Did screening lead to the death of my wife, Tish? There is no definitive answer to this question and it is a possibility. The question re benefits and harms re breast and prostate screening rages on. The giants hurl stats at each other and we are encouraged to screen.

This video is a must see. For the speaker, professor Baum, breast cancer is an upfront and personal issue. His mother died from it and it runs in his family. He was a professor of surgery in a teaching hospital in London. He, with others, set up the first breast screening clinic in Camberwell, London. He’s as expert or giant as they come.

About 14 years ago my wife decided not to have any further mammograms, not an easy decision for her. She was in town 12 years ago when she heard of a friend’s recent breast cancer diagnosis, she arranged an appointment. There was some hesitation about the findings on the mammogram. After a needle biopsy the histology report stated that the lesion was an invasive ductal carcinoma.

The power of that word carcinoma or cancer is quite extra ordinary. The news felled me, even though I knew her outlook was pretty good.

After surgery we found out that the tumour was less than 1cm. There were no nodes effected. It was HERS negative, oestrogen positive and progesterone negative. It was grade 1. She was advised not to have chemo or hormone treatment. Clearly she was low risk but was advised to have radiotherapy.

There are various calculators out there. Here is one you can used on your mobile. Tish’s chances of being alive in ten years time was somewhere between 90 and 92%. Let’s take the 90%. Take 1000 women in Tish’s situation aged 60. In ten year time 900 would be alive and 100 dead. Somewhere between 5 and 10 would have died from breast cancer and the rest from other causes, a substantial number from heart disease.

We knew post surgery advice to have radiotherapy would be forth coming. I researched this. There is debate as to whether radiotherapy in breast cancer effects overall mortality especially in low risk patients like Tish. It reduces deaths from breast cancer but increases deaths from long cancer, heart disease and maybe sarcomas. Over all mortality includes deaths from any cause.

Decision making requires an assessment of absolute risks, and the decision may depend on the histopathologic characteristics of the tumor and on a woman’s comorbidities and life expectancy. For example, even if we accept that the mortality increase of 8.6% (from not having radiotherapy) applies to all women, a 65-year-old woman with a 1-cm estrogen receptor–positive tumor and negative lymph nodes would have a minuscule improvement in survival due to radiotherapy

The above was Tish’s situation – a minuscule advantage, with regards to overall mortality, with having radiotherapy and yet exposed to all the potential harms. There is no doubt that radiotherapy reduces the risk substantially of local recurrence in the breast. This fact is a clincher for a woman like Tish in fear of dying from breast cancer. However once a person has radiotherapy, if they have a recurrence, the next offering is total mastectomy. If they don’t have radiotherapy and have a recurrence the next offering is radiotherapy. From my readings there is debate as to whether there is any difference in mortality between these two options.

Tish had approximately a one percent increased risk of death in ten years compared to a woman of her age with no diagnosis of breast cancer. If there is an overall survival benefit of say 10% with radiotherapy, then this reduces her risk by 10% of 1, from 1% to 0.9%. I am willing to be corrected on my maths.

Let’s take a look at the harms of radiotherapy. Here’s a page from the NHS in the UK. Pretty much wherever you look radiation induced cancers are mentioned last and to my mind minimised. Here is some evidence that Tish’s cancer was induced by radiotherapy. She had many lesions in her lungs and liver. There was no way of knowing where it started. The biggest were in the liver. If this is where it started maybe that makes radiation as the cause unlikely. If it started in the lungs, then maybe it was the radiation, no way of knowing. She did have a cough with blood stained sputum for a few weeks before she became unwell!!

In a calculator, used by oncologists, that used to be on line adjuvantonline.com, the health of a patient made a difference to the numbers and Tish was in extremely good health. She did drink a bit but otherwise was of impeccable habits, vegetarian, walker, meditator, regular yoga routine, organic foods, a giving and generous person. It’s my opinion she would have been better off not having radiotherapy. I believe there is a clinical trial going on which is looking at low risk patients like Tish to see whether there is overall benefit or harm with use of radiotherapy. Maybe her hepaticangiosarcoma was caused by a genetic mutation caused by a plutonium atom entering her system. Whatever the truth of the matter it’s difficult to make the best decisions when our life is threatened and we are scared.

One more point – how long does it take for a radiation related sarcoma to present? What is the latency period. Do the clinical trials last long enough to pick these up? Looks like its 10 to 20 years.

I talked with Tish about my findings re radiotherapy and my concerns that there could be more harm than benefit. Prior to our visit to her surgeon she asked me not to argue with the man. I began to ask about harms and benefits of radiotherapy. The specialist, a guy I liked, turned to Tish and said “don’t listen to him”, some answer to my question. I had to clam my mouth shut.

A few months ago I went to see a therapist. I was surprised but not surprised that after some major sobbing up welled aa rush of intense rage for Tish’s specialist. I gather at the time his wife was suffering form some kind of metastatic. But……..