NHS Breast Screening Programme (NHSBSP)

1. NHS Breast Screening Programme (NHSBSP)

2. 1987 – Forrest report • To detect early, non-palpable disease in WOMEN • Mammogram • Every 3 years • 50 and over (47-73 from 2010 onwards)

3. 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

4. ’08-’09 – 1.8 million women 45+ screened 14,116 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

5. 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

6. 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

7. What questions would you ask? • How would you manage this?

8. 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)

9. Ethnic background • Ask about their hx.and FH - ?lump, COCP and >35, HRT • Refer – Breast team – risk assessment (raised or high risk - - -> genetics testing)