The UK Breast Screening Programme
One in nine women in the UK will develop breast cancer at some point in life. Breast screening is a method of detecting breast cancer at a very early stage, which involves taking an x-ray - a mammogram - of each breast. The mammogram can detect small changes in breast tissue which may indicate cancers that are too small to be felt either by the woman herself or by a doctor. The National Health Service Breast Screening Programme (NHSBSP) was set up in 1988. It offers free breast screening every three years for all women in the UK aged fifty and over. Between the ages of 50 and 70 women are routinely invited for screening every three years. Women over 70 are encouraged to make their own appointments.
Women can ask their GP to refer them to a hospital breast clinic if they have a specific breast problem or are otherwise worried about the risk of breast cancer. This is outside the NHS Breast Screening Programme, which uses a routine call and recall system to invite well women, but the same techniques are used in breast screening clinics and hospital breast clinics for diagnosing breast cancer and many staff work in both settings (see 'Talking about - Diagnostic mammograms in the UK').
Many of the women we spoke with had heard of the NHS breast screening programme before they received their first invitation. Women who'd worked in the health field were particularly familiar with the programme and had access to a lot of information on both breast screening and breast cancer. Others told us that, although they were aware of the programme, they didn't know what to expect of the actual procedure (see 'Talking about - The procedure'). A few women, whose first language was Cantonese, hadn't heard about breast screening until they'd received the invitation letter. Their children translated it and the accompanying information leaflet for them.
The invitation letter
Women don't necessarily receive their first invitation for breast screening in the year that they turn fifty, but will be invited sometime between their 50th and 53rd birthdays. A few women expected to receive an invitation at fifty and were concerned when it hadn't arrived. One person had been disappointed at having to wait until she was fifty-three for the mobile screening unit to revisit her area. Another paid for a private mammogram for her fiftieth birthday as she didn't want to wait up to three more years for her first NHS mammogram, partly because a colleague had recently been diagnosed with breast cancer.
Some women remembered when their invitation letter was due every three years after the age of fifty. A few said that, on the odd occasion when it hadn't arrived in the month they'd been expecting it, they'd phoned the unit to find out why. Several women said they were grateful for being sent an invitation letter every three years and that, if they had to phone and make their own appointments every three years, there was a chance they'd forget.
A few women wondered why they were routinely invited every three years and not more often. Others felt that, if they did have any concerns between their three-yearly screens, they'd visit their doctor. A large research trial in 2002 concluded that the NHS Breast Screening Programme has got the interval between screening and invitations about right at three years, compared with more frequent screening. The trial was organised through the United Kingdom Coordinating Committee on Cancer Research (UKCCCR) and was supported by the Medical Research Council, Cancer Research UK and the Department of Health. A few women chose to continue having mammograms after the age of 70 when they stopped being routinely invited (see 'Talking about - Breast screening after age 70).
Several women had their first mammogram before the age of fifty. One woman had been for screening since she was forty because of a private health care scheme at work.
Some women, who'd had benign problems at a younger age, said they'd had mammograms before the age of fifty (see 'Talking about - Benign breast problems' and 'Diagnostic mammograms in the UK'). Other women, who'd had breast cancer in the family, had also been screened earlier. One woman had had her first mammogram at the age of 43 as part of a clinical trial of breast screening.
Most women were invited by post to attend for a routine mammogram. Although many felt that the accompanying leaflet gave them enough information about breast screening, some would have liked more (see 'Talking about - Information'). A few women mentioned that they didn't read the information leaflet very carefully before their first mammogram. One person had read the leaflet after having her first mammogram in case the information was off-putting.
A few women noted how easy it was to rearrange their appointment if they couldn't attend on the date they'd been given. One woman changed her appointment to a time in her menstrual cycle when her breasts would be less tender. Another felt that the invitation letter should also state when to expect the results letter.
