Breast cancer (female) - Screening 

Breast screening 

In 2011-12, almost two million women aged 45 and over were screened as part of the NHS Breast Screening Programme.

Women who are 50-70 years of age and registered with a GP are automatically invited for screening every three years. You will first be invited for screening between your 50th and 53rd birthday.

If you're over the age of 70, you'll stop receiving screening invitations. However, you're still eligible for screening and can arrange an appointment through your GP or local screening unit.

The NHS is currently in the process of phasing in breast screening for all women in the extended age range of 47-73. The programme started in 2010 and should be completed by 2016.

More details about the extended age range for breast cancer screening can be found on the NHS Breast Screening Programme website.

What happens during breast screening

Breast screening is carried out at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms (X-rays of the breast).

The aim of screening is to detect breast cancer at an early stage, when any changes in the breast would be too small to feel and when there's a good chance of successful treatment and full recovery.

During screening, your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently, but firmly, compressed with a clear plate. Two X-rays are taken of each breast at different angles.

Most women find the procedure uncomfortable and can occasionally be painful. However, the compression is necessary to ensure that the mammogram is clear. Any discomfort will be over quickly.

After your breasts have been X-rayed, the mammogram will be checked for any abnormalities. The results of the mammogram will be sent to you and your GP.

Not all breast cancers are found during screening. Breast cancer can develop between screening appointments. Even if you attend your screening appointments, it's still important for you to be familiar with your breasts, so you can spot any unusual changes early and report them to your GP.

Pros and cons of breast screening

Most experts agree that regular breast screening is beneficial in identifying breast cancer early. The earlier the condition is found, the better the chances of surviving it.

You're also less likely to need a mastectomy (breast removal) or chemotherapy if breast cancer is detected at an early stage.

Studies carried out in Sweden and England have shown that more women's lives are saved through breast screening compared with women who are over-diagnosed.

Over-diagnosis is when cancers are picked up and treated that wouldn't have been diagnosed in a woman's lifetime had screening not taken place.

The Swedish study found that in a group of 1,000 women who were screened from the age of 50 over a 20-year period, there were around nine breast cancer deaths compared with four over-diagnoses.

In the English study, which also followed 1,000 women who were screened from the age of 50 over a 20-year period, it was found that there were around six deaths due to breast cancer and about two over-diagnoses.

Taking the results of the two studies together, this represents 9-13% of women's lives saved following breast screening, compared with 4-7% of women over-diagnosed.

Screening may not help if you already have advanced stage breast cancer.

Misdiagnosis

Cancers may sometimes be found that are treated even though they may not have caused any symptoms or become life-threatening.

There's a chance that the results of the mammogram may not be accurate. There are two types of misdiagnosis, known as:

  • a false negative result  where you receive a negative (all clear) result, but cancer is present
  • a false positive result  where you receive a positive result (cancer present) and go on to have further tests, but there's no cancer

Following screening, about 1 in 20 women will be called back for further assessment. Being called back doesn't mean you definitely have cancer. The first mammogram may have been unclear.

About 1 in 6 women who are called back for further assessment are diagnosed with breast cancer.

Radiation

During a mammogram, your breasts are exposed to a small amount of radiation (2-5 millisieverts, or mSv).

For comparison, in the UK, a person receives a dose of 2.2 mSv a year from natural background radiation. However, the benefits of screening and early detection are thought to outweigh the risks.

Screening for women at high risk of breast cancer

You may be eligible for breast cancer screening before the age of 50 if you have a higher-than-average risk of developing breast cancer. You may be considered to have an increased risk if you have a family history of breast cancer (female or male) or ovarian cancer.

If you have an increased risk of developing breast cancer, you may have yearly magnetic resonance imaging (MRI) scans or mammograms, depending on your age and your specific level of risk. MRI scans are sometimes used instead of mammograms, because they're better at detecting cancer if you have dense breast tissue.

