Plans to let male health workers perform breast screening exams has provoked a furious backlash – with some women experts saying the move could put lives at risk.
Last week, medical leaders called for men to be allowed to work as mammographers in the NHS breast cancer screening programme, in a bid to ease ‘critical’ staff shortages.
The X-ray scans are offered every three years to all British women aged 50 to 71, with the aim of detecting tumours too small to see or feel. It is currently the only health exam carried out only by female staff.
But, according to the Society of Radiographers (SoR), male healthcare workers who could excel in the field – or ‘offer a different perspective’ – are being held back due to their gender. This, they argued, needed to change.
The suggestion attracted high-profile criticism from Conservative leader Kemi Badenoch, who said she would ‘definitely want a woman’ when going for a breast screening.
‘I’ve had a mammogram – it is a very, very intrusive process,’ she told Times Radio.
‘It involves the clinician holding both of your breasts for a long period of time, feeling them, manipulating them, putting them in a machine. I would not want a man doing that.’
Addressing staff shortages – with 17 per cent fewer mammographers than are needed to run clinics, and numbers set to grow as more retire – she added: ‘I think the solution is to get more radiographers, not to ask women, yet again, to sacrifice their privacy and dignity to deal with a supply issue.’
The X-ray scans are currently the only health exam carried out only by female staff
Last week, Mail on Sunday columnist and GP Dr Ellie Cannon strongly disagreed. She pointed out that male medics already carry out other intimate examinations on women – and asked readers for their thoughts. We have been inundated with emails and letters in response – and the issue is clearly divisive.
For administrator Julie Wilson, 52, it was a hard no. ‘Ordinarily, I wouldn’t object to a male doctor: in fact my daughter was delivered by one and I have had gynaecological procedures carried out by male doctors with no issues,’ she said.
But the Lincolnshire-based mum of two says mammograms require a different level of proximity. ‘There’s no modesty screen in a mammogram as there are in procedures at the ‘other end’, so it feels like a more close-up and hands-on process,’ she said.
School administrator Amanda Elliott, 55, agreed. As well as two routine mammograms, she recently underwent a round of radiotherapy for ductal carcinoma in situ (DCIS), a form of early breast cancer, during which her technicians were men.
‘My heart sank each time I had to undress and walk across the room to the machine in front of them,’ she said. ‘I felt very vulnerable and teary.
‘I’m a very private person and do not get undressed in front of anyone, so it just made the whole experience more traumatic – especially having their hands on me, moving me around. Even given my diagnosis, I would really struggle to attend any future mammograms if I thought the staff were going to be male.’
And medical secretary Jan Hardy, 70, says a bad experience of a breast exam by a male doctor makes the idea of men doing mammograms uncomfortable. ‘I had gone in for a different issue and the doctor told me he wanted to do a full check-up – including a breast examination,’ she said.
‘He said he was going to stand between my legs to get a proper feel and proceeded to thoroughly explore my breasts – so close that I could feel his breath on my hair. It was 20-odd years ago but it’s never left me. And it immediately came to mind when I read about the proposal to bring in male mammographers. It’s something I will never be comfortable with.’
Mammograms are offered every three years to all British women aged 50 to 71, with the aim of detecting tumours too small to see or feel
But not all women feel the same. Teaching assistant Helen Murphy, 55, welcomes the idea.
‘There are plenty of male gynaecologists, obstetricians and midwives – and the people who treat you if you do have breast cancer can be male oncologists as well, so why are we drawing the line here?’ the Swansea-based mum of one asked. In fact, Helen has found male doctors often make for a more comfortable examination – perhaps because they have more sympathy and a gentler touch than other women.
‘It’s been proven throughout my life – whenever a man’s been involved in a female procedure, it’s been a better experience,’ she said. ‘If I could request a smear test done by a man I would, for this reason. The same would likely be true of male mammographers.’
So, what should the NHS do? Experts say changing the female-only policy isn’t simple.
‘As someone who has experienced breast cancer, I’m biased – I’m used to being poked and prodded,’ says Dr Liz O’Riordan, former breast cancer surgeon at Ipswich Hospital NHS Trust.
‘But it’s about what healthy women in their 50s to 70s want. If you’re 50 to 53 and have never had a mammogram, you’ll think differently to a woman who has and knows what they’re like. In some parts [of the country], a third of women aren’t going for their first screening mammogram.’
