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.
References
-
Allgood PC, Warwick J, Warren RM, et al;
A case-control study of the impact of the East Anglian breast screening
programme on breast cancer mortality. Br J Cancer. 2008 Jan
15;98(1):206-9. Epub 2007 Dec 4. [abstract]
-
Tabar L, Yen MF, Vitak B, et al;
Mammography service screening and mortality in breast cancer patients:
20-year follow-up before and after introduction of screening. Lancet.
2003 Apr 26;361(9367):1405-10. [abstract]
-
Barratt A, Howard K, Irwig L, et al;
Model of outcomes of screening mammography: information to support
informed choices. BMJ. 2005 Apr 23;330(7497):936. Epub 2005 Mar 8.
[abstract]
-
Zackrisson S, Andersson I, Janzon L, et al;
Rate of over-diagnosis of breast cancer 15 years after end of Malmo
mammographic screening trial: follow-up study. BMJ. 2006 Mar
25;332(7543):689-92. Epub 2006 Mar 3. [abstract]
-
Gotzsche PC, Nielsen M; Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001877. [abstract]
Comprehensive patient resources are available at www.patient.co.uk
© EMIS and PiP 2008 Updated: 20 Mar 2008
