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Practical Guide Assessment Tool


									Having a Breast Test
Professional Pack

       Version 3 – April 2011
       Having a Breast Test
  A Guide for Health Professionals

• This guide has been developed for use in
  conjunction with the:

           Having a Breast Test
   An Information Pack for Women with a
             Learning Disability
          Aims of the Guide
• To provide health professionals with a
  background knowledge of the Breast
  Screening Programme
• To assist health professionals to educate
  other members of their team, to deliver
  information on the breast screening
  process to their clients
• Provide useful website links for staff to
  access further information as required
         How to use this Guide
• Before using the teaching pack with your client, you will
  need to work through the professional pack
• The professional pack allows you to develop your own
  knowledge base, at your own pace
• Each slide provides the key messages relating to breast
• For more detailed information follow the relevant website
• To open the links, click on the hyperlink, you will be
  directed to the relevant site
• N.B Hyperlinks will only be active when you are using
  the guide online
    About Breast Test Wales
•      Breast Test Wales is responsible for the
       delivery and quality of breast screening
       throughout Wales
•      It is part of Public Health Wales, NHS Trust,
       Screening Division
•      The programme has been established since
•      The aim of the programme is to reduce the
       number of deaths from breast cancer among
       women we screen.
              Organisation chart
                      Public Health Wales
                           NHS Trust

                       Screening Division

               Cervical      Bowel          Newborn
Breast Test                                             Antenatal
               Screening    Screening        Hearing
  Wales                                                 Screening
                Wales         Wales         Screening
               What is Breast Cancer?
• Click here


 A – cancer cell
 B – basement membrane

     Principles of Screening
• Screening provides an opportunity to reduce the
  risk of contracting a disease or suffering its
• The breast screening programme reduces the
  risk of dying from breast cancer.
General principles of screening
1. The condition screened should pose
   an important health problem
2. The natural history of the condition
   should be well understood.
3. Recognisable latent or early stage
4. Treatment of the disease at an early
   stage should be more beneficial than
   treatment started at a later stage.
 General principles of screening

5. Suitable test or examination
6. Acceptable to the population
7. Screening should be repeated at intervals
   determined by the natural history of the
   General principles of screening
8. Adequate diagnostic and treatment facilities

9. The cost - should be economically balanced
    against the benefit it provides.

10. The chance of physical or psychological harm
    should be less than the chance of benefit.
                 Wilson Jungner criteria [1968]
• We recommend that screening should be seen as a risk
  reduction programme, rather than a prevention
  programme in order to reduce the psychological impact
  of issues such as receiving false negative results.

  Screening is not fool proof but it must be recognised
  that it does save lives and often significantly improves
  quality of life by early diagnosis of serious conditions.’
  (Dr Muir Gray: Network 2000 Issue 38)
Disadvantages of Screening
•   Cancer can occur between screens.
•   Screening does not prevent breast cancer.
•   Screening is not 100% effective.
•   It will not detect all cancers.
•   Some women will have unnecessary investigations.
•   Discomfort
•   Radiation.
  Advantages of Screening

• Screen detected cancers are significantly smaller
  than symptomatic cancers.

• Earlier treatment.

• Less radical treatment.
          Informed Choice

      UK National Screening Committee

“ The public should be given a realistic view of
the merits and flaws of screening so that they
can make an informed choice and decline an
invitation if they wish”.
                                  BMJ 14.10.2000
 Why screen for breast cancer?
• By far the most common cancer in women in the UK
• In 2007 there were 2,457 new diagnoses of breast cancer
   and 637 deaths from breast cancer in Wales (all ages).
• One in nine women will develop breast cancer at some
   time in their lives
• Each year more than 41,700 women in the UK are
   diagnosed with breast cancer.
• 80% of breast cancers occur in women over the age of
       What is breast screening?
• Breast Screening is a way of checking for
  Breast Cancer
• Screening can find those changes that you
  cannot see or feel
• A breast X-ray or Mammogram is a good
  way of finding breast cancer
     14                           Breast
     10                           Ovary
      8                           Stomach
      6                           Bladder
Statistics from CRC
All Wales Results 2007 - 2008

• Total Invited                                       129,767

• Total screened                                       94,448

•     All Wales Uptake                                 72.8%

•     Uptake set out by Forrest Report                 70%

    •Source: KC62, routine invitations, age 50 - 70
  Who can go for breast screening?
• All women who are registered with
  a GP, who reside in Wales and are
  aged between 50 -70 will be
  routinely invited to attend for breast
• Invitations are sent out every three

• mailto:info@cancer screening
    What happens to women over 70?

