Sarah Harte: Being proactive and vocal is key to women's health outcomes

After a scare of her own, Sarah Harte learns that women who miss their first breast cancer screening appointment are 40% more likely to die from the disease

Around four out of five breast cancers occur in women aged 50 and over. A third of all breast cancers are detected through the routine screening programme.

October is Breast Cancer Awareness Month. There’s a massive value in the initiatives being run to highlight the facts of breast cancer.

One in seven women are diagnosed with breast cancer, and there are 3,704 new cases of breast cancer detected annually — with only 30 of those being men. However, breast cancer has the highest five-year net survival rate, 85.1%, when it's detected early. It pays to be breast aware.

I have literally come off the back of a breast cancer scare. I was concerned and made that first call to the GP who, after an examination, sent me to the symptomatic rapid access breast clinic at the Orchid Clinic in Cork University Hospital.

It has a dedicated clinical team of doctors and consultants, all focused on women who are displaying symptoms of breast cancer. My GP told me that the team is clinically stellar.

Literally nobody in the packed waiting room spoke. There was a television on, but you could hear a pin drop

It’s not like BreastCheck, which is routine screening for women with no symptoms of breast cancer. In the Orchid Clinic, many women had partners or friends accompanying them. I had my notebook and pen, and I kept writing down random thoughts that I might use someday or not.

I had a clinical exam, followed by a mammogram, and I was released into the wild feeling lucky. Returning to the carpark with a life is wonderful, God is good, spring in my step, no sooner had I turned the key in the ignition and headed down the road than I was rang and told to come back.

They said: “Where are you now?” I asked why. They said that they felt more tests were needed (not the exact words). I turned the car around, abandoned it in a carpark, and sped towards the hospital thinking: "What the hell?"

So, I went back for an ultrasound. This is why I ended up on the hard-backed chair opposite a haunted-looking young man. I had been sitting near him earlier, when he had been with his partner in the first waiting room. In fact, they were right behind me in the queue for initially registering our details at the reception.

I thought she looked quite young, relatively speaking. Around four out of five breast cancers occur in women aged 50 and over.

My eyes met his — it was just the two of us at this point on the hard-backed chairs — but we didn’t speak. In Ireland, we often chit-chat in these situations: "Oh, and what are you in for?" 

However, in this environment, no way. Total silence.

Dense tissue

She and I had clearly "failed" the first tests — which isn’t the clinical way to put it, but it felt like that. The staff were highly professional as I asked why they had brought me back, and managed to provide no information with poker faces while being lovely, simply saying we need to have another look.

You sit opposite the pictures of wigs and ads for prosthetic breasts on the wall and think: “No way this is happening.” 

Apparently, having dense breast tissue, as I do, is a strong risk factor for developing breast cancer and makes it more challenging to detect breast cancer, masking cancer, which shows up as white on a mammogram.

Ultimately, they said that they needed to compare the current mammogram with the one taken through BreastCheck two years earlier and would be in touch. 

It was positive, they said, that I had attended for my routine breast check

A third of all breast cancers are detected through the routine screening programme. Last week, Dr Aliss Connors, the lead director at BreastCheck, said: “Coming for screening every time you are invited is about ensuring you have every opportunity for early detection, and ultimately survival. 

"This October, during Breast Cancer Awareness Month, our goal is to give every woman the facts so she can make an informed choice and, we hope, choose to attend breast screening when invited. We know that 50% of women don’t attend their first screening appointment.” 

This is madness and, if this month does anything, hopefully it will encourage women to take up on appointments. A new study published in the British Medical Journal, which analysed data for roughly  500,000 Swedish women, showed that women who miss their first breast cancer screening appointment have a 40% higher risk of dying from the disease.

Fretting about a diagnosis

I exited the hospital in shock. It was a profoundly lonely moment. At times like that, even if you have brilliant family and friends, which I do, your mind goes into overdrive. 

Waiting for a diagnosis is a cruel experience. It took a long month to get out of the gap. Results go through triple and quadruple checks, the administrator told me on the phone, which is why the clinic is so great. 

However, I spent that month fretting about how a cancer diagnosis would work out on the employment front and how I would afford the time driving from rural Ireland for treatment. 

On the day, the team that dealt with me consisted entirely of female staff members and, honestly, I found that reassuring. New research from Laya Healthcare, part of AXA, highlights a gender health gap — which means that women can face delayed diagnoses, limited access, and less focus in research, not just in Ireland but globally. The study found that women’s health conditions don’t always get the attention they should.

The research also highlights the importance of listening to women and not dismissing their concerns.

Some 37% of women delayed seeking help because they feared not being taken seriously, with 56% of women aged between 25-44 feeling dismissed when discussing their health concerns. Four in 10 women said they felt their health concerns were misunderstood, which they felt led to a delayed or incorrect diagnosis.

This is not a huge surprise. Over the last year or two, I have had many conversations with friends making a switch, feeling that a female doctor would better understand female health, or because they thought their male doctor seemed disinterested in or patronising about their specifically female concerns. 

To be fair, female doctors have an advantage over male colleagues because they know how a woman’s body feels

You wonder, though, if older male doctors need refresher courses in women’s reproductive health. Could it be that there’s an element of traditional, unthinking medical misogyny due to historical medical biases? 

I read one male GP online saying that the notion was "insulting bollocks". Yet, one much-quoted American study last year suggested that hospitalised female patients fare better under female doctors, with the gender of the doctor not impacting male patients' treatment.

Ultimately, though, the first steps are down to us as women being proactive and vocal about our health.

So, check your breasts regularly and grab your invitation to BreastCheck with both hands when you get it. 

There are many resources on self-checking, including the video on the HSE website.

Modern medicine has made strides, but it's better, as they say, not to let the hare sit.