NHS Breast Screening Programme

• What is breast screening?
• What does the NHS Breast Screening Programme do?
• When was the NHS Breast Screening Programme set up?
• How is the programme organised?
• How much does the programme cost?
• How will the programme develop in the future?
• Digital mammography
• Why are women under 50 not invited?
• Does breast screening save lives?

If you have been invited for screening, or have been for screening and have any questions about the result, you should contact the name and address shown on your invitation letter or result letter. If you are worried about a specific problem, or otherwise worried about the risks of cancer, then you should talk to your GP.

What is breast screening?

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 which may indicate cancers which 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 which 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.

Click here for the latest statistics on the NHS Breast Screening Programme (England)
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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 which are monitored through a national quality assurance network. For England, there is a national coordination office, based in Sheffield, and an advisory committee which 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.

The NHS Breast Screening Programme will extend the age range of women eligible for breast screening to ages 47 to 73 over time. The current age range is 50 to 70. An extra 200,000 women a year will be screened.

Digital mammography

Future developments in the breast screening programme will include the introduction of digital mammography. A multi-disciplinary steering group, set up in 2004, has undertaken an evaluation and clinical assessment of equipment currently available. There has also been a study of the acceptability to women of digital screening. This has looked at their perceived pain or discomfort and levels of satisfaction with the experience when compared with conventional mammography. Recommendations on commissioning and routine testing of full field digital mammography have also been prepared.

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