•   Women who are over 70 are not
    excluded in any way

•   They will not be routinely called
    for breast screening

•   Therefore they will need to ring up
    Breast Test Wales and request an
  Why women under 50 are not
     eligible for screening
• Currently there is no research evidence to
  demonstrate that screening younger women
  reduces mortality rates
• Women under 50 and those with breast
  symptoms are NOT screened by Breast Test
• Women concerned about a change in their
  breasts need to see their GP or Practice Nurse
What if there is a Family History of
          Breast Cancer
• Where there is a family history of breast
• The eligible woman may be referred by her
  GP to the local Genetic Service
• They will then contact the woman to
  determine her level of risk
     How are the women invited for
          breast screening?

• All eligible women are sent
  are sent an invitation letter and
  leaflet inviting them to attend
  for their breast screening
    Where women are screened

•   In most parts of
    Wales, women are
    invited to attend
    screening on a
    mobile unit
   Where women are screened
• Women can contact      • If they have breast
  Breast Test Wales if     implants or have a
• They wish to change      disability, they will
  or cancel your           need to be screened
  appointment              at one of the static
• If they have had a       units
  mammogram in the       • They can contact
  last six months.         Breast Test Wales for
                           more information
             The Mammogram
•   Breast is compressed
    between two plates.
•   This is quite firm in
    order to give better
    detail and clearer
•   Four x-rays are taken
    in total.
•   Only performed by       Top to bottom and side-
    female staff.           to side view taken of
•   Takes just a few        each breast
    What is a mammogram?
      What happen next?

• Once the Mammogram has been taken the woman
  can get dressed
       How will I get my results?

• Depending on screening area
• Results are sent out within
  three weeks of screening.
• 95% of women are given a
  normal result 5% are recalled.
      What do the results mean?
•    95% of women will get a   • 5% of women may be called
    normal result                back for further investigation
          Recalled for further tests

If a woman is to be recalled she
 is only given 2-3 days notice to
         minimise anxiety.

Out of women who are recalled
only 1 in 6 is given a diagnosis
of cancer.
          What happens at this
• At the assessment clinic   • Diagnosis follows review
  the woman will have a        of assessment results by
  triple assessment            specialist multidisciplinary
• This consists of:            teams comprising:
• Imaging – further films    • Radiologists
  are taken                  • Breast Surgeons
• Clinical examination id    • Pathologists
  given by one of the        • Breast Care Nurses
  surgeons                   • Supported by Medical
• Pathology                    Physicists and
         Breast Test Wales
• Breast Test Wales is a population based
  screening programme
• It is responsible for screening well women
• If a woman requires treatment, this may be
  performed at any hospital, but is usually at
  a hospital where a BTW surgeon is based
  What do I need to tell the woman
   once she has been screened?
All women need to be breast aware.
The five point code is listed below:

•Know what is normal for you

• Look and feel

• Know what changes to look out for

• Report any changes without delay

• Attend for breast screening if you are
aged over 50
            How can you help?
• Update your knowledge and skills regularly
• Ensure you are giving the correct information
• Have to hand appropriate resources – leaflets/ picture
  books/ fact sheets
• If you are unsure of anything relating to breast
  screening - Contact us
    For Further Information….
•   Contact:
    Heather Ramessur
    Screening Promotion Officer
    01492 860888.

•   Write to us at:
    Maes Du Road,
    LL30 1QZ

•   E-mail:
•   heather.ramessur-marsden@velindre-

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