Anyone who has ever survived primary breast cancer will know the feeling of fear that lives with you every single day. That is the fear that the disease will at some point return or metastasise, leading to incurable secondary breast cancer.
The further we get from the end of active treatment, the fewer and less frequent the consultations and hospital visits become. While this is a relief on the one hand, on the other it adds to the worry because we want reassurance in the form of clear test results and positive nods from the doctor.
For survivors like me there is no ‘screening’ for metastasis. There is no point regularly scanning my brain or bones to see if the cancer has spread to those parts when there is no reason to suspect it has. The only way of detecting secondary cancer is through other symptoms like persistent aches and pains and unexplained health problems that eventually lead to further tests.
The one thing they can do is regularly examine the breasts themselves for recurrence, and this takes the form of regular manual examinations by the oncologist as well as mammograms or MRI scans.
In an ideal world I would have as many tests and scans as possible to keep me continually reassured. But the problem with mammograms is they expose you to potentially harmful radiation. When you are in your 20s, 30s or even 40s, you are looking at one mammogram per year for the next 30 to 60 years, and that is a lot of radiation. This is one of the reasons why the National Institute for Health and Care Excellence (NICE) recommends MRIs for ‘high-risk’ women aged 30-49.
However, having breast cancer in your 20s or 30s does not necessarily put you in the ‘high-risk’ category, so an annual MRI is not the natural option for every young person who has survived the disease. ‘High risk’ refers to people with a strong family history, or those who have tested positive for BRCA or TP53 gene mutations.
In my case, the fact that my maternal grandmother had breast cancer in her 30s puts me into the high-risk category, but if you have had the disease in your 20s or 30s and don’t have a family history or gene mutation, you aren’t necessarily at a much higher risk than the general population of developing breast cancer a second time.
I ended up having both a mammogram and an MRI scan this summer and thankfully both came back clear. In January I’ll have my first consultation with my surgeon in over a year, and hopefully he’ll be able to tell me whether he recommends one or the other going forward.
There’s a lot of confusion among young survivors over the MRI/mammogram question, so my advice is to talk to your doctor about the NICE recommendations and find out where you stand. Only the medical professional knows what’s right for you, but there’s nothing more reassuring than being given a proper explanation as to why something is best. So keep on asking until you really understand.
Laura also writes blogs for two other websites. You can read more from her at the Huffington Post or her blog the big scary 'C' word, or follow her on Twitter @bigscaryCword. You can also ‘like’ her Facebook page.Vita's bloggers views are their own and do not necessarily represent those of Breast Cancer Care or Vita magazine.