Breast screening programme

Did you know that breast screening in the UK is estimated to save the life of about 1,300 women annually? Or, put another way, screening may help save three to four women’s lives every day!

Statistics like this can easily convince you that breast screening is an absolute must. However, before making your decision, it’s crucial that you understand what the programme consists of and any associated risks.

What is breast screening and what are its benefits?

In a nutshell, breast screening involves the use of a mammography (an X-ray test) to examine the breasts for cancer before any signs or symptoms appear. The mammogram, the image of the breast tissue, can indicate breast changes that are too small for either you or your doctor to see or feel.

Detecting cancer or abnormal tissue at an early stage can facilitate treatment and make it more effective. Early treatment can also stop the cancer from spreading – according to Cancer Research UK, women diagnosed with breast cancer at its earliest stage have a 90% chance of surviving for at least five years after initial diagnosis. Their chance of surviving for three years is better than 99% – but for women diagnosed at the latest stage, this rate falls to only 27.9%.

Who qualifies for the NHS breast screening programme?

In the UK, the NHS will usually send screening invitations every three years to women aged between 50 and 70 years, provided they are registered with a GP. Women younger than 50 aren’t invited for routine screening, since 81% of breast cancer cases occur in women over this age.

Bear in mind that this programme is a rolling one and while you may not receive the invitation as soon as you reach your 50th birthday, you should get it before you turn 53. However, in some areas of England, women aged 47 to 73 may also receive these screening invitations as researchers are investigating the potential benefits of extending the age boundaries of the screening programme.

While you will probably no longer automatically receive invitations after the age of 70, you are still eligible for screening. Contact your GP or breast screening unit to schedule an appointment.

What happens at the screening unit?

The visit to the screening centre should take about half an hour. The staff on duty will check your details and ask about any breast issues (such as pain, discharge or swelling) you may have experienced, or any history of breast disease. The mammography expert will then explain how a mammography is carried out and what to expect during the process – be sure to ask any questions you may have at this stage.

Understanding the results

After the mammograms are analysed, the results will be sent to you and your GP within two weeks.

Most women will have a normal result.

Out of every 100 women who go for screening, around 96 will receive a letter informing them that their mammograms were normal, meaning that no traces of breast cancer were detected. Their next screening appointment will be in three years’ time.

If you get a normal result, keep in mind that cancer may still develop between mammograms – be breast aware and consult your GP if you discover any abnormal changes.

Some may need more tests.

The letter will clearly state whether another mammography is needed due to technical reasons (for example, if the mammogram was not clear enough), or if further tests such as a clinical examination, ultrasound or more mammograms at various angles or with magnification, are required. Some women may also need a biopsy to sample breast tissue for further analysis.

If you are called for extra tests, don’t panic: this does not automatically mean you have cancer. In fact, Cancer Research UK reports that out of every five women who are called back, four will be cancer-free. It is quite common for the screening service to spot areas that appear different from the surrounding tissues especially if it’s the woman’s first mammogram – that’s because every breast is unique and the experts won’t know yet what is normal for you.

What if you’re diagnosed with cancer?

A breast care team will review the best treatment options for you while taking into account your preferences, the type of breast cancer you have and the probability that it will grow and spread.

What are the risks associated with breast screening?

Overdiagnosis and over-treatment

Screening can detect cancer that would otherwise never cause the woman any clinical problems. This is sometimes referred to as ‘overdiagnosis’ but does not imply that a mistake was made during diagnosis. Overdiagnosis is not a false positive – it’s a genuine cancer or pre-cancerous change that would otherwise never have become life threatening if it wasn’t discovered through screening.

The issue with overdiagnosis is that it can lead to over-treatment since almost all women with a breast cancer diagnosed through screening will be offered some form of treatment that could have been unnecessary.

How common is overdiagnosis?

It’s not possible to identify which breast cancer cases are overdiagnosed and which aren’t. However, experts know that overdiagnosis occurs because more breast cancers are identified in a population of women who have been screened compared to one that wasn’t screened. They estimate that in a group of 200 women who have breast screening every three years, three will be overdiagnosed.

Concerns with X-rays

Exposure to any type of radiation can increase the risks of cancer. However, the X-ray dose used during a mammography is very low and detecting a cancer at an early stage may far outweigh any danger associated with the X-rays.

Missing cancers

Breast screening is not a perfect science and for every 2,500 women screened, one case of breast cancer may go undetected.

Emotional stress

As mentioned earlier, most women with an abnormal screening result are never diagnosed with breast cancer. This can cause unnecessary worry.

The risks of breast screening vs. its benefits

In 2012, the Independent Breast Screening Review, an independent panel of experts, reported that the NHS should continue to provide breast screening. After reviewing the outcome of breast screening, the experts concluded that for every 200 women screened every three years, the programme saves about one life from breast cancer.

Be breast aware

Breast awareness is about becoming more familiar with the way your breasts look and feel – the rationale behind this concept is that every woman’s breasts are unique and being breast aware can help her detect abnormal changes at an early stage.

You don’t need any training and there are no specific techniques – you simply have to touch your breasts, feel for anything different and look for any abnormal change in shape or texture. If you suspect there is anything unusual, have your breasts checked out by a doctor. The National Institute for Health and Clinical Excellence (NICE) also encourages women aged 50 and above to go for routine breast screening.

If you have any questions regarding breast screening, talk to your GP or contact your local breast screening centre.

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