Breast Screening

What is breast screening?

Breast screening aims to detect breast cancer at an early stage, before symptoms develop. It involves having an x-ray picture of the breasts which is called mammography.

Who has breast screening?

Currently, all women aged 50-70 years in the UK are offered a routine breast screening test every three years. If you are under the age of 50 then routine breast screening is not currently available unless:

• You have had breast cancer in the past.
• You have a first degree relative (mother or sister) who has had breast cancer at a young age.
• You are known to have a gene which makes you more prone to breast cancer such as genes called BRCA1, BRCA2 and TP53. (Most women will not know their genetic make up, but some women have genetic tests for various reasons.)

If you are under 50 and are unsure whether you should be screened then see your GP who can advise. The government is looking into extending the age range for routine breast screening to include women from age 47 to 73.

What about women over the age of 70?

About 1 in 3 breast cancers occur in women over the age of 70. So, if you are over 70 you should still consider having breast screening every three years. You will not get an invitation automatically. However, you are still entitled to breast screening on the NHS every three years. What you need to do is to contact your local breast screening unit to make an appointment by phone or by letter. For details of your nearest breast screening unit, phone NHS Direct - 0845 4647 - or ask at your GP surgery.

How is breast screening done?

There are many breast screening units throughout the UK. Some are at hospitals but many of the units are mobile and move from area to area. Appointments are sent out to women in each area in rotation.

When you attend the unit you will be asked to undress down to the waist. Therefore, it is best to wear a skirt or trousers and a top. A radiographer will help to position each breast between two x-ray plates. This can be a little uncomfortable but is only for a few seconds as the x-ray picture is taken. The whole visit does not take long. As an appointment system operates, waiting times at the units are usually short. The result of the test is sent to you and your GP.

The administration of breast screening is a large exercise. Problems can sometimes lead to errors such as if you move to a different area or if you change your surname. Tell your GP if you did not receive the result of your test or if you have not been invited to attend in the last three years and you are aged 50-70.

What if there is an abnormality?

Most women have a normal test result. However, about 1 in 20 women are asked to attend again for further more detailed tests. This may be because the x-ray picture is not clear, or to look more closely at a particular area of the breast. This is obviously a concern, but only 1 in 8 of women who are called back for further tests actually have cancer. In the rest (7 in 8) the shadows, marks or other abnormalities that are detected in the screening test turn out to be harmless.

And remember, if it does turn out to be cancer, it is likely to be an early cancer when there is a good chance of successful treatment.

How effective is breast screening?

Breast screening saves lives. About 1 in 12 women develop breast cancer at some stage in life, mostly over the age of 50. On average, breast screening with mammography can detect 3 in 4 breast cancers at least one year before they can be felt as lumps in the breast. For every 1000 women that are screened, about 7 cancers are detected. Most of these cancers are early in their development. And, the earlier breast cancer is detected, the better the chance of a cure.

Research studies have shown that breast screening has significantly reduced the number of deaths from breast cancer in the UK. One study published in 2008 concluded that breast screening may have reduced the number of deaths from breast cancer by about 35%. Statistics indicate that the NHS breast screening programme saves about 1400 lives every year in England.

However, there is some controversy about breast screening and the possibility that it may do more harm than good for some women.

Firstly, there is concern that some women will be diagnosed as having breast cancer when they do not, or when they have a condition called ductal carcinoma in situ (DCIS). This is like a 'pre-cancer' where abnormal cells develop on the lining of a breast duct. This can be detected with breast screening. Some women with DCIS may go on to develop full breast cancer, but some do not. It is not possible to tell which women with DCIS will and which women will not develop breast cancer. Therefore, all women found to have DCIS tend to be treated for cancer. But - those women with DCIS that would not have progressed may never have had the DCIS detected if it were not for breast screening. In short, a small number of women diagnosed and treated for breast cancer as a result of screening would not have been diagnosed as having breast cancer in their lifetime.

Secondly, some people worry about the risk of radiation from the x-ray screening test and that it may be harmful. However, the amount of radiation used is small and the risk of the x-ray test itself being harmful is very small indeed.

Thirdly, some women become very anxious if they are recalled for further tests following the screening test. But remember, 7 in 8 women who are recalled for further tests do not have cancer.

In general, most doctors would probably say that the benefits of breast screening far outweigh these concerns because of the number of lives saved.

Breast awareness

Most breast cancers are detected early by breast screening. However, a small number are not. All women of every age should still remain 'breast aware'. That is, get to know how your breasts and nipples normally look and feel, and any changes that occur before and after your periods. See you GP if you notice any changes, lumps, or other abnormalities in your breasts or nipples.

Further information

NHS Breast Screening Programme

Web: www.cancerscreening.nhs.uk/breastscreen/

Breast Cancer Care

5-13 Great Suffolk Street, Southwark, London, SE1 0NS
Helpline: 0808 800 6000
Tel (Text): 0808 800 6000 (for Typetalk prefix 18001)
Web: www.breastcancercare.org.uk
Breast Cancer Care is a leading provider of information, practical assistance and emotional support for anyone affected by breast cancer.