient to undergo all her treatments between chemotherapy and radiotherapy. We see her in follow up. We follow her up for five years and we frequently ask if she wants to go through that but she usually wants to move on. It is not a major issue in clinical practice but there is a very open climate about asking if she wants to look back. We know this is going to happen because of the limitations of the test. A mammogram is not a perfect test. We are familiar with this. Where we see approximately 400 breast cancers a year, there will be 30 or 40 women each year in the symptomatic service whose previous mammogram did not show it. We are very familiar with the environment and what to do in that case. There is a really open plan to discuss it with the women.