Although many women fail to attend callback screenings at BreastCheck, the majority have nothing to fear. Anne Dempsey reports
The white envelope gave no clue, so I was unprepared for the letter within. From BreastCheck, the national screening programme, it recalled me for reassessment a week after keeping an initial appointment. The accompanying brochure was not reassuring.
Following the first mammogram, further tests were necessary, it said, which could take the entire morning or afternoon. Additional examination could include more X-rays, ultrasound, clinical examination and a needle test. One sentence struck a particular chill. "If you would like to bring someone with you, please do." What did they know? Why would I need such hand-holding?
It had all been so different seven days before. I had received an appointment for the free screening and, having cancelled two previous dates due to a family illness and cowardice in equal parts, this time I had noted the time in my diary and kept it. The event, in fact, had proved less painful than expected, and I had returned home in virtue and triumph.
Now I went to a place of extreme terror, fearful that the two missed appointments and a family history of breast cancer were to be my undoing. I arrived at BreastCheck on the recall Wednesday, in fear and trembling, had a second mammogram, was subsequently given the all-clear, burst into tears and received sugary tea, digestives and kindness.
How representative was my experience? Why are some women recalled, and how much a factor is fear for those who miss appointments and stay away?
The service, which invites women aged 50-64 for a free breast X-ray every two years, is available along most of the east coast and midlands.
Figures from 2005 released last week reveal that 78,262 women were invited for screening last year and 59,960 attended - just over three in four. What about the ones who don't turn up?
BreastCheck says it makes every effort to encourage attendance, sending each woman a letter and two appointments, with another appointment when next they are screening women from that location.
Sheila Caulfield, BreastCheck's communications officer, says fear can be a big issue in the women who stay away. "There can be fear of what might be found, bearing in mind that we are inviting well women to attend. There is fear of compression and pain during the mammogram. There may be embarrassment at breasts being perceived as too small or too large. There may be practical difficulties, transport, literacy difficulties, not understanding the benefits of screening and other cultural reasons." Cultural reasons can include our being more accustomed to a curative rather than preventive approach, and the way women can put their own health at the end of the family queue.
According to BreastCheck, about one woman in 20 is called back for further tests, and staff will contact them if necessary to ensure attendance.
"On reassessment morning there is a multidisciplinary team in attendance offering a thorough and speedy service knowing that this is a very anxious time," says Caulfield.
Last year, 1,923 women, or 3.2 per cent, were recalled - most receiving a positive result with no detection of early cancer. What are the reasons for a callback screening that subsequently gives an all-clear?
Joanne Hammond is BreastCheck's radiography services manager. "The radiographer is looking for any small patterns or patterns and changes in the breast tissue. The initial mammogram can suggest that some such change has occurred, and we may need to take an extra film to get an extra view or to do more tests to ensure that the situation is benign."
In 2005, cancer was detected in 318 cases, a ratio of 5.3 cancers per 1,000 women screened. "These women are offered the best treatment available with the best possible outcome. As breast cancer is very treatable if found early, breast screening is accepted as effective protection against breast cancer, allowing the maximum number to be detected at the earliest possible stage," says Caulfield.
A straw poll of acquaintances who have attended BreastCheck yields a variety of responses regarding fear. One is pragmatic: she is invariably recalled, and eventually gets a thumbs-up. Another friend curled up in a foetal position, convinced, like me, that her hour had come. Fear can play a part particularly if there is a family history of cancer, breast surgery or malignancy. A recall can trigger memories of other losses, particularly at a vulnerable time.
BreastCheck is aware of the effect of that letter landing on the mat. "We don't send it out too soon; we give you just two days' notice to get organised, so that you're not wracked with worry for days," said my support nurse after I received the good news. On checking, I found the letter, dated the day of the initial mammogram, had not been sent out until five days later.
BreastCheck is not yet a national service, and many women in the west of Ireland would be glad of the opportunity to undergo the rigorous screening involved, even including a callback. For those of us who do have the luxury of this service, putting your head in the sand on receiving such a call is not a sensible option. Ignorance is bliss, but being wise is not a folly - it could be a lifesaver.
• To contact BreastCheck, tel: 1800 454555 or visit www.breastcheck.ie