Transcript Breast Cancer screening in th NHS

Breast Cancer screening in the NHS
Dr D J Rohan Subasinghe
What is it?
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Set up by the Department of Health in 1988 in
response to the Forrest report
The NHS Breast Screening Programme provides
free breast screening every three years for all
women in the UK aged 50 and over. Around oneand-a-half million women are screened in the UK
each year.
Women aged between 50 and 70 are now routinely
invited.
Women are then be invited every three years until
her 70th birthday
Why 50-70 age group?
Women under 50 are not offered routine
screening –
1)mammograms are not as effective in premenopausal women.
2)Incidence of breast cancer is lower in this
age group.
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How does it work?
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80 breast screening units across the UK
Call and Recall system
Mammogram is a low dose x-ray that can
detect changes in breast tissue which may
indicate cancers which are too small to be
felt either by the woman herself or by a
doctor.
Assessment clinic- clinical examination,
more mammograms ,examination using
ultrasound. Fine-needle aspiration cytology
,core biopsy
Specialist referral
Why is it important?
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Most women with DCIS have no signs or symptoms
so it is mostly found through breast screening.
Early detection
In September 2000, research was published which
demonstrated that the screening programme had
lowered mortality rates from breast cancer in the 5569 age group
Saving 1,400 lives every year in England.
Out of every 500 women screened, one life will be
saved.
Latest stats - England
In 2003-04 :
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76% of women aged 50-64 invited for screening
were screened.
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Over 1.4 million women of all ages were screened
within the programme; of these, nearly 1.2 million
were women aged 50-64.
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Over 11,200 cases of cancer were diagnosed in
women of all ages screened, of which nearly 8,400
were diagnosed in women aged 50-64.
What do the critics say?
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the incidence of breast cancer in women who declined to
participate in the NHS breast screening programme.
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Not all women invited to participate in the NHS breast screening
programme will do so; those who do not may differ in their risk of
breast cancer from those who do. This "self selection" for
screening can result in women at either high or low risk being
over-represented in those screened.
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The risk of breast cancer in non-attenders is lower than that in
the population targeted for screening.
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Targets must be revised.
Quality control
Institute of cancer research
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A cohort study of more than two million women to evaluate the
effectiveness of the NHS Breast Screening Programme in reducing
deaths from breast cancer in women invited and screened by the
programme
Other epidemiological studies of the NHS Breast Screening Programme
(including international comparisons, surrogate outcome measures,
interval cancer rates and screening of women >70 years)
A randomised controlled trial studying the effectiveness of
mammographic screening in young women
Quality assurance and monitoring of the breast screening programme
External quality assurance of pathology in the NHS Breast Screening
Programme