|Volume 6 Issue 113 Published - 14:00 UTC 08:00 EST 22-Apr-2004 Next Update - 14:00 UTC 08:00 EST 23-Apr-2004||Editor: Susan K. Boyer, RN
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Info on breast cancer detection techniques, confusing, culturally insensitive, misleading
Information on breast cancer detection techniques, such as screening and self examination, is confusing, culturally insensitive, and misleading, concludes an analysis in the Journal of Medical Ethics.
The researchers base their findings on a trawl of print and web material on screening, breast awareness, and self examination techniques, as well as 20 focus group discussions, 12 of which were held in languages other than English.
The women taking part in the discussion groups had never had breast cancer and lived in Hackney, a culturally diverse but deprived area of north east London. The discussions aimed to assess women's understanding of breast cancer and the three methods used to encourage early diagnosis of the disease.
The women said they were unsure what to look for when trying to detect abnormalities. All the illustrations showed only pictures of healthy breasts, with no visual clues. And the pictures were usually of white breasts, with guidance pointing to different colouration as a sign that something might be amiss.
The information also conveyed the idea that breast cancer occurs predominantly in younger women, with illustrative material showing firm young breasts rather than the breasts of older women: half of all cases are identified in women over the age of 65.
The Screening Programme information says that women who fall outside the age span of coverage will not be invited for screening, but can request it. This advice fails to convey any sense of urgency, say the authors.
Information was also confusing, the analysis suggested, with an uncritical use of idiom and metaphor, say the authors. For example, breast self examination guidance dismisses pain/tenderness as a normal part of the menstrual cycle, while breast awareness leaflets suggest new or persistent pain or discomfort are signs to look out for. A leading cancer charity's website warns women to be on the look-out for pain and discomfort, but then says that pain without other symptoms is unlikely to be due to cancer.
Women also said they were confused about the time frame in which breast cancer could develop: breast awareness demands constant vigilance, while the national breast cancer screening programme sends out invitations every three years. Some cited this as a reason for a lack of faith in all three detection methods.
Guidance covered only what to look for before and after the menopause?never during?while there was nothing for women taking hormone replacement therapy, which affects the consistency of breast tissue.
Breast self examination has been discredited since research was unable to prove that it reduces the death rate from cancer, yet it continues to enjoy support from non-governmental sources of health promotion information, say the authors. And breast awareness, which enjoys the support of the Department of Health, has not been scientifically tested, they say.
The authors are also critical of the lack of clarity about the value of early detection in terms of whether it saves lives, reduces the need for extensive treatment, or both, and the level of risk individual women face.