Breast Screening
The NHS breast screening programme (NHS BSP)
Breast cancer is the most common type of cancer among women in the UK, and breast screening is a method of detecting breast cancer at a very early stage, before it is able to be seen or felt.
Breast screening involves taking an X-ray called a mammogram of each breast. The mammogram can detect small changes in breast tissue which may indicate cancer.
The National Health Service Breast Screening Programme (the NHS BSP) was set up in 1988, and aims to give better prognosis and long-term survival by catching breast cancer at an early stage when effective treatment is more likely.
How does the breast screening programme work?
All people registered as female with a GP between the ages of 50 and 70 are routinely invited for free screening every 3 years.
While screening invitations are no longer sent to people over the age of 71 through the programme, people can still request breast screening appointments on the NHS after age 70.
Screening is for all well women without symptoms whether they have a family history of breast cancer or not, though women who are at an increased risk of breast cancer may be eligible to attend screening before age 50 (NICE, May 2022).
Between 2009-2020 some people aged 47-49 and 71-73 were invited for additional screening in a study to see if extending the age range to 47-73 would be beneficial (the AgeX trial). This study is still in progress and aims to produce findings in 2031 (Oxford Population Health, 2025).
Though breast screening is an important way to detect cancer early, it is not the only way breast cancer is detected. It is important that women be 'breast aware' and 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 testing is done outside of the NHS Breast Screening Programme, which uses a routine call and recall system to invite well women without symptoms.
However, 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 also 'Diagnostic mammograms in the UK').
Experiences with the invitation to attend breast screening
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.
Some women told us that although they were aware of the programme, they didn't know what to expect at the actual mammogram appointment.
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 (see 'Resources and Information').
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 breast screening programme invitation letter
Women don't necessarily receive their first invitation for breast screening in the year that they turn 50, but will be invited sometime between their 50th and 53rd birthday.
A few women expected to receive an invitation at age 50 and were concerned when it didn't arrive. One person had been disappointed at having to wait until she was 53 for a mobile screening unit to revisit her area.
Another paid for a private mammogram for her 50th birthday as she didn't want to wait up to 3 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 that their invitation letter was due every 3 years after the age of 50. A few said that, on the odd occasion when it hadn't arrived in the month they'd been expecting it, they phoned the unit to find out why.
Several women said they were grateful for being sent an invitation letter every 3 years and said that if they had to phone and make their own appointments every 3 years, there was a chance they'd forget.
She always remembers when her screening appointment is due every three years.
She always remembers when her screening appointment is due every three years.
They send me a letter, I put it in my diary straight away and my memory's not very good [laughing].
And is the letter always clear?
Oh yes, yes. It's time for my appointment, they give me a date and I can come any time I think, between certain times. A certain time in the morning and a certain time in the afternoon, I think that's, and if I go, if I can make it, that date's clear, I go [laughing].
You've always felt, have you, that you've had the information you needed?
Oh yes, yes. I felt I hadn't had a letter some time ago so I went down the road and asked, and she said "yes, your letter is coming," it's just a matter of process and how they do it. And they do it alphabetical order, I'm not sure. So she said "yes, it will come, don't worry" and a couple of weeks later it came. I get anxious if I think it's time to go because as you get older, it doesn't stop, does it? You know it can always occur so...
So you kind of keep abreast of things?
Yes.
And you know when your appointment's about to come up?
Oh yes, yes. I forgot some while ago that it was every 3 years so now I know, it's imprinted on my memory [laughing].
The frequency and timing of breast screening
A few women wondered why they were routinely invited every 3 years and not more often. Others said that they'd visit their doctor if they had any concerns between their 3-yearly screening appointments.
The breast screening programme is managed with recommendations made by the UK National Screening Committee (UK NSC), which makes recommendations based on internationally recognised criteria with a rigorous evidence review process.
Screening recommendations are reviewed and updated by the UK NSC based on the best quality evidence available 3 times per year (GOV.UK, 30 November 2015). Having breast screening every 3 years is based on these recommendations.
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 50. One woman had been going for screening since she was 40 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 (non-cancerous) breast problems at a younger age said they'd had mammograms before the age of 50 (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 her first mammogram at the age of 43 as part of a clinical trial for 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.
Her first mammogram was in a clinical trial of mammography.
Her first mammogram was in a clinical trial of mammography.
I had a letter through the door saying I had been picked up at random from so many thousand women to take part in trials for mammograms. They asked me to go for a mammogram the following Thursday. I nearly didn't go because I'd not had any symptoms, I had not felt any lumps or anything in my breasts.
You just had a letter through the post right at the beginning didn't you?
Yes and I had been picked up random, you know.
So this was a clinical trial?
Clinical trial, yes they were doing on mammograms for younger women.
Based at a University Hospital?
No, from the city hospital. Yes.
And how did you decide that you would take part in that?
I just thought 'oh, I might as well go along'. As I say, I nearly didn't go, I nearly, I was busy at work and everything and I nearly didn't bother. And then I thought 'well, I suppose I better do, I ought to go'.
Information and attending breast screening
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 said they 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 only 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 that is sent with the invitation letter does now also include information about when to expect the results (see 'Helping you decide', GOV.UK, 24 February 2025 ('Resources and Information').
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.
See also 'Breast screening before age 50'.
AI and breast screening
In February 2025, the Departmnet of Health and Social Care approved a world-leading artificial intelligence (AI) trial called the EDITH (Early Detection using Information Technology in Health) trial to test the use of AI tools and technology with breast screening mammograms to help radiologists detect breast cancer.
700,000 women in the UK registered with the NHS BSP will have the option to take part in the AI trial at their routine breast screening appointment. AI tools will be used to assist radiologists with identifying and detecting changes in breast tissue and possible signs of cancer.
For more information and updates, see The Department of Health and Social Care and NHS England at GOV.UK ('Resources and Information').
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