Breast Screening Ann-Marie Curran Cancer Awareness and Early Detection Project Coordinator a nn-marie.curran@knowsley.nh

1. Breast Screening Ann-Marie Curran Cancer Awareness and Early Detection Project Coordinator ann-marie.curran@knowsley.nhs.uk 0151 443 2649 / 07824 498 180

2. How common is breast cancer? • Breast cancer is the most common cancer in the UK (and in Knowsley) and the lifetime risk of being diagnosed with breast cancer is 1 in 8 for women. • In 2008, in the UK: • Almost 47,700 women were diagnosed with breast cancer, that’s around 130 women a day. • 341 men were diagnosed with breast cancer. • 8 in 10 breast cancers are diagnosed in women aged 50 and over. • In Knowsley, between 2006 and 2008 there were 127.7 new cases per 100,000 females. • Since the mid-1980’s there has been a 73% increase in Knowsley females being diagnosed with breast cancer, even though mortality levels for this form of cancer are low.

3. How many people die from breast cancer? • In the UK about 12,000 women die of breast cancer each year. • Every year there are around 1,300 deaths from breast cancer are in women under 50. • More than half of breast cancer deaths are women aged over 70. • In the last ten years death rates for breast cancer have fallen by almost a fifth.

4. How many people survive breast cancer? • More people are surviving breast cancer than ever before. • In the 1970s around 5 out of 10 women with breast cancer survived the disease beyond five years, now it is 8 out of 10. • Almost 2 out of 3 women with breast cancer now survive beyond 20 years. • Around 9 out of 10 women diagnosed with stage I breast cancer survive the disease beyond five years whereas this is only 1 in 10 diagnosed with stage IV.

5. Benefits of breast screening • Regular screening prevents deaths from breast cancer. • Screening can find cancer early, before you know it is there. The earlier breast cancer is found, the better your chance of surviving it. • If a breast cancer is found early, you are less likely to have a mastectomy (your breast removed) or chemotherapy.

6. Why screen for breast cancer? Success of the programme • The NHS Breast Screening Programme was the first of its kind in the world. It began inviting women for screening in 1988 and national coverage was achieved by mid 1990s. • Around one-and-a-half million women are screened in the UK each year. • The programme in the UK has screened more than 19 million women and has detected around 117,000 cancers. • In the UK in 2007/2008 the NHS Breast Screening Programmes detected more than 16,000 cases of breast cancer. • It is estimated that the NHS breast screening programme saves over 1,000 lives each year

7. Breast Screening Breast Screening Uptake • National target 70% uptake. • Knowsley uptake: 70% • Differs depending on practices but uptake varies between 55-81%.

9. What is breast screening? • Breast screening is a method of detecting breast cancer at a very early stage. • The first step involves an x-ray of each breast - a mammogram - which is taken while carefully compressing the breast. • Most women find it a bit uncomfortable and a few find it painful. • The mammogram can detect small changes in breast tissue which may indicate cancers which are too small to be felt either by the woman herself or by a doctor.

10. Does breast screening find every cancer? • No. • Some cancers do not show up on a mammogram and sometimes a cancer is not spotted. • This can happen no matter how skilled the people reading the mammograms are.

11. Where do I go for breast screening? • Women are invited to a specialised screening unit, which can be hospital based, mobile, or permanently based in another convenient location such as a shopping centre. • For patients registered with GP practices in Huyton, Kirkby and Halewood • Liverpool Breast Screening Unit (Liverpool Womens Hospital) • Telephone 0151 709 7295/7296 • For patients registered with GP practices in Whiston and Prescot • Warrington Breast Screening Unit(Warrington Hospital) • Telephone 01925 230 923

12. The screening process The invitation • If you are aged between 50-70 years and registered with a GP you will automatically be invited for breast screening every three years.  • Because the programme is a rolling one which invites women from GP practices in turn, not every woman will receive an invitation as soon as she is 50. But she will receive her first invitation before her 53rd birthday. • You will be invited every three years until your 70th birthday. • Some women aged 46-49 and 71-73 are also being invited as part of a national trial that is currently taking place.  • If you are over 70 years and have not been screened for 3 years or more you can ring your local screening unit and request an appointment. • The NHS call and recall system holds up-to-date lists of women compiled from GP records, and records levels of attendance and non-attendance.

13. The screening process • Women who have special needs, such as a physical or a learning disability, are asked to contact the breast screening unit at the address shown on the invitation letter. • The screening unit can arrange a special appointment, usually at the hospital screening unit, where there is easier wheelchair access, better provision for a supporter to accompany the woman if she wishes, and more time can be allowed than is possible on a mobile screening unit.

