Invasive Lobular Carcinoma (ILC) can be difficult to detect by mammography. ILC cancer cells grow more diffusely in the breast and often do not cause the changes seen with other types of breast cancer, such as a mass (lump), distortion or calcifications, which are used to detect cancer on mammograms. This means that invasive lobular cancer is more likely to be larger when detected and more likely to present with symptoms after an apparently normal screening mammogram. To reduce the risk of missing the subtle early changes of breast cancer, every mammogram is double read by experts and any woman whose mammograms are not normal or clearly benign is called back for further assessment.
At the assessment clinic, she will have more tests. These may include a clinical examination, more mammograms at different angles or with magnification, or examination using ultrasound. A needle test (core biopsy) to sample the breast tissue may be carried out if these further tests confirm an abnormality. Core biopsy is done with a local anaesthetic. All core samples are analysed by the breast pathology team to find the cause of the abnormality. If the biopsy shows invasive lobular cancer the breast team may suggest a breast MRI scan to more accurately assess the size of the cancer.
Individuals who are undergoing female to male gender reassignment will continue to be invited for breast screening as long as they are registered as a woman, unless they ask to be ceased from the programme or have had a bilateral mastectomy.
Individuals who are undergoing male to female gender reassignment may be screened as a self referral at the request of their GP. If you have a symptom, you should see your GP in the usual way.
Does taking Hormone Replacement Therapy (HRT) increase my risk of breast cancer?
The risk of breast cancer is increased in women who take HRT for several years:
- Combined HRT has been associated with the highest risk
- For oestrogen-only HRT, risk is lower than with combined HRT. Some studies have not shown an increased risk for oestrogen-only HRT
- Risk increases with duration of use and returns to baseline within a few years of stopping treatment.
HRT, especially combined therapy, may increase mammographic density, which may adversely affect radiological detection of breast cancer. In the Women’s Health Initiative trial, conjugated equine oestrogens (CEE) and CEE plus medroxyprogesterone increased the likelihood of having an abnormal mammogram that needed further evaluation.
(From MHRA Drug Safety Update Bulletin Vol 1, Issue 2, September 2007)
For further details of how HRT can affect breast screening, see the Million Women Study.
If the person you care for is unable to make their own decisions about screening, then you, as their carer, should make what is called a ‘best interests’ decision on their behalf, in the same way as you may be making other decisions about their care and treatment. You will need to weigh up the benefits of screening, the possible harm to them and what you think the person would have wanted to do themselves. Whether you are a paid carer, or an unpaid carer, family member or close friend, the process is the same.
Some people may have fluctuating mental capacity, in which case, the decision about screening should be delayed until the individual is able to decide for themselves.
If you do need to make a decision on someone else’s behalf, you will need to consider what is involved in the screening process (including any further diagnostic tests that may be needed if the person receives an abnormal screening result). You may find it helpful to speak to their GP to discuss, for example, the person’s risk of developing the cancer in question and how screening may affect them.
You must also consider what you think the person themselves would want. For example, did they used to go to screening, or express an opinion about it? Did they express more general views about their health and whether they would want to know if they had a disease or condition? Or did they refuse screening in the past? Paid carers in particular should get advice from family members or friends about the person’s views. If, after all this, you consider that screening is in the best interests of the person you care for, then you are within your rights to help that person to be screened. You should feel confident that if someone asks you, you will be able to explain the reasons for the best interests decision that you have made – either for, or against, screening.
To find out about the breast screening process, please read our leaflet NHS Breast Screening and additional information can be found in the Macmillan booklet Understanding breast screening.
To help someone with limited capacity to understand the screening process, you may find the picture leaflet An easy guide to breast screening helpful.
To find out more on making a best interests decision, the following publications are available from the Office of the Public Guardian;
To find out more about consenting to screening, please read our Consent to cancer screening guidance.
To find out more general information regarding consent and access to screening, please refer to our guidance Equal access to breast and cervical screening for disabled women.
Mammography is a procedure which is technically difficult and which requires a high degree of cooperation between the mammography practitioner and the woman. The woman has to be carefully positioned on the x-ray machine, and must be able to hold the position for several seconds. This may not be possible for women with limited mobility in their upper bodies or who are unable to support their upper bodies unaided. If a woman has a physical disability, or is a wheelchair user, then the breast screening unit should advise on whether breast screening is technically possible, and where would be the most appropriate place for her to be screened. This will usually be at a static unit.
If a mammogram is not technically possible, the woman should still remain in the call and recall programme, as any increased mobility at a future date may make screening easier. There is no alternative to screening by mammography.
If a woman cannot be screened she should be advised on breast awareness.
Before any new technology is introduced into the NHS Breast Screening Programme it must be thoroughly evaluated for both clinical and cost effectiveness. This ensures that we can provide the best possible service to the greatest number of women.
The NHS Breast Screening Programme isn’t organised like this. All breast screening units (including mobile ones) serve a defined population of eligible women (aged 50 to 70) who are invited for breast screening every three years based on their GP practices.
If you are interested in encouraging women to be ‘breast aware’ and to accept their invitations for breast screening we suggest you contact your local health authority to see if they have health promotion people who could help you.
It doesn’t. Although women over 70 are not routinely invited for breast screening, they are encouraged to call the local unit to request breast screening every three years.
We produce cards to help them remember which are handed out at their last routine breast screening appointment.
Please see Over 70? You are still entitled to breast screening for further information.
We are currently phasing in the expansion of the programme to routinely invite women up to the age of 73.
Sorry, the NHS Breast Screening Programme doesn’t operate on a walk-in basis. It invites women in the target age group (50 to 70) for routine breast screening every three years.
If you have found something that worries you or are concerned about your breast health, don’t wait for your routine screening appointment. You should contact your GP in the usual way.
Sorry, we don’t routinely give out such details. Women wanting to know the whereabouts of an individual breast screening unit will find it listed in their local telephone directory.
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It’s probably the case that your sister is registered with a different GP and the women on her practice’s list have been called before those registered with your GP. Check with your surgery that they have your correct contact details and ask them when the women on their list are next due for screening.
The NHS Breast Screening Programme is a population screening programme which invites all women aged 50 to 70 as a matter of routine. It is not aimed at women who already have symptoms.
If you have found something that worries you or are concerned about your breast health, do not wait for your routine screening appointment. Instead, you should consult your GP in the usual way. He or she will decide whether or not you need to be referred for further investigations or treatment.
A large research trial in 2002 concluded that the NHS Breast Screening Programme has got the interval between screening and invitations about right at three years, compared with more frequent screening. The trial was organised through the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) and was supported by the Medical Research Council, Cancer Research UK and the Department of Health.
Here are the results from the UKCCCR Randomised Trial (PDF-186Kb) from the European Journal of Cancer, 2002.
Don’t worry. The mammography practitioners are used to screening women of all sizes and will do their best to minimise any discomfort.
During the mammogram each breast is placed in turn on the x-ray machine and gently but firmly compressed with a clear plate. The compression only lasts a few seconds and doesn’t cause any harm. It’s needed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible.
Some women do find compression slightly uncomfortable and some feel short-lived pain but research has shown that for most women it’s less painful than having a blood test and compares with having blood pressure measured. For women with very large breasts, additional pictures are sometimes required to ensure that all the breast tissue is included.