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Breast screening
Breast screening (mammography) is an x-ray examination of the breasts. It may help to detect breast cancer before there are any signs or symptoms. The sooner breast cancer is diagnosed the more effective treatment may be.
Going for screening
In the UK, women between 50 and 70 are invited for breast screening every three years as part of the National Health Service Breast Screening Programme (NHSBSP). In England, this age range is being extended to 47–73 by the end of 2016.
Women under 50 are not invited for routine breast screening. This is mainly because the number of women who develop breast cancer is much lower in this age group – 81% of breast cancers occur in women over the age of 50 and the risk continues to increase with age. Also, breast tissue in younger women can be dense making the x-ray image less clear. This means normal changes or benign breast conditions can be harder to identify.
To be invited for screening you have to be registered with a GP. Your name will be taken from your GP’s list and you’ll be sent an appointment from the screening service to come for a mammogram. This may not happen in the year you turn 50 but it will happen by the time you are 53.
If you’re over 70 you won’t be sent an appointment for screening. However, you’re still entitled to breast screening every three years if you ask for it. You can contact your local breast screening unit by calling NHS Direct on
0845 4647 (or NHS 24 on 08454 242424 in Scotland). You can also ask your GP or practice nurse to arrange an appointment for you.
The results of your screening mammogram are sent by post to you and your GP. Some women will be sent a recall letter asking them to come back. It will explain if another mammogram is needed because of technical reasons (for example, if the image is unclear), or if further tests are needed to assess a problem seen on the mammogram. This doesn’t necessarily mean that it will be breast cancer, but further tests will be needed to find out what it is.
Why you are being invited for screening
Over the years the number of people diagnosed with breast cancer each year has increased. Breast cancer is the most common cancer in the UK and unfortunately, the rise in numbers is continuing. However, deaths (mortality) from breast cancer are falling. This is due to a number of factors, such as earlier diagnosis and newer and more personalised treatment. Evidence suggests that breast screening has contributed to this reduction in mortality.
Breast cancer can develop in the time between mammograms, so it’s important to continue to be breast aware and report any changes to your GP even if you’ve had a mammogram recently.
Potential benefits of routine screening
Going for breast screening will not prevent breast cancer from developing, but it can help to spot breast cancer sooner – before it can be felt. Invasive breast cancers (that have the potential to spread to other parts of the body) found through screening are more likely to be small and have a better outlook. They are less likely to require a mastectomy (removal of all the breast tissue including the nipple area).
Potential limitations of routine screening
Mammograms are the most reliable way of detecting breast cancer sooner, but like other screening tests they are not 100 per cent reliable. For example, not all breast cancers can be seen on a mammogram, some breast cancers are very difficult to see, or very occasionally the doctors reading the mammogram may miss the cancer, no matter how experienced they are.
Other issues about screening
Some benign conditions diagnosed through screening cannot be confirmed by the mammogram alone. Further investigations and sometimes an operation may be needed to confirm the diagnosis, which can cause a period of anxiety and some physical discomfort.
For more information about benign conditions, see our benign breast conditions leaflets.
Other conditions called DCIS (ductal carcinoma in situ) and pleomorphic LCIS (lobular carcinoma in situ) are more commonly diagnosed following screening as they are less likely than invasive breast cancer to cause symptoms. In a proportion of women these conditions will never develop further. Even if DCIS does develop further, it may grow so slowly that it would never cause harm during a woman’s life. However in some cases, these conditions will develop into an invasive breast cancer (cancer that has the potential to spread to other parts of the body). There is no way of telling which patients with DCIS or pleomorphic LCIS will go on to develop invasive breast cancer at some point in the future. Because of this uncertainty specialists will usually recommend treatment (including surgery) and this will inevitably lead to some patients being ’over-treated’ as their condition would never have caused them harm.
Our factsheets Ductal carcinoma in situ (DCIS) and Lobular neoplasia have more information about both of these conditions.
As with all x-rays, mammograms use ionising radiation to make an image of the breast. Exposure to any radiation has the potential to increase a person’s risk of developing cancer in the future. The amount of ionising radiation a woman receives when she has a mammogram is very small; the radiation exposure is equivalent to a two-month period of natural background radiation or put another way, the same as flying from London to Australia and back again. Because of the potentially harmful effects of radiation, the dose received by women attending the breast screening programme is continually being assessed to ensure that which a person receives is as low as possible, while still providing a good quality image.
If you have any questions about breast screening, talk to your GP, practice nurse or to a breast care nurse at your local breast screening unit. You can also visit one of the following screening websites:
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