African Woman and Child Feature Service

As a breast cancer survivor, I read with great concern views expressed recently in regular column in a local daily where the writer (a doctor) appeared to discourage women from taking screening mammograms arguing that “A mammogram is a screening tool used when there is a suspicion of breast cancer already”.

This is factually incorrect since by its very definition, the word ‘screening’ cannot take place where a disease is already being ‘suspected’, but it is normally used a prevention measure to either established whether you are free from breast cancer or if incase the screening establishes that one has the cancer, then doctors are able to effectively decided which way forward.

Therefore a mammography is an X-ray exam of the breast that can be used as a screening tool to detect early breast cancer in women experiencing no symptoms – with the operative words here being no symptoms. Screening mammograms make it possible to detect tumors that cannot be felt in a physical examination and can also find microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer.

It is a fact scientifically validated by several large studies conducted around the world that breast cancer screening with mammograms can reduce the number of deaths from breast cancer for women ages 40 to 69, especially for those over age 50 by upwards of 30% to 40%.

For this reason, countries such as the UK accord women over the age of 50 free screening mammograms every year at the expense of the state. Although studies conducted to date have not shown a benefit from regular screening mammograms or from a baseline screening mammogram (a mammogram used for comparison) in women under age 40, but we do also know that many women have had their breast cancer diagnosis at age 40 from baseline mammograms.

I am living proof of this having been diagnosed at age 40 on a baseline mammogram despite the fact that a clinical breast exam by my gynaecologist did not yield any lump.

Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of breast cancer has been found. This type of mammogram is called a diagnostic mammogram. Such symptoms may include pain, skin thickening, nipple discharge or a change in breast size or shape.

A diagnostic mammogram may also be used to evaluate changes found during a screening mammogram, or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances such as the presence of breast implants. Where a mammogram is used for screening, there are clear guidelines and not every woman who walks in for screening is sent for mammography. I believe that this is what is happening in the ‘Free Screening Clinics’ being conducted by many hospitals in October every year.

As someone who have gone through the suffering of having a breast cancer and also seen many women going through the same, I can recommend that;

• Yearly or biennial mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health;
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over; and
• Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

It is recommended that some women -- because of their family history, a genetic tendency, or certain other factors -- be screened with MRI in addition to mammograms. In Kenya many women do know their familial history or genetic profiles and even in western countries, the number of women who fall into this category is small: less than 2% of the women in the US.

Since breast cancer is the most diagnosed cancer and the second cause of cancer deaths among women in Kenya, shows that incidences of breast cancer are on the rise and those being diagnosed are getting younger. With this in mind breast screening and in particular mammography screening which has saved the lives of women all over the world is the way to go for women in Kenya.

It is therefore reckless and irresponsible to suggest that women should shun mammography screening. I wish to urge Kenyan women to ignore charlatan advice and take control of their health by making informed choices. ‘Knowledge is Power’. And the same way we are encouraged to visit the VCT’s and know our HIV status, it should be in the same spirit that women should go for breast screening and if in the process one is referred for a screening mammogram – take it. It might mean the difference between life and death.

The Writer is the Vice-Chair of the National Cohesion and Integration Commission and also a member of the Kenya Breast Health Programme

This article also appeared in the Daily Nation on 12 October 2010