Kristin Hallenga is now a name familiar to us all. Back in 2009 at the age of 23 years she was diagnosed with stage 4 breast cancer. Whilst a diagnosis of these proportions would usually cause people to retreat into themselves, to look for solace in routine, be amongst family and friends. Kristin had other ideas. Why hadn’t she been aware of the importance of self-examination? Would this knowledge have rewritten the course her life has now taken?
She tells her story eloquently. How her story is not to be told as one of tragedy but one of success. She wants to educate the young people of Britain about regular breast examination, to have the courage to speak up if something is wrong, to reduce the stigma associated with cancer and ensure it does not claim lives needlessly due to late diagnosis. Less than two months after diagnosis and Coppafeel! was born, it’s message and reputation far far reaching. Kristin being the brain-child, she has penned her own story with an inspirational 360 spin.
Amongst magazine articles, interviews, winning a Pride of Britain award and the BBC documentary ‘Kris: Dying to Live’ the campaign has been gathering speed and supporters for some time now. On March 4th the charity teamed up with The Sun to launch the “Check ‘em Tuesday” campaign. A small charity at this time with little marketing budget, offered the opportunity to share their message to the 5 million female weekly readers.
I work as a GP and whilst the campaign faced some public criticism it also faced some from the medical profession. This was due to the potential for over-diagnosis, for women under-going unnecessary biopsies of benign lumps. The concern was in part due to the heightened anxiety women would feel in checking their breasts, the responsibility put on them of noticing a change. Plus the lack of evidence base and validity to show self-examination to reduce breast cancer deaths.
I do not share these concerns.
Over-diagnosis is a reality in the medical world and an increasing problem. One of the prime drivers for this are screening programmes for breast and cervical cancer plus the highly controversial PSA test for the prostate. Take as an example routine mammography offered to women aged 50-70 years. This screening programme detects breast cancer early and numerous studies have shown it to reduce the number of deaths. In essence this is health promotion at its very best. But it has flaws, many in fact. Screening saves about 1300 lives from breast cancer every year. On the flip side to this impressive statistic are the 4000 women diagnosed each year with a cancer that will never cause them symptoms and never threaten their life. Treatment of these cancers exposing women unnecessarily to the adverse effects of cancer therapy and surgery.
Screening programmes must fulfil numerous criteria to be put in place and the benefit should always outweigh the physical and psychological harm caused by the test, diagnostic procedures and treatment. Despite the figures, mammography meets this criteria, it incurs more good than it does bad. Bearing this in mind when thinking of the question posed by critics – will breast awareness result in over-diagnosis, unnecessary referral and biopsies. Yes of course it will. Mammography, the governmental screening initiative for those most at risk of breast cancer does the very same. It would be naïve of us to think breast awareness would be any different. But knowing what is normal for you is a good thing. Recognising when something changes and seeking appropriate medical advice, surely this can’t be purported as doing harm. What breast awareness seeks to do is simple, more good than bad.
So why is there no evidence base to suggest self-examination improves mortality? Simply because no study has been performed in the last decade. And yet breast cancer mortality has been reducing over this time period with the biggest difference noted in the 15-39 year old age group. The improved survival rates being due to improved detection, increased specialisation of care and better access to more effective treatments. In the absence of screening in this age group improved detection can only be through self-examination and awareness.
Personally, until there is unrefutable evidence to the contrary, I believe breast awareness can save lives. I believe it can increase the likelihood of having a 100% 5 year survival rate with early detection as opposed to a 22% chance. One Wednesday morning, days after The Sun’s Fabulous magazine had run a feature on Coppafeel! a patient brought the article to me having recognised some of the symptoms in herself and found a lump. Two other ladies have since thanked Coppafeel! for their campaign after being diagnosed with breast cancer at an early stage. I find it hard to believe the campaign is doing harm and right now it’s the best we’ve got.