FOLLOWING our session on breast screening at the recent breast cancer forum, Leena Chagla, new secretary of the association of breast surgeons, gives an overview of the current screening programme.
THE breast screening programme started under the leadership of Sir Patrick Forrest in 1988 in Edinburgh. Initially women between the ages of 50 and 64 were screened every three years with mammography. Today the age range has been extended and women between 50 and 70 are screened every three years by two view mammograms that are double read (ie seen by two radiologists or film readers). There is an age extension trial ongoing that is looking at women between 47 and 50 and 70 and 73 years.
The running of NHS breast screening programme (NHSBSP) in England is now under the care of Public Health England along with other screening programmes. The aim of the screening programme is to reduce the mortality from breast cancer by finding these cancers at an early stage. The screening programme also undertakes high-risk screening for patients with gene mutations (eg BRCA1 and BRCA2) and those that have had radiotherapy for lymphomas at a young age.
This screening consists of annual mammography or MRI scans depending on the age of the patient and the risk factors involved. This arm of the screening programme is not to be confused with the routine population based 3-yearly screening mammograms. It is important to remember that patients who have had breast cancer have their initial follow up mammograms under the care of the treating unit and not under the NHSBSP. They are advised to go back to the breast screening programme once they have been discharged by their treating unit.
The breast screening programme is quality assured and there are teams of professionals that visit screening units to make sure that the standards set are met. Audit is an integral part of the programme and the data is religiously collected, analysed and presented annually.
Some have questioned whether the screening programme causes more harm than good by “over diagnosis” and “over treatment” hence an independent panel of experts led by Professor Sir Michael Marmot conducted a review, and in October 2012 they concluded that the breast screening programme did save lives though some women did come to harm by being diagnosed to have pathology which would not have affected them in their normal life span.
Further details regarding the breast screening programme including information about your nearest centre can be obtained from Public Health England through the gov.uk website.
Leena is also consultant surgeon, St Helens and Knowsley NHS Teaching Hospitals Trust, and will be presenting at next year’s breast cancer forum.