May 15, 2017

Dear Sir
We are recently retired breast cancer surgeons from Kent enjoying more time in our home in Benissa.
May we comment on Maria Ferrer Miraller’s campaign for routine mammograms to be offered to all women over 30 years of age.
In our opinion, however well intentioned, this would be misguided. Thankfully, breast cancer is very uncommon under 40 and so the vast majority of these women would be undergoing needless irradiation at a time when many consider breasts to be more susceptible to actually inducing malignant change.
As mentioned in your article, young breasts are denser and cancer easily overlooked. In other words, there is an established higher false negative rate.
Conversely, because of the difficulties in interpretation at this age, many more women would be recalled for further assessment than in older women. This would cause a great deal of unnecessary anxiety and unnecessary biopsies.
The correct approach is to seek out those at increased risk of developing breast cancer. The biggest group is those with a strong family history of breast cancer, although there are other groups. For women concerned about these risks, special family history clinics have been established across the UK for many years.
After taking a detailed history and establishing a family history tree it is possible to select those at significant increased risk. Gene testing is offered to this group and for those with positive BRAC 1 or 2 gene abnormalities, or other reasons, better screening with regular breast MRI is offered. In addition, the option of risk reducing surgery is discussed and made available on the NHS for those who choose it.
So please campaign for the establishment of specialist family clinics run by suitably trained staff and not for the wholly inappropriate routine screening of women under 40.

Yours faithfully
Peter and Sue Jones


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