Interval Breast Cancers
Posted 9/27/2012
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Interval cancers are those that appear between screenings. Meaning: you have a mammogram in March that is read as normal. In November, you feel a lump, see a doctor, have another mammogram or ultrasound or MRI (or all of the above), have a biopsy....and it is diagnosed as breast cancer. How did this happen? Was it not there in March? If it was not there, that feels really scary as it may mean that the cancer is growing wildfire quickly. Was it there and no one saw it? If so, that is scary, too, as we need to trust that the techniques are good and the radiologists are excellent.
This comes up quite often in my practice, and women agonize over the unanswerable question. The absolute bottom line is that it probably does not matter much. We are where we are. It is what it is is, and the only reasonable plan is to go on from here. But surely those middle of the night thoughts intrude and nag at us and make it difficult to sustain hope and trust in the screening and surveillence systems that we have.
This is a bit different than breast cancers that never show up on mammograms -- and there are plenty of those, too. My 1993 cancer was a case example: I felt it, had an additional mammogram that showed nothing, had a biopsy and there it was. The explanation for those cancers is usually dense breasts where mammograms are not so helpful (remember the old simile: like trying to spot a polar bear in a snow storm.)
This is an article from Social Science and Medicine about these issues:
Mammography screening and trust: The case of interval breast cancer
Marit Solbjør, John-Arne Skolbekken, Ann Rudinow Sætnan, Anne Irene Hagen, Siri Forsmo
Interval cancer is cancer detected between screening rounds among screening participants. In the Norwegian Breast Cancer Screening Programme, 19 per 10,000 screened women are diagnosed with interval cancer. We conducted semi-structured interviews with 26 such women. The women interpreted their interval breast cancer in two ways: that mammography can never be completely certain, or as an experience characterized by shock and doubts about the technology and the conduct of the medical experts. Being diagnosed with interval cancer thus in!uenced their trust in mammography, but not necessarily to the point of creating distrust. The women saw themselves as exceptions in an otherwise beneficial screening programme. Convinced that statistics had shown benefits from mammography screening and knowing others whose malignant tumours had been detected in the programme, the women bracketed their own experiences and continued trusting mammography screening. Facing a potentially lethal disease and a lack of alternatives to mammography screening left the women with few options but to trust the programme in order to maintain hope. In other words, trust may not only be a basis for hope, but also a consequence of it.
Read more »
(you have to register to read the whole study, but it is free to do so)
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