What happens at a NHS Breast Screening Unit?

• The invitation
• At the screening unit
• The mammogram
• The results
• Further investigation
• Open biopsy
• What happens if cancer is found?
• Is there anyone to talk to?
• Treatment

A flow chart indicates the screening process:

The invitation

Every woman registered with a GP will receive her first invitation to attend for a mammogram at her local breast screening unit sometime between her 50th and 53rd birthdays. She will then be invited every three years until her 70th birthday: By 2012, women will be routinely invited up to the age of 74. The NHS call and recall system holds up-to-date lists of women compiled from GP records, and records levels of attendance and non-attendance.

Women who have special needs, such as a physical or a learning disability, are asked to contact the breast screening unit at the address shown on the invitation letter. The screening unit can arrange a special appointment, usually at the hospital screening unit, where there is easier wheelchair access, better provision for a supporter to accompany the woman if she wishes, and more time can be allowed than is possible on a mobile screening unit.

At the screening unit

A visit to a screening unit for breast screening takes about half an hour. The woman is greeted by a receptionist or female mammography practitioner who checks her personal details (name, age and address). The mammography practitioner asks the woman about any symptoms or history of breast disease, explains what will happen when the mammograms are taken, and answers any questions about breast screening. If the woman is happy to proceed, the mammography practitioner then takes the mammogram. She explains when and how the woman will get her results, and reminds her of the need to be breast aware between screening appointments. If it is the woman's last routine screening invitation, the mammography practitioner also reminds her that she can ask for another screening appointment in three years' time.

The mammogram

The mammogram is a low dose x-ray. 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 does not cause any harm to the breasts. Compression is needed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. Some women find compression slightly uncomfortable and some feel short-lived pain. Research has shown that for most women it is less painful than having a blood test and compares with having blood pressure measured.

The results

The mammograms are examined and the results sent to the woman and her GP within two weeks. In 2006/2007 around 8.3 per cent of women attending for a first screen, and around 3.7 per cent¹ of those attending a subsequent screen, were asked to go to an assessment clinic for a further mammogram, either for technical reasons (if the picture was not clear enough) or because a potential abnormality was detected.

Further investigation

At the assessment clinic, more tests are carried out. These may include a clinical examination, more mammograms at different angles or with magnification, or examination using ultrasound. Fine-needle aspiration cytology may be carried out in which some breast cells or fluid are drawn off through a very fine needle for laboratory analysis. Another common technique used in the clinics is core biopsy, whereby some of the breast tissue can be removed and taken away for analysis. This is always done under local anaesthetic.

About 95 per cent of women are reported as normal after the first mammogram and will be routinely invited for screening three years later. Of those recalled for further investigation, only around one in six will be found to have cancer.

Open biopsy

Some women (less than one per cent), may need a biopsy.¹

What happens if cancer is found?

If a woman is found to have cancer, she is referred to a consultant surgeon for a discussion of the options available to her. This is essential before making any decisions on treatment. Many women have a choice about the type of treatment they receive depending on the type and location of their cancer.

Is there anyone to talk to?

Assessment clinics have a specialist breast care nurse available to give advice and help to women who are undergoing diagnostic tests or who have been diagnosed as having breast cancer.

Treatment

This usually involves some form of surgery: a lumpectomy where just the lump and a small amount of surrounding tissue is removed, or a mastectomy where the whole breast is removed. Surgery is likely to be followed by radiotherapy, chemotherapy or hormone therapy or a mixture of these. The exact course of treatment will depend on the type of cancer found and the woman's personal preferences. Women might also be offered the opportunity to participate in research trials.