Breast cancer screening

The UK's NHS breast screening programme was launched in 1987 based on the recommendations of the Forrest Committee, in an attempt to detect early, non-palpable, local disease.

The main elements are:

• to invite three-yearly, all women in the 50-70 year age group (1) for single oblique-view mammography in static or mobile units, with the option of self-referral for older women
  
  
• to recall all women with mammographically detected abnormalities for further investigation in specialist assessment units, using clinical examination, special view mammography, ultrasonography, or fine needle aspiration cytology

In women over 50 years of age, mammographic screening has been shown to reduce the mortality from breast cancer by at least 25%.

After 10 years, the UK screening programme is expected to produce a reduction of 1250 breast cancer deaths annually, with each woman in whom death from breast cancer is prevented, surviving, on average, an extra 20 years.

NHS Breast Screening Programme defines an "acceptable level" of screening as 70% (4)

• the detection rate was 8.1 per 1,000 women screened (2017-18)

Notes:

• breast screening from the age of 40 years
  • there is trial evidence that annual breast screening (mammographic screening) beginning at the age of 40 years of age did not reach statistical significance to reduce breast cancer mortality after 10 years in women (2)
  • a systematic review concluded (3) that:
    • although few women 50 years of age or older have risks from mammography that outweigh the benefits, the evidence suggests that more women 40 to 49 years of age have such risks

Reference:

1. Advisory Committee on Breast Cancer Screening (February 2006). Screening for Breast Cancer in England: Past and Future.Advisory Committee on Breast Cancer Screening. NHSBSP Publication No 61.
2. Moss SM et al. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet. 2006 Dec 9;368(9552):2053-60.
3. Armstrong K et al. Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians. Ann Intern Med. 2007 Apr 3;146(7):516-26.
4. NHS Digital (February 2019). Breast Screening Programme England, 2017-18