The NHS Breast Screening Programme began in 1988, with the aim of cutting rates of breast cancer in women over 50, who make up more than 80 per cent of all cases. When treated early, the survival rate for breast cancer is more than 90 per cent. By the time the cancer has spread, however, this plunges to just 32 per cent.
By screening women before they have symptoms – such as a lump, skin change or nipple discharge – the national programme finds a third of all cancers, saving an estimated 1,300 lives a year.
But, despite every GP-registered woman being invited to attend screenings every three years from the age of 50 – or earlier if they are high-risk – just 64 per cent show up.
Reasons for not attending vary, according to surveys. Some women are too busy, some feel fit and healthy and don’t think they’re at risk, while others are deterred by the possible pain or discomfort of having a mammogram – which requires the breasts to be held flat between two plates while the X-ray is run.
Television presenter Vanessa Feltz has a mammogram on ITV’s This morning
And breast cancer charities fear that even the possibility of having a man in the room could deter women further.
Claire Rowney, chief executive of Breast Cancer Now, is against men performing screening mammograms. ‘We’re acutely aware of the significant shortages across the imaging and diagnostic workforces and the urgent need to address these to secure the long-term sustainability of the breast screening programme,’ she said.
‘And while we welcome every effort to reduce staff shortages and delays, we know that concerns about being seen by a male mammographer already deter some women from attending breast screening, even with current staffing being all-female.
‘This is particularly an issue among women from some ethnic minority communities, who may have greater concerns around modesty, and among whom current uptake rates are lower.’
Other than Malta, no other country allows male mammographers – though many have similar staffing shortages. And research indicates this could be for good reason. According to a British study in 2020, as many as 27 per cent of women wouldn’t attend if a male mammographer was involved in her breast screening. In face-to-face interviews, the presence of a female chaperone reassured some, while others claimed it still wouldn’t affect their decision.
And the number appears even higher for women from ethnic minorities. A recent study found that just 45 per cent of black women and 49 per cent of Asian women attended a breast screening between March 2016 and September 2020 – compared with 63 per cent of white women.
The researchers suggested stigma, religious beliefs, low-risk perceptions and distrust in health professionals were to blame. But on top of this, according to a 1996 study, nearly a third of women from ethnic minorities in the UK who did not attend had been influenced by the chance of being seen by a man.
The problem is, says Sue Johnson, professional officer for the Society of Radiographers, there’s currently a serious lack of mammographers – with a significant amount more set to retire in the next five to ten years. ‘Lots of women recruited when the breast screening programme began are now reaching retirement age,’ she said.
Meanwhile, an aging population, increased evidence of breast cancer and the success of screening means there’s growing demand for mammographic services. As a result, the need to recruit mammographers is more urgent.
‘There’s currently no waiting list for screening, which is due to the fabulous work done so far to recruit mammographers,’ said Ms Johnson. ‘But people working as mammographers are working over their hours and appointment times are already being squeezed. We need to keep recruitments coming.’
Mammographers must undertake an extra year of training on top of a three-year course in radiography, which slows recruitment.
So, even if the change was made tomorrow, added Ms Johnson, it would take around five years for men to be present at screenings. And, as with smear tests, women would be given the choice of a male or female practitioner – and offered a chaperone.
But experts say that this could bring with it other staffing issues.
While clinics must already offer chaperones for all intimate procedures, research shows more women would take them up on it if their mammographer was a man.
‘There would need to be a female chaperone in the room as well as the male mammographer – which would be a staffing issue as well,’ said Dr O’Riordan.
Dr Joyce Harper, Professor of Reproductive Science at the Institute for Women’s Health, University College London, thinks bringing in male mammographers is worth a go. ‘We do have a problem with people taking up breast screening – and we really don’t want to put any women off,’ she said. ‘But we can’t assume changing the policy will reduce take-up even further – and it would certainly solve the employment problem and be a bit more progressive.’
Fiona MacNeill, consultant breast surgeon at the Royal Marsden NHS Foundation Trust and director of surgery at The London Breast Clinic said: ‘What matters – as with any medical professional – is that a mammographer is properly qualified, not their sex.’
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