Genetic screening for breast cancer

After having an assessment at a specialist clinic, you may be thought to be at increased risk of breast cancer due to your family history. This may be because one of the genes that make breast cancer more likely runs in your family. If this is the case, you should be offered genetic counselling before genetic testing.

Genetic counselling is a service that provides information and advice about genetic conditions. It's provided by healthcare professionals who are specially trained in the science of human genetics (a genetic counsellor or a clinical geneticist).

The counsellor will discuss the risks, benefits and limitations of genetic testing with you. They'll also explain how the information found as a result of genetic testing could have implications for both you and your family.

After you've had genetic counselling, a genetic blood test to look for mutated (altered) versions of genes called BRCA1, BRCA2 and TP53 will be offered, because having one of these altered genes increases your chances of developing breast cancer.

If possible, a relative who's already had breast cancer will be tested first, because this will make it easier to find any genetic faults. If a faulty gene is found, other family members can then be tested to see if they have the same gene.

If a close relative isn't available for testing, you should be offered testing yourself if your family history suggests you have at least a 1 in 10 chance of having a faulty gene.

If genetic tests show you have one of these faulty genes, you may be offered regular screening to check for signs of breast cancer. Possible treatments to reduce your risk should also be discussed.

Read our page on preventing breast cancer for more information about treatments to reduce your risk.

Want to know more?



Page last reviewed: 19/08/2014

Next review due: 19/08/2016

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Ichuveyem said on 30 October 2012

NHS choices and NHS Screening never reveals the full information. Patient leaflets for screening do not provide selective data and generic advice. Real information can only be given with facts and opinion which is qualified by the author.

In reply to User 559420 an independent panel led by University College London's Professor Sir Michael Marmot was tasked with analysing data from screening trials from a number of countries over recent decades. The report was published in The Lancet this month (Oct 2012). It concluded screening reduces breast cancer mortality but that some overdiagnosis occurs. It found that for every life saved, three women were overdiagnosed. In detail, screening saved 1,307 lives every year in the UK, but led to 3,971 women having unnecessary treatment.

The panel reported 'Of the roughly 307,000 women aged 50--52 years who are invited to begin screening every year, just over 1% would have an overdiagnosed cancer in the next 20 years'

Breast cancer screening is a massive industry for the NHS and the private sector. There is a financial motivation to encourage, continue and extend screening. Profit, wages, and reputation gets in the way of some simple facts.

All I can suggest is seek out as much information as you can find from as many sources as you can find and make your own decision. It is your choice.

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tiddles20 said on 02 February 2012

Having received an invite for breast screening & reading the booklet I find that the comment the screening is only carried out by female staff to be sexual discrimination for males who are ruled out of this employment opportunity. I don't suppose that if women are found to have a problem they will then refuse further treatment to be carried out by males! Does that mean that only males treat men genitiles?

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User559420 said on 28 May 2011

I have read that many women undergo unneccessary treatments due to breast screening. I am trying to find out how many or what percentage compared to the well publicised figures for the number of lives saved. The leaflet I have been sent does not have reference to the downside of screening only a single sentence about the low radiation exposure. Can any help?

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Body_Byoot said on 31 October 2010

Why are there so little facts around the numbers. Yes, breast screening can and does save lives. These numbers are always quoted. But why is this not balanced with the number of patients who have to undergo unnecessary callbacks, biopsies, treatments and pain who will not have breast cancer or not die of it? Why does NHS choices once again not fully inform patients of the pros AND cons of screening and encourage choice?

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chatsubo said on 25 October 2010

I do not think that the potential risks associated with screening are fully explained in this section (though the article as a whole is very good)

The Nordic Cochrane Centre estimates that for every life saved by screening a further ten women will be treated unnecessarily.

I think it is important that people have the information needed to make an informed decision on screening.

For more information see:
http://www.cochrane.dk/screening/mammography-leaflet.pdf

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