Breast Screening
Referral to a breast clinic
Some women (about four in every houndred that are screened) are called back because the x-ray indicates that more tests are needed (NHS Breast Screening Programme- "Helping you decide" leaflet July 2013). Most of these women (3 out of 4) will have no problems. Women should not be surprised if they are called back and then tests show that there is nothing to worry about (see 'False positive results').
At the breast clinic, more tests are done. These may include a clinical examination, more mammograms at different angles or with magnification, examination using ultrasound or an MRI. A core biopsy, which removes a small sample of breast tissue under local anaesthetic is often taken for analysis and should not cause more discomfort that a blood test. Fine-needle aspiration cytology (FNAC) may also be done. This involves drawing off some breast cells or fluid through a fine needle for laboratory analysis, but a core biopsy is more commonly used.
Together, the breast examination, mammogram/ultrasound and core biopsy/ FNAC are called 'triple assessment'. For most women a full assessment will show nothing more serious than a specific benign breast condition (see 'Benign breast problems'). Of those recalled for further investigation, only around one in four will be found to have cancer (NHS Breast Screening Programme- 'Helping you decide' leaflet July 2013). Women who have breast symptoms, either between three year screens or otherwise, may also be referred to a breast clinic by their GP. The same tests are done to find out if there is a problem (see 'Diagnostic mammograms').
Some women were recalled for more tests after having a routine mammogram on the NHS breast screening programme. Being recalled for tests can cause anxiety. Some were not worried as they assumed the x-rays weren't clear for technical reasons and they didn't think there would be anything wrong. Others had felt slightly anxious. A few were frightened. Some said they couldn't believe it was happening to them, while one said she wasn't surprised. Some women's recall letter arrived on a Saturday morning and they were often angry because they had the whole weekend to worry about it and couldn't contact the screening unit or their GP to discuss it.
Did not feel anxious when she was recalled as she didn't think there would be anything wrong.
Did not feel anxious when she was recalled as she didn't think there would be anything wrong.
I thought well this is just a mistake, there is, there has been some glitch with the process. Again it wasn't going to be breast cancer. In fact I was joking with them because I have very small breasts and I just kept saying "Well they couldn't find anything on the mammogram, that's what it was, there wasn't a breast there, I'm too small."
Was frightened when she was recalled.
Was frightened when she was recalled.
Several people who were recalled told us that their mammograms were retaken and no problems were found (see 'False positive results').
Some women who were recalled after having a routine mammogram, discussed further tests that were carried out to find out if there was a problem. In addition to having more mammograms, several women described having ultrasound scans, which use high-frequency sound waves to produce an image of the breast. Ultrasound scans are painless and quick.
Describes having an ultrasound scan.
Describes having an ultrasound scan.
Some women had a fine needle aspiration (FNAC). Many did not find it painful. One woman who did find it painful, also said that it was a quick procedure.
A core biopsy uses a larger needle to obtain a sample of tissue. Some woman discussed being given a local anaesthetic to numb the area. One woman who described having a core biopsy didn't find it painful. For several other women, however, having a core biopsy did cause pain. One woman found it extremely distressing. A few women found that their breasts ached afterwards and were bruised. One woman took painkillers to ease the pain.
Had a core biopsy, which was not painful.
Had a core biopsy, which was not painful.
You're, again, you are put in a clamp like a mammogram and then they, first they looked under x-ray to see where the calcium dots were and then they punched, and it's more than a needle, it's thicker, but they punch down on the breast and then this, out it comes and within that tube, it takes a little sort of tube full of tissue and that's what they then analyse.
Was this on local anaesthetic, or...?
Yes, yes. You had an injection just to anaesthetise the area. That, I mean some people have found it incredibly painful, I didn't really find that too bad at all. A tiny little scar from it and that's all.
Having a core biopsy was painful and distressing.
Having a core biopsy was painful and distressing.
They got me in for my needle and my core biopsy, which was the first time I'd ever had it. The needle wasn't too sore but the core biopsy was like a kind of a pellet gun that they put over my breast and that was quite sore. And I remember crying and one of the Nurses bringing me, the only thing she had was paper towels which was such a shame I thought. And I remember being terribly aware of myself staring at a picture of some kind of a medical thing or something on the wall and I remember going, when I was upset, going out of the room I thought "Why didn't they have a nice picture of flowers or something to look at whenever we're in that situation", it was so kind of distressing.
Many women said that they had not known what to expect of the core biopsy and would have liked more information beforehand. One woman had her tests done privately and wanted to know what all the tests would involve and to have a copy of the report. Another said that the core biopsy was painful but she recognised that it had to be done to find out what was wrong, because all her other tests had proved inconclusive. One woman (who turned out to have breast cancer) said the core biopsy was actually more painful than her mastectomy.
Didn't know what to expect of the core biopsy and would have liked more information beforehand.
Didn't know what to expect of the core biopsy and would have liked more information beforehand.
He mentioned biopsy, he said, and then, "I can do that now". He went through the procedure with the needle just so that I would hear the click at the end and how they did it and said "now don't worry and once it does that, we will give you a local anaesthetic, if you feel any pain whatsoever we can give you more". And then, I thought well, I don't like needles particularly, so I didn't know what to expect and so I thought, I'll let them get on with it. [laughing] So I'm a bit of a coward, so I wasn't watching at the beginning, and then and I thought 'I think I'll have a look at this'. It was quite fascinating [laughs] because I could see the needle going in but I did think that five samples did seem a lot.
Yeah. So he, did he click five times?
Oh yes it went in five times. Yeah, yeah. And I think I looked after about the third. And I was amazed at how long it was. And that you could see it actually moving round inside you, it was.
