Breast Screening
The UK breast screening programme
Breast cancer is the most common type of cancer in the UK and 1 in 8 women in the UK develop breast cancer during their lifetime (Cancer Research UK 2015). Breast screening is a method of detecting breast cancer at a very early stage, which involves taking an x-ray - a mammogram - of each breast. The mammogram can detect small changes in breast tissue which may indicate cancers that are too small to be felt either by the woman herself or by a doctor.
The National Health Service Breast Screening Programme (NHSBSP) was set up in 1988. Women between the ages of 50 and 70 are routinely invited for free screening every three years. In some areas, women aged 47 to 49 and 71 to 73 also receive invitations for screening. This is part of a study looking at whether to extend the breast screening age range. Screening is for all well women without symptoms, whether they have a family history of breast cancer or not.
Breast screening is an important way to detect cancer early and around a third of breast cancers are diagnosed through screening (according to The Department of Health's Improving Outcomes: A Strategy for Cancer - January 2011). It is not the only way breast cancer is detected, though, and it is important women be 'breast aware' (check their breasts regularly).
Any woman who is concerned about her breasts should see her GP, regardless of her age. If she needs further tests, she will be referred to a breast clinic. This is outside the NHS Breast Screening Programme, which uses a routine call and recall system to invite well women without symptoms, but the same techniques are used in breast screening clinics and hospital breast clinics for diagnosing breast cancer and many staff work in both settings (see 'Diagnostic mammograms in the UK').
Many of the women we spoke with had heard of the NHS breast screening programme before they received their first invitation. Women who'd worked in the health field were particularly familiar with the programme and had access to a lot of information on both breast screening and breast cancer. Others told us that, although they were aware of the programme, they didn't know what to expect of the actual mammogram procedure. A few women, whose first language was Cantonese, hadn't heard about breast screening until they'd received the invitation letter. Their children translated it and the accompanying information leaflet for them. Information on breast screening is available in other languages from the NHS Breast Screening Programme.
She works in the health field and has enough information about breast screening.
She works in the health field and has enough information about breast screening.
Well this was the first mammogram I've ever had and I didn't feel at all anxious about it. I mean you know that when you reach 50 you're going to have a mammogram and, in some ways, because I work with sort of women of my, the same age, we all sort, you know we talk about it, there's no anxiety involved at all. But also, because we are dealing with patients who have cancer, breast cancer, we realise the importance of having it now. You know, if it's detected early enough that the treatment is positive.
Well, it's sort of considered to be a sort of, how can I put it? A rite of passage, really. You know when you reach fifty, that's it, you go for your mammogram and I don't know, we just talk about it here and, you know, some people say “oh, it's painful” and no, we just, how can I put it? We just accept it, it's no big deal and. As I say, we all sort of enquire how it all went and you know, the results and things like that.
The invitation letter
Women don't necessarily receive their first invitation for breast screening in the year that they turn 47, but will be invited sometime between their 50th and 53rd birthdays. A few women expected to receive an invitation at fifty and were concerned when it hadn't arrived. One person had been disappointed at having to wait until she was fifty-three for the mobile screening unit to revisit her area. Another paid for a private mammogram for her fiftieth birthday as she didn't want to wait up to three more years for her first NHS mammogram, partly because a colleague had recently been diagnosed with breast cancer.
She lives in a rural area, and didn't have her first mammogram until 53.
She lives in a rural area, and didn't have her first mammogram until 53.
I knew, you know, it was important and I was a little bit disappointed and disillusioned when I was told I'd have to wait another three years. But I was very busy and it's just one of those things you accept.
Did you talk to your GP at that stage or did you phone the breast clinic?
No I didn't, I didn't speak to anybody, no.
Who told you that you have to wait another three years?
The person I spoke about them coming round for the next time, that they would come in this area would be three years. It was a mobile screening unit you see.
Yes. OK. And so you waited another three years?
Yes.
And when you were invited, did you get a letter to go?
Yes, I got a letter.
She decided to have a private mammogram rather than wait for an NHS appointment.
She decided to have a private mammogram rather than wait for an NHS appointment.
Yes, I expected to be called. I wasn't actually, I actually booked the private one before I was fifty I made an, because I phoned up about two months before to the NHS knowing that I was going to be fifty and ask them when I could expect to be called, and it was when they told me "Well any time within the next three years", I thought that's too long. And I don't know why I thought it was too long Suman, I just thought it was too long and that's why I organised the private one.
Did you know much about breast screening before that, you knew you were going to get a letter, did you know about that through friends or through things you'd read?
I think with, I've always known that you can get mammograms once you reach the age of fifty on the NHS and you should be called routinely. And I thought it's coming up to my fiftieth birthday. This is my fiftieth birthday present to myself.
So I actually paid for a mammogram privately as a fiftieth birthday present.
Some women remembered when their invitation letter was due every three years after the age of 47. A few said that, on the odd occasion when it hadn't arrived in the month they'd been expecting it, they'd phoned the unit to find out why. Several women said they were grateful for being sent an invitation letter every three years and that, if they had to phone and make their own appointments every three years, there was a chance they'd forget.
