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.

The NHS Breast Screening Programme will extend the age range of women eligible for breast screening to ages 47 to 73 by 2012.

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.

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)
(A separate browser window will open).

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?

In December 2007, the Department of Health's Cancer Reform Strategy announced that from 2012 the NHS Breast Screening Programme would be extended to cover women between the ages of 47 and 73. This means that all women will get two extra screening invitations in their lifetime. It also means that all women will get their first screening invitation before their 50th birthday.

The age extension will be phased in across England over a three-year period, with full coverage from 2012. Before that begins, however, a pilot study is being undertaken in six areas across England that have volunteered to take part. The pilot study will provide information which can be used in the planning and rollout of the age extension across the rest of England.

Women aged 50-70 in the pilot areas are invited for screening as usual. In order for the pilot to be evaluated, the female population that falls within the extended screening ages has been randomised. Around half of the women aged 47-49 and 71-73 in the pilot areas have been selected at random to receive screening invitations. This means that the pilot only affects some women aged 47-49 and 71-73, as all women aged 50-70 continue to get their screening invitations as normal.

The results of the pilot will be available by the end of 2009.

For more information see;
http://clinicaltrials.gov/ct2/show/NCT00890864?term=NCT00890864&rank=1.

A study looking at targeting the younger cohort and comparing it with the status quo has been undertaken. An extension of the modelling to the older cohort is included in the appendix.

ScHARR Initital Assessment Report (PDF 183Kb).

Digital mammography

The introduction of digital mammography was started in 2005. Whereas conventional mammography captures images of breast tissue on x-ray film, digital mammography uses computer imaging. A multi-disciplinary steering group, set up in 2004, undertook an evaluation and clinical assessment of equipment currently available. There was also 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.

By 2010 every breast screening unit should have at least one digital set for assessment.

Why are women under 50 not invited?

Women under 50 are not currently offered routine screening. This is because film 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 film mammogram and makes interpretation of the x-ray more reliable.

The extension of the NHS Breast Screening programme to women aged 47 which will be complete by 2012 has been made possible by the introduction of digital mammography. The DMIST study has shown that digital mammography is better for screening younger women and women with denser breasts, and is equally effective as film mammography in older women.

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 2010.²

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.³

^[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] Breast Cancer Screening 1991: Evidence and Experience since the Forrest Report, Department of Health Advisory Committee, NHS Breast Screening Programme 1991
^[3] 7th Handbook on Cancer Prevention, IARC, Lyons 2002