Breast Cancer screening in the NHS

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Breast Cancer screening in the NHS

• Dr D J Rohan Subasinghe

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What is it?

• Set up by the Department of Health in 1988 in
  response to the Forrest report
• 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.
• Women are then be invited every three years until
  her 70th birthday

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Why 50-70 age group?

• Women under 50 are not offered routine screening
  
• 1)mammograms are not as effective in
  pre-menopausal women.
• 2)Incidence of breast cancer is lower in this
  age group.

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How does it work?

• 80 breast screening units across the UK
• Call and Recall system
• Mammogram is a low dose x-ray that can detect
  changes in breast tissue which may indicate
  cancers which are too small to be felt either by
  the woman herself or by a doctor.
• Assessment clinic- clinical examination, more
  mammograms ,examination using ultrasound.
  Fine-needle aspiration cytology ,core biopsy
• Specialist referral

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Why is it important?

• Most women with DCIS have no signs or symptoms so
  it is mostly found through breast screening.
• Early detection
• In September 2000, research was published which
  demonstrated that the screening programme had
  lowered mortality rates from breast cancer in the
  55-69 age group
• Saving 1,400 lives every year in England.
• Out of every 500 women screened, one life will be
  saved.

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Latest stats - England

• In 2003-04
• 76 of women aged 50-64 invited for screening
  were screened.
• Over 1.4 million women of all ages were screened
  within the programme of these, nearly 1.2
  million were women aged 50-64.
• Over 11,200 cases of cancer were diagnosed in
  women of all ages screened, of which nearly 8,400
  were diagnosed in women aged 50-64.

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What do the critics say?

• the incidence of breast cancer in women who
  declined to participate in the NHS breast
  screening programme.
• Not all women invited to participate in the NHS
  breast screening programme will do so those who
  do not may differ in their risk of breast cancer
  from those who do. This "self selection" for
  screening can result in women at either high or
  low risk being over-represented in those
  screened.
• The risk of breast cancer in non-attenders is
  lower than that in the population targeted for
  screening.
• Targets must be revised.

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Quality control

• Institute of cancer research
• A cohort study of more than two million women to
  evaluate the effectiveness of the NHS Breast
  Screening Programme in reducing deaths from
  breast cancer in women invited and screened by
  the programme
• Other epidemiological studies of the NHS Breast
  Screening Programme (including international
  comparisons, surrogate outcome measures, interval
  cancer rates and screening of women gt70 years)
• A randomised controlled trial studying the
  effectiveness of mammographic screening in young
  women
• Quality assurance and monitoring of the breast
  screening programme
• External quality assurance of pathology in the
  NHS Breast Screening Programme