NHS Breast Screening Programme (NHSBSP)

• 1987 – Forrest report

• To detect early, non-palpable disease in WOMEN

• Mammogram

• Every 3 years

• 50 and over (47-73 from 2010 onwards)

• Rolling invite – invites GP practices in turn (routine call and recall).

• Film mammograms not as effective in Pre-menopausal women

• > 70 years - no longer routinely invited but encouraged to request 3 yearly imaging

• ’08-’09 – 1.8 million women 45+ screened14,116 cases cancer

11,212 = invasive

5,850 = 15mm or less (could not have been detected by hand)

• 1,250 lives saved/year (DoH Advisory Committee)

• 35% reduction in mortality (50-69 year olds) = 1 life saved/500 screened.

• Between 2 and 2.5 lives saved for every over-diagnosed case – Duffy et. al – 2010

Mammogram

• Results within 2 weeks

• 1 in 20 to clinic for further tests (examination, LN biopsy, FNA, Core needle biopsy)

• 1 in 6 recalled have cancer

Scenario

• 38 year old female

• Mother develop breast cancer at 48

• Mother’s Consultant advised her children would need screening from the age of 38

• What questions would you ask?

• How would you manage this?

• Has a genetic cause been established?

No...Hx. – (involving blood relatives on both sides)

- the age at which any cancer was diagnosed?

- where was the primary?

- ? More than one cancer in same person (e.g. bilateral breast)

• Ethnic background

• Ask about their hx.and FH - ?lump, COCP and >35, HRT

• Refer – Breast team – risk assessment (raised or high risk - - -> genetics testing)