On the screen?
Yeah. Quite fascinating really [laughs]. And then it was, they just, I'd got to wait outside until the bleeding had stopped a little bit and then went to the desk to make an appointment for the following week.
When you would get the results?
When I get the results. And they gave me a piece of paper and that's when I knew I'd had a core biopsy. Didn't even know, they say 'have you got any questions?' but you need some input to ask questions. And I hadn't anything to, no guidelines whatsoever so, nothing to go on. So, that was where we were from there.
So you had an appointment to come back in two weeks?
One week.
One week?
Yeah
Okay, you didn't ask any questions because you didn't feel you had enough information?
That's right.
Had several tests and then a core biopsy when these proved inconclusive.
Had several tests and then a core biopsy when these proved inconclusive.
So they did two needle biopsies and they were inconclusive. But when they did the second screening it was still showing up, this suspicious tissue was still showing up and they then did a core biopsy which wasn't pleasant. It was quite sore but it had to be done because the two needle tests were inconclusive. So they decided to send the core biopsy off to the hospital but in the meantime they were, from all their speak and all their body language, I was quite sure that they knew there was something not right.
So then they did a core biopsy.
What does that involve?
It involves actually, I didn't know until afterwards because I probably, I was very naïve to it all because it was all so unknown to me and I hadn't a clue what this core biopsy was. And basically they put a needle in and take out part of the tissue surrounding the breast where they think there is a problem. And they take that out and send it to the hospital to be analysed and that was quite painful. And I remember coming home and my breast and surrounding area was black and blue. And no, I suppose it's not fully explained to you what exactly a core biopsy is and how it can affect you and what you'll be like afterwards, nobody actually told you, I mean, it was all very matter of course that it was done, you know. Because this was all happening you're not in the position to ask questions, you know you just feel that they know what they're doing and let them get on with it.
Where possible, women are given the results of their tests on the same day, although some have to wait. Women often said that they became more anxious the more tests they needed and the longer they were at the assessment clinic. One woman, who felt that she might have breast cancer, found being recalled and waiting for her test results extremely worrying. However, some women we talked to had to go back on another day either to complete all the tests or to be given the results. Waiting for the results of a core biopsy can take a few days, causing anxiety in several women. One woman, who worked in cervical screening, explained how she insisted on having her core biopsy results as soon as possible. She felt that, ideally, all test results should be available to women on the same day or overnight if that was impossible. A couple of women had to come again for an open biopsy, which involves having a larger sample of tissue removed surgically under a general anaesthetic.
Found being recalled and waiting for her test results extremely worrying as she felt something was wrong.
Found being recalled and waiting for her test results extremely worrying as she felt something was wrong.
I went for my normal mammogram, it was my second one, and I got a letter on the Saturday morning saying that I had to return on the Tuesday. Now part of me thought this is it, and I was quite accepting of it. My youngest daughter kept saying, "You're always a pessimist. This'll just be they took the film wrong." My son was more in tune with me and he was very concerned.
Went and had the mammogram, and she showed me it and she says, "You know, just there was something not clear there." I could see something on the mammogram.
My son kept phoning me on my mobile, "What's happening? What have they said?" So then they took me in and they did a biopsy, which I found really painful [laughs] and they did a scan at the same time, as they scanned, they did the biopsy. And then they called in another doctor, pathologist in, and they asked him to do another two. And the radiologist I presume it was that did the scan, said it's very dry isn't it? And I thought, why don't they just tell me what's going on as they're doing this. They were saying things like, "I know this is probably a bit painful." And I would say, "No, it is really painful." and you had to keep waiting in between, and the waiting is, I know it was quick in comparison to somebody waiting for an appointment for two weeks or something, but that afternoon to me was like ten hours.
So I came out and they told me I'd have to wait for perhaps another hour, and I went into the waiting room. My son phoned again, and I told him yes there was something but they didn't know whether it was malignant or not.
She wanted her core biopsy results quickly and feels that results should be available as soon as possible.
She wanted her core biopsy results quickly and feels that results should be available as soon as possible.
And then he said that he wanted to put a needle in, to use his words. I had to know a bit more so I asked him if he was going to do a fine needle aspirate. He said no, that that wasn't policy in that particular hospital but that he would be taking a sample for histology so he'd be taking a core sample. And he would go and try and make the arrangements with the radiologist.
But he came back to say it was too late that day to do it. I was a little bit annoyed at that time because I thought that they ought to do the whole assessment in one. So he said, "come back next week," for the biopsy, which I wasn't too happy about but despite sort of making my opinions known I had to go back the next week. And I had the core biopsy. I really got annoyed at that time because they told me to go back the week after for the results and I knew, I'd already spoken, I knew the histo-pathologist was a friend, a colleague; I'd already spoken to him and he'd said that he would report it, if it went down that afternoon, he would process it overnight and report it the next morning.
So I made my feelings known and managed to get the results the next day, which really was only because I was in the know. Most women wouldn't have had that opportunity.
If you could make any changes to how things were done, ideally, what kinds of things would you suggest?
Oh, I'd do everything in a one- stop visit, for the assessment clinic definitely. I mean I know it's difficult because histology takes time to process whereas fine needle aspiration, you can get the answer almost straightaway. But I would have made that such that everything was done on one day and the results were available the next day. I don't think it's acceptable to keep women waiting for results.
Many women found the staff at the assessment clinic nice and friendly. A few said that a member of staff had an off-putting manner or didn't explain enough about what they were doing during tests.
Last reviewed March 2016.
Last reviewed March 2016.
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