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Theme 01: Risk

BCNA News 03 Jul 2017

PRE-DIAGNOSIS ISSUES

MISSING THE BREASTSCREEN BUS

While BreastScreen Australia services are provided for women in remote areas of every state and territory, services are delivered from a mobile centre. If women are away when the bus visits, they are less likely to participate and are generally unaware of what they should do to start or catch up with the two-year BreastScreen cycle. For Aboriginal and Torres Strait Islander women, there is an added difficulty if BreastScreen buses provide clinics during ‘men’s business’ when women are not able to leave their community to participate, or clinics are set up on men’s land.

BREAST DENSITY

Women are not routinely told about their breast density, and most do not understand that breast density can be a risk factor for breast cancer. Western Australia is the only state where women are advised if they have dense breasts. They are advised that their screening mammogram is less sensitive to breast cancer than those who do not have dense breasts, and that they may need additional screening tests and encouragement to be vigilant to the signs and symptoms of breast cancer. As the debate around how to assess and manage breast density continues among health professionals and researchers, women who were found to have an interval breast cancer (cancer diagnosed between regular screening mammograms), who was then advised they had dense breasts, reported feeling angry they were not informed about their risk.

POST-DIAGNOSIS ISSUES

Most women who have experienced breast cancer understand at least some of their options for acting on their own risk of recurrence. However, when there are practical barriers or information gaps, they are less confident that they can keep on top of their own risk profile. Sixty-seven per cent of Member Survey respondents were worried that their cancer may recur.

FEAR OF RECURRENCE

Women who have had breast cancer often experience anxiety prior to follow-up screening. They worry that screening will detect a new or recurrent cancer. They reported that their anxiety impacted the whole family. They are also prone to experience fear and anxiety whenever they have pain in other areas of the body, and want to know how to access quality information to deal with this anxiety, including advice on when not to worry. They do not understand the evidence around why additional tests and scans are not included in routine follow-up care, or why early detection of asymptomatic systemic recurrence does not improve

survival.

DIET AND EXERCISE INFORMATION

Thirty-six per cent of Member Survey respondents who reported needing information about physical activity and healthy eating said only some or none

of their information needs had been met. In the consultations, some women reported that they didn’t understand what they were ‘allowed’ to do, and

therefore hadn’t changed their behavior. Exercise was rarely a topic of discussion with their treatment team. This is a disappointing finding considering the volume of emerging evidence that highlights how regular exercise before, during and after treatment reduces the severity of side effects and the risk of new and recurrent cancers.

ALCOHOL

Research is increasingly exploring the role alcohol may play in increasing the risk of a breast cancer diagnosis or recurrence. A number of women who participated in the Member Survey expressed uncertainty about the recommendations around alcohol consumption and how alcohol may impact breast cancer risk.

FEAR FOR DAUGHTERS

Even if women do not have a strong family history, many reported that they were fearful for their daughters following their own diagnosis. Daughters who attended consultations were also worried about their risk, with many taking up screening much earlier at their own cost.

FEAR FOR MEN

Men with breast cancer expressed their concern that there was significant anxiety among other men who understood that they could be diagnosed with breast cancer, but are not included in screening programs.