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The NHS Breast Screening Programme

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					                 The NHS Breast Screening Programme

Breast screening is a method of detecting breast cancer at a very early stage.
The first step involves an x-ray of each breast - a mammogram - which is taken
while carefully compressing the breast. Most women find it a bit uncomfortable
and a few find it painful. The mammogram can detect small changes in breast
tissue that may indicate cancers that are too small to be felt either by the
woman herself or by a doctor.

What does the NHS Breast Screening Programme do?
The NHS Breast Screening Programme provides free breast screening every
three years for all women in the UK aged 50 and over. Around one-and-a-half
million women are screened in the UK each year. Women aged between 50 and 70
are now routinely invited.


Because the programme is a rolling one that invites women from GP practices in
turn, not every woman will receive an invitation as soon as she is 50. But she will
receive her first invitation before her 53rd birthday. Once women reach the
upper age limit for routine invitations for breast screening, they are encouraged
to make their own appointment.


The NHS Breast Screening Programme is an effective part of the UK's efforts
to reduce the death toll from breast cancer. In September 2000, research was
published which demonstrated that the screening programme had lowered
mortality rates from breast cancer in the 55-69 age group1.


The latest research shows that the NHS Breast Screening Programme is now
saving 1,400 lives every year in England.2

When was the NHS Breast Screening Programme set up?
The programme was set up by the Department of Health in 1988 in response to
the recommendations of a working group, chaired by Professor Sir Patrick
Forrest, which had been set up to consider whether or not to implement a
population screening programme in the UK. The report Breast Cancer Screening
was published in 1986, and became known as The Forrest Report. The NHS
Breast Screening Programme was the first of its kind in the world. It began
inviting women for screening in 1988 and national coverage was achieved by mid
1990s.
How is the programme organised?
There are around 80 breast screening units across the UK, each inviting a
defined population of eligible women (aged 50 to 70) through their GP practices.
Women are invited to a specialised screening unit, which can be hospital based,
mobile, or permanently based in another convenient location such as a shopping
centre.

The NHS Breast Screening Programme is nationally coordinated. It sets national
standards that are monitored through a national quality assurance network. For
England, there is a national coordination office, based in Sheffield, and an
advisory committee that oversees the programme and reports to government
ministers. The programme was commended as a "model service" in the Health
Select Committee's third report into breast cancer services in July 1995.

How much does the programme cost?
In England, the budget for the breast screening programme is now estimated to
be approximately £75 million. This works out at about £37.50 per woman invited
or £45.50 per woman screened.

How will the programme develop in the future?
The NHS Cancer Plan, published by the Department of Health in September
2000, promised the extension of the NHS Breast Screening Programme. This
has now taken place. Women up to and including the age of 70 now receive
routine invitations for screening. In addition, all women now have two views of
the breast taken at every screen - one from above (craniocaudal) and one into
the armpit diagonally across the breast (mediolateral). Research has shown that
this increases small cancer detection rates by up to 43 per cent.

Why are women under 50 not invited?
Women under 50 are not offered routine screening. This is because
mammograms are not as effective in pre-menopausal women. as the density of
the breast tissue makes it more difficult to detect problems, and also because
the incidence of breast cancer is lower in this age group.

The average age of the menopause in the UK is 50. As women go past the
menopause, the glandular tissue in their breast "involutes" and the breast tissue
is increasingly made up of only fat. This is clearer on the mammogram and makes
interpretation of the x-ray more reliable. Breast cancer is also far more common
in post-menopausal women and the risk continues to increase with rising age.
Women can ask their GP to refer them to a hospital breast clinic if they are
concerned about a specific breast problem or otherwise worried about the risk
of breast cancer. This is not part of the NHS Breast Screening Programme,
which uses a routine call and recall system to invite well women. However, the
same techniques are used in both breast screening clinics and hospital breast
clinics for diagnosing breast cancer and many staff work in both settings.

Does breast screening save lives?
The programme in the UK has screened more than 19 million women and has
detected around 117,000 cancers.


A report by the Department of Health Advisory Committee published in 1991
suggested that the programme would save 1,250 lives each year by 2010.3
The latest research shows that the NHS Breast Screening Programme is now
saving 1,400 lives every year in England.2


The World Health Organisation's International Agency for Research on Cancer
(IARC) concluded that mammography screening for breast cancer reduces
mortality. The IARC working group, comprising 24 experts from 11 countries,
evaluated all the available evidence on breast screening and determined that
there is a 35 per cent reduction in mortality from breast cancer among screened
women aged 50 - 69 years old. This means that out of every 500 women
screened, one life will be saved.4




[1]
      Effect of NHS Breast Cancer Screening Programme on Mortality from Breast Cancer
in England and Wales, 1990-8: Comparison of Observed with Predicted Mortality. BMJ
2000:665-669
[2]
      Screening for Breast Cancer in England: Past and Future, Advisory Committee on
Breast Cancer Screening, 2006 (NHSBSP Publication no 61)
[3]
      Breast Cancer Screening 1991: Evidence and Experience since the Forrest Report,
Department of Health Advisory Committee, NHS Breast Screening Programme 1991
[4]
      7th Handbook on Cancer Prevention, IARC, Lyons 2002

				
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