Laparoscopic surgery

Screening for breast cancer

  • 3-10-2012
  • Categorized in: Cancer

Who has breast screening?

Currently, all women aged 50-70 years in the UK are offered a routine breast screening test every three years. More than 1.7 million women were screened in 2007-2008. The government is planning to extend the age range for routine breast screening to include women from age 47 to 73. This should be available nationwide by 2012.

If you are under the age of 50 (or 47 from 2012), 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 unsure whether you should be screened from an earlier age then see your GP.

What about older women?

Over the next few years, all women between the ages of 47 and 73 will be invited for breast screening. However, it will take some time before women between 70 and 73 in all areas of the UK are automatically invited. In the meantime, if you are over 70 (and in the future if you are over 73), you should still consider having breast screening every three years. You are entitled to this as a free service. 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. An invitation for breast screening will usually arrive by post, giving you the date, time, and place to attend. If this is inconvenient for you, you can telephone to change the appointment. The whole appointment usually takes about 30 minutes.

When you attend the unit you will be asked to undress down to your waist, including removing your bra. Therefore, it is best to wear a skirt or trousers and a top. Note: don't use talcum powder or spray-on deodorant on the day of your mammogram as this can sometimes interfere with the test. A radiographer will help to position each breast between two flat X-ray plates. This can be a little uncomfortable but is usually only for a few seconds as the X-ray picture is taken. In some women, the pain may persist for a short time afterwards. Two X-rays are taken of each breast (one from above and one into the armpit diagonally across the breast). The result of the test is sent to you and your GP. Results generally take about two weeks.

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 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 in the screening age range.

Note: if you have had breast implants, you can still have breast screening. This may be done in a hospital-based screening unit. Also, the breast screening programme is a rolling programme. Women from different GP practices are invited in turn. This means that you may not receive an invitation for screening as soon as you are 50 (or 47 as from 2012). However, you should receive your first invitation before your 53rd birthday (by your 50th birthday as from 2012).

What if there is an abnormality?

Most women have a normal test result. However, about 1 in 20 women is 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 called back for further tests actually has 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.

Does breast screening save lives?

Research studies have shown that breast screening has significantly reduced the number of deaths from breast cancer. The International Agency for Research on Cancer has shown that there is a 35% reduction in the chance of death due to breast cancer in women who are screened regularly with mammography. 

Statistics also show that the NHS Breast Screening Programme saves about 1,400 lives every year in England. For every 400 women screened regularly by the NHS Breast Screening Programme over a 10-year period, one woman fewer will die from breast cancer than would have died without screening.

Also, the longest-running breast cancer screening study ever conducted (29 years) was published in 2011 (cited below). The study of 130,000 women in two communities in Sweden showed that the benefit of breast screening was even greater than previously thought. There was a large reduction in breast cancer deaths in women who had breast screening compared with those who had not been screened.

Are there any risks or harms with breast screening?

Having a mammogram is a reliable way of screening for breast cancer. But, as with any screening test, it is not perfect. There has been some controversy about breast screening, with some people suggesting the possibility that it may do more harm than good for some women. Some of these concerns are discussed here.

Firstly, there is concern about the over-diagnosis of breast cancer. This refers to breast cancers that are detected through screening that would not have been diagnosed without screening, and would not have threatened the lives of the women screened. Once diagnosed through screening, these cancers have to be treated. This is because it is not currently possible to predict which cancers found through screening will develop aggressively and which will grow very slowly. So, without screening, a proportion of women would never have been treated for breast cancer - they would never have known that they had breast cancer in their lifetime and would have died from other causes. 

One controversial review (that has been criticised by some people) looked at breast screening and suggested that for every one prevented breast cancer death per 2,000 women screened over a 10-year period, there will be 10 women unnecessarily treated for breast cancer. However, the Director of the NHS Cancer Screening Programme has said that these numbers are estimated to be nearer to 4 or 5 lives saved and 4 or 5 women who might have been unnecessarily treated because of breast screening. 

Secondly, some women become very anxious if they are recalled for further tests following the screening test because of concerns about an abnormality. However, about 7 in 8 women who are recalled for further tests do not have cancer. Some people argue that these women are put through this anxiety and these further tests unnecessarily because, without screening, they would not have needed these further tests.

Thirdly, some people worry about the risk of radiation from the X-ray screening test and that it may be harmful and even increase your risk of breast cancer. However, the amount of radiation used is small and the risk of the X-ray test itself being harmful is very small indeed.

Also, very occasionally, breast screening may miss some breast cancers. This may be because the cancer is very difficult to see on the mammogram (some cancers cannot be seen at all), or the person reading the mammogram may miss the cancer (this can even happen with the most experienced of people).

In summary, breast screening does reduce deaths from breast cancer. It is thought that 1 in 8 women diagnosed with breast cancer through the NHS programme would have been missed if it were not for screening. Based on all the current evidence, most doctors still believe that the benefits of detecting breast cancer early outweigh any harms from breast screening because of the number of lives saved.

A note about magnetic resonance imaging breast screening

It has been suggested that magnetic resonance imaging (MRI scanning) may be better than mammography as a way of screening for and detecting early breast cancer in certain groups of women. For example, those who are at high risk of developing breast cancer, perhaps because they have a strong family history of breast cancer. However, the effect that using MRI scanning as a screening test has on actually reducing the number of deaths due to breast cancer is uncertain. 

In the UK, the National Institute for Health and Clinical Excellence (NICE) has advised that some women who have a high risk of breast cancer may be screened using MRI scanning instead of mammography. This may be the case if there is a strong history of breast cancer that runs in your family, particularly if you are known to carry a gene that makes you more prone to breast cancer. If you have breast cancer in your family and you are uncertain about your risk of developing breast cancer, you should discuss this with your GP. Remember that most women do not develop breast cancer. Even though you may be told that you have a raised or high risk, it does not mean that you will definitely develop breast cancer.

Breast awareness

A lot of breast cancers are detected early by breast screening. However, a small number are not. Some women may have developed breast cancer before they have their first mammogram and some may develop breast cancer between mammograms. 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 your GP if you notice any changes, lumps, or other abnormalities in your breasts or nipples. Don't just wait until your next screening mammography.

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
Web: www.breastcancercare.org.uk
The leading provider of breast cancer information and support across the UK.

References

  • NHS Breast Screening publications, Screening for breast cancer in England; past and future, February, 2006
  • Tabar L, Vitak B, Chen TH, et al; Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Radiology. 2011 Jun 28. [abstract]
  • Familial breast cancer, NICE Clinical Guideline (October 2006); the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care
  • 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]
  • 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]
  • Warner E, Messersmith H, Causer P, et al; Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 2008 May 6;148(9):671-9. [abstract]
  • Mayor S; Number of breast cancer cases detected by screening has doubled in a decade in England. BMJ. 2009 Feb 2;338:b414. doi: 10.1136/bmj.b414.
  • 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]
  • 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


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