Medical Q&As

Breast cancer - angry with doctors?

I have just learned that my mother who is now 83 years old has cancer. She was taken into hospital for an X-ray on her chest because she was short of breath. A lump has now been found in her right breast and the doctors say that it has spread extensively to her lungs. They say that the lump could possibly have been there for as long as 1 year. How is it possible for this to happen at her age? Also she was in hospital last September when she took a dizzy spell. She was sent home then with a clean bill of health. In fact we were told that she was a very strong woman for her age with a great strong heart. What are the procedures in Irish hospitals when old people are taken in unwell? Is it common practice to completely examine these patients? I am very angry that this has been discovered now and not a year ago.

Breast cancer in the elderly can be just as aggressive as that found in younger women. Approximately 40% of all breast cancers occur in women over the age of seventy. The mammogram remains the cornerstone of breast screening. BreastCheck, the national screening service for breast cancer is only currently available to women that reside within the catchment areas of three health boards, namely the Eastern Regional Health Authority, the North Eastern Health Board and the Midlands Health Board. However, your mother would not have been a candidate for screening under the terms of this programme because of her age. BreastCheck provides screening for women between the ages of 50 and 64. With regard to your question about admission procedures it is standard practice for all patients to be fully examined when being admitted to hospital. That examination would include a breast examination. With regard to the comment that the cancer could have been present for a year or more it is important to emphasise that a cancer can be present without being clinically detectable. The cancer is very likely to have been present when your mother was assessed in September but she might not have had a palpable lump at that time. Breast examination has a low sensitivity rate with regard to detecting breast cancer. For example breast self-examination has a sensitivity rate of between 20 to 30% and has been shown to make no impact on survival rates. In other words if every woman examined her breasts on a regular basis no more than 30% of breast cancers would be detected and the overall survival rate of women with breast cancer would not improve. Clinical examination of the breast also has a poor sensitivity rate at approximately 50%. That means that if every woman in the relevant age group underwent examination of the breast only one in two cases of breast cancer would be detected. I can sympathise with your hurt and anger about your motherís illness but it would be wrong to reach the conclusion that she had a palpable lump when she was last in hospital and the doctor failed to detect it. My central point is that the cancer is likely to have been present but may not have been clinically detectable.