A few women wondered why they were routinely invited every three years and not more often. Others said that they'd visit their doctor if they did have any concerns between their three-yearly screening appointments. A large research trial in 2002 concluded that the NHS Breast Screening Programme has got the interval between screening and invitations about right at three years, compared with more frequent screening. The trial was organised through the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) and was supported by the Medical Research Council, Cancer Research UK and the Department of Health. A few women chose to continue having mammograms after the age of 70 when they stopped being routinely invited (see 'Breast screening after age 70').
Several women had their first mammogram before the age of fifty. One woman had been going for screening since she was forty, because of a private health care scheme at work.
She had private mammograms as part of a health care scheme at work.
She had private mammograms as part of a health care scheme at work.
Some women, who'd had benign problems at a younger age, said they'd had mammograms before the age of fifty (see 'Benign breast problems' and 'Diagnostic mammograms in the UK'). Other women, who'd had breast cancer in the family, had also been screened earlier. One woman had had her first mammogram at the age of 43 as part of a clinical trial of breast screening.
She had breast screening from the age of 34 because of a family history of breast cancer.
She had breast screening from the age of 34 because of a family history of breast cancer.
So when these two sisters were diagnosed, I think it was just after Christmas I went to the GP, and started discussing with him that I wanted to go on some kind of screening program. He was very helpful and didn't try to deter me from it at all, very helpful and referred me to the hospital straight away. So within about six months from going to the GP I was on a screening program.
It was three years - this was my third screening, this one in 2003, so it was 2000, so I was 34, yeah, 34. So I joined the screening program and just went every year, so I [first] went in 2001.
Most women were invited by post to attend for a routine mammogram. Although many felt that the accompanying leaflet gave them enough information about breast screening, some would have liked more (see 'Information'). A few women mentioned that they didn't read the information leaflet very carefully before their first mammogram. One person had read the leaflet after having her first mammogram in case the information was off-putting.
She read the information about breast screening after her first mammogram.
She read the information about breast screening after her first mammogram.
Yes, I didn't know what to expect. And I didn't actually pick up a leaflet when I went in, I'd rather experience it first hand and then I picked up leaflets on the way home. And I thought it was very thorough, it did hurt slightly but I thought, well a little bit of pain like that didn't really matter as long as it detected anything that might be there. And I felt very confident about the whole thing.
So, you didn't pick up any information beforehand. Was it because you might have become worried if you'd picked up the leaflets?
Yes, I'm a little bit like that, yes [laughing]. But once I'd experienced the mammogram I did pick up leaflets and read about, you know what they were looking for. And it's all very easy going so that's okay.
A few women mentioned how easy it was to rearrange their appointment if they couldn't attend on the date they'd been given. One woman changed her appointment to a time in her menstrual cycle when her breasts would be less tender. Another felt that the invitation letter should also say when to expect the results letter. The information leaflet ('Helping you decide') that is sent with the invitation letter does now include informatrion about when to expect the results.
It was easy to change her appointment to a more convenient date.
It was easy to change her appointment to a more convenient date.
They just sort of said that it's the breast screening unit thing and would you like to, you know it tells you a date and if you don't want to go or you can't go on that date would you please ring this number and say that you don't, you know you don't want to go. Same as on the last one I got, and I can't remember whether it was too early for me or something, I think it was so I just rang them up and I said "Can I change it?" And she said "Yeah." And I said "Well can I make it on a Tuesday?" and about, well you know dinner time, after eleven or something and she said "oh yeah." So they made it for was half past twelve weren't it, yeah, yeah. So they're quite good at that, they will change it, I think that's twice I've had to change it yeah.
Have you ever missed an appointment?
No, no I've always sort of rang, I think this is just the second time when I've, I think there was another time. Something happened and I thought oh I can't go on that day so I just rang up and I said "Can I come," I said it again "can I come on a Tuesday please?" and she just looked at it on Tuesday "Oh yeah so and so," if you say, like you want to go after eleven or something I mean they're quite good, they will get you in you know yes. I mean actually when I cancelled it I think I was only about two more weeks you know after that before I could go again, so it wasn't too bad then. Because I thought oh it'll probably be about five or six weeks but it wasn't, it was only about two weeks so it was good yeah.
She works in the health field and has enough information about breast screening.
She works in the health field and has enough information about breast screening.
Well this was the first mammogram I've ever had and I didn't feel at all anxious about it. I mean you know that when you reach 50 you're going to have a mammogram and, in some ways, because I work with sort of women of my, the same age, we all sort, you know we talk about it, there's no anxiety involved at all. But also, because we are dealing with patients who have cancer, breast cancer, we realise the importance of having it now. You know, if it's detected early enough that the treatment is positive.
Well, it's sort of considered to be a sort of, how can I put it? A rite of passage, really. You know when you reach fifty, that's it, you go for your mammogram and I don't know, we just talk about it here and, you know, some people say “oh, it's painful” and no, we just, how can I put it? We just accept it, it's no big deal and. As I say, we all sort of enquire how it all went and you know, the results and things like that.
Last reviewed March 2016.
Last updated March 2016.
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