Ductal Carcinoma in Situ (DCIS)
Routine mammograms: the UK Breast Screening Programme
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 NHS Breast Screening Programme (NHSBSP) was set up in 1988 with the aim of reducing the death toll from breast cancer. People registered as female with a GP between the ages of 50-71 are invited for free breast screening every 3 years. Screening is for people without symptoms: anyone with symptoms needs to speak to their GP. People older than 73 are encouraged to make their own appointments for screening every 3 years. For more information, see our 'Resources and Information' section.
People can ask their GP to refer them to a hospital breast clinic if they have a specific breast problem or are otherwise worried about the risk of breast cancer. This is outside the NHS Breast Screening Programme, which uses a routine call and recall system to invite people who are well, but the same techniques are used in breast screening units and hospital breast clinics for diagnosing breast cancer and many staff work in both settings (see 'Diagnostic mammograms').
The invitation
Most of the women we spoke with were diagnosed with DCIS that was found after a routine mammogram they’d had on the NHS Breast Screening Programme. Many of them had heard of the Programme before they received their first invitation, though didn’t know what to expect of the actual mammogram.
Because the NHS Breast Screening Programme operates on a rolling schedule that invites people from GP practices in turn, not every person will receive an invitation as soon as they reach screening age but will receive the first invitation within 3 years. They will then be invited every 3 until their 71st birthday. The NHS call and recall system holds up-to-date lists of people with female sex organs compiled from GP records, and registers levels of attendance and non-attendance.
Most women said they received a letter through the post inviting them for a routine mammogram, though one woman said a nurse had arranged her mammogram appointment for her when she went for routine cervical screening.
One woman who was invited for her first mammogram at 49 said she nearly didn’t go because she thought she may have been invited by mistake. Several other women who had been invited at 49 said they felt lucky to have been invited sooner rather than later, especially because their DCIS might have become more serious if they had to wait another 3 years to be screened.
A few women expected to receive an invitation at 50 and were concerned when it hadn’t arrived. One person was disappointed at having to wait until she was 53 for the mobile screening unit to revisit her area.
Patricia was keen to be screened at 50 but lives in a rural area and didn't have her first mammogram until 53.
Patricia was keen to be screened at 50 but lives in a rural area and didn't have her first mammogram until 53.
A few women said that when they received their first invitation for routine screening, they were reluctant to go because they were scared, expected it to be painful, or thought that they were not at risk of breast cancer. However, they were glad they had gone. One said her husband persuaded her to go. Several others said they had postponed their appointments because they’d been busy at the time, though had always intended to go. A few women noted how easy it was to rearrange their appointment if they couldn’t attend on the date they’d been given.
Getting to the screening unit was easy but Liz postponed her appointment several times because of other commitments.
Getting to the screening unit was easy but Liz postponed her appointment several times because of other commitments.
Some women said they were ‘scared’ before going for their first mammogram, though others said they had not been concerned. One said she had felt confident that nothing abnormal would be found but went because she was curious about the process. Another said she ‘dreaded’ going when she was invited every 3 years. Many women who had been for more than one mammogram said they had always attended when invited and never really thought about screening before or afterwards.
Maisie was scared to have a mammogram but the radiographer was reassuring, and she now advises other women to attend.
Maisie was scared to have a mammogram but the radiographer was reassuring, and she now advises other women to attend.
A few women said they were glad the NHS Breast Screening Programme was set up because they probably wouldn’t have paid to have a routine mammogram privately. Others said that, if they weren’t routinely invited by letter, there was a chance they could forget to arrange their own appointment every three years, so were grateful the programme existed. A 72-year-old woman said she was surprised and pleased to be invited for screening when she was 70 because she had assumed she was no longer eligible.
Mammograms before the age of 50
A few women said they’d had mammograms before the age of 50 through private healthcare schemes. Some had known of or heard about other women who’d had breast cancer, so were particularly keen to find out if they were healthy. One woman said that, whenever she was invited for a routine mammogram on the NHS, she had the X-ray done privately because she had health insurance and would see the same doctor she’d seen before for breast pain.
Some women who have a family history of breast cancer have regular mammograms before the age of 50. One such woman had had mammograms since she was 41 and went into the Breast Screening Programme at 50.
At 41, Agnes asked her GP if she could have yearly mammograms because she was concerned about her family history.
At 41, Agnes asked her GP if she could have yearly mammograms because she was concerned about her family history.
One woman had her first mammogram at the age of 43 as part of a clinical trial of breast screening.
Jacqui was chosen to take part in research and nearly didn't go for a mammogram because she'd had no symptoms.
Jacqui was chosen to take part in research and nearly didn't go for a mammogram because she'd had no symptoms.
Most women we interviewed said they’d had no symptoms before they went for routine screening. One woman, though, said that both she and her husband had noticed changes in her breast, but she didn’t see her GP because she thought the changes could be related to the menopause. She waited until she was invited for a routine mammogram to find out if anything was wrong.
People often feel worried if they have breast symptoms, and it is best to see a doctor straight away. Most symptoms, including lumps, turn out to be harmless. In terms of breast cancer, the incidence increases with age. The older the person, the higher the risk. Incidence rates of DCIS cases in the UK occur most often in persons aged between 65-69 in the UK (Cancer Research UK, 2016-2018 data).
Beverley ignored changes in her breast for eight months because she'd had a cyst in the past, but felt something could be wrong.
Beverley ignored changes in her breast for eight months because she'd had a cyst in the past, but felt something could be wrong.
Many women talked about their experiences at the screening unit and of the mammogram. See the Breast Screening section of our website for more information.
A few women we spoke with had been diagnosed with DCIS outside the NHS Breast Screening Programme because they were under fifty and had symptoms. They were referred to a breast clinic by their GP (see Diagnostic mammograms).
Copyright © 2024 University of Oxford. All rights reserved.