Breast Screening Services

Yesterday I attended a public meeting of the HSCNI Local Commissioning Group, which was presenting a ‘Pre-consultation, consultation’ on the provision of breast screening services in Northern Ireland. The presentation included a slide showing a >30% increase in breast cancer deaths since 2011 yet the presenter made it clear that the intention was to address only how increased numbers of people seeking screening services were to be provided for. This struck me as a wonderful problem for a manager tasked with planning how to increase the capacity of a railway network but completely inappropriate for a branch of the National Health Service whose central function is to protect our citizens, not to ignore the reasons for their illness and the ineffectiveness of the treatment protocols provided. She then explained the complexity of the clinical teams that are assembled to support the screening programmes and how services can be disrupted when team members, with multiple commitments, are unable to attend. One possible solution being tabled was to reduce the number of specialist centres in Northern Ireland where breast screening services are provided, from the current five, so that larger numbers of staff can be trained to increase flexibility for the clinics. Cancer cells produce energy through the inefficient fermentation of glucose in the mitochondria rather than the normal process of ‘fuel and air combustion’ used by healthy cells. One of the observable hallmarks of cancer is that of ever-increasing demands for the limited resources available to the body. Metastasis in Stage 4 cancers spreads the malignancy through the body and is generally regarded as terminal. The NHS might choose to revisit the proposed concentration of ever more of their activities in fewer hospital centres as this appears to mirror the cancer process itself. An alternative proposal could be to actually increase the number of centres providing breast screening services and to lower clinical costs by simplifying the service provided. This could be done using relatively low-cost Thermograhic imaging to search for temperature differences between the breasts. Temperature differences arise as the network of blood vessels grows to support tumour development and such changes can be observed several years before a tumour has become visible on conventional mammograms. On detecting a temperature difference the patient can be presented with evidence of the need to adopt lifestyle changes that improve the capacity of the body’s immune system to prevent disease. This reinforces the understanding that we are individually responsible for our health and that it should not be abdicated to others. Our National Health Service could then engage proactively in Health Protection rather than limiting its concerns to disease management.