14. The screening process At the screening unit • A visit to a screening unit for breast screening takes about half an hour. • Breast screening is carried out by female staff only. • You will be greeted by a receptionist or female mammography practitioner who will check your personal details (name, age and address). • The mammography practitioner will ask you about any symptoms or history of breast disease, explain what will happen when the mammograms are taken, and answers any questions about breast screening.

15. The screening process At the screening unit • You will only be asked to undress from the waist up. • The woman that takes your mammogram will place one breast at a time between two special plates on the mammogram machine and take two pictures of each breast. • Your breast needs to be pressed firmly between the plates for a few seconds so that clear mammograms can be taken. • The mammograms are examined and the results will be sent to you and your GP within two weeks. • If it is your last routine screening invitation, the mammography practitioner will also reminds you that you can ask for another screening appointment in three years' time.

16. The screening process The mammogram • The mammogram is a low dose x-ray. • Each breast is placed in turn on the x-ray machine and gently but firmly compressed with a clear plate. • The compression only lasts a few seconds and does not cause any harm to the breasts. • Compression is needed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. • Some women find compression slightly uncomfortable and some feel short-lived pain. • Research has shown that for most women it is less painful than having a blood test and compared with having blood pressure measured.

17. The screening process The results • Most women (95%) get a normal screening result (their mammogram show no sign of cancer) and will be routinely invited for screening three years later. • Around 1 in 20 are called back because their mammogram show more tests are needed. • This happens more often for women having their first mammogram. • Of those recalled for further investigation, only around 1 in 6 will be found to have cancer.

18. The screening process Further investigation • More tests may be needed. • These may include more mammograms, a clinical examination or an ultrasound scan or a needle biopsy. • These tests are done to show whether or not you have cancer.

19. The screening process What happens if cancer is found? • You will be referred to a specialist breast cancer team. • They will talk to you about your diagnosis, the support you can get and your treatment options. • Many women have a choice about the type of treatment they receive depending on the type and location of their cancer. • Most, but not all, cancers found at breast screening can be successfully treated.

20. The screening process Treatment • If cancer is found by screening you my be offered treatment. • Most women will be offered a combination of treatments. • You may be offered surgery. Where cancer is found by screening: • About 7 out of 10 women will have a lumpectomy (removal of the affected breast tissue and a small amount of surrounding tissue) with radiotherapy. • About 3 in 10 women will have a mastectomy (have a breast removed). • You may be offered chemotherapy. Where cancer is found by screening: • About 2 out of 10 women have chemotherapy. • The exact course of treatment will depend on the type of cancer found and the woman's personal preferences.

21. To reduce your risk of developing breast cancer • Keep active: at least 30 minutes of moderate physical activity, 5 days per week. • Keep a healthy weight. • Cut down on alcohol intake.

22. Be Breast Aware • Women can develop breast cancer at any time (this includes the time in between screening appointments). • Changes to look out for: • changes in the size, shape or feel of your breast • a new lump or thickening in one breast or armpit • puckering, dimpling or redness of the skin. • changes in the position of the nipple, a rash or nipple discharge • pain or discomfort that is new to you and felt only on one side. Remember, most changes will be perfectly normal and will not be cancer.

23. Be Breast Aware • Changes in your breasts may be harmless but you should get them checked straight away. Know what is normal for you!! • Be breast aware: know the breast awareness 5-point code: 1. know what is normal for you, 2. know what changes to look for, 3. look and feel your breast, 4. report any changes to your GP without delay, 5. go for breast screening if you are aged 50 or over • If women notice any changes in their breasts that are not normal for them, they should speak to their GP straight away.

24. Be Breast Aware • Local project in Huyton, July 2011 • Postcards produced and will be circulated October 2011

25. For more information: • Contact Breast Cancer Care on 0808 800 600 (free helpline) Internet sites • www.cancerscreening.nhs.uk • www.cancerresearchuk.org • www.knowsley.nhs.uk/live-well/cancer-prevention/nhs-cancer-screening • http://breakthrough.org.uk/ • www.breastcancercare.org.uk/

26. FAQ’s

27. Risks of breast screening • Radiation: Any x-ray involves radiation but mammograms only require a very low dose. It is about the same as the dose a person receives by flying from London to Australia and back. The risk that such a low dose could cause a cancer is far outweighed by the benefits of early detection of breast cancer. The radiation dose delivered by breast screening x-rays is continually monitored to ensure that it remains as low as possible while still providing a good quality image.

28. Why are women under 50 not routinely invited for breast screening? • Women under 50 are not currently offered routine screening. • This is because film mammograms are not as effective in pre-menopausal women, as the density of the breast tissue makes it more difficult to detect problems, and also because the incidence of breast cancer is lower in this age group. • The average age of the menopause in the UK is 50. As women go past the menopause, the glandular tissue in their breast "involutes" and the breast tissue is increasingly made up of only fat. This is clearer on the film mammogram and makes interpretation of the x-ray more reliable.