Routine mammograms: 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 NHS Breast Screening Programme (NHSBSP) was set up in 1988 with the aim of reducing the death toll from breast cancer. Women between the ages of 50-70 are invited for free breast screening every three years. Screening is for women without symptoms. Anyone with symptoms needs to speak to her GP. From 2010 the NHS Breast Screening Programme started phasing in an extension of the age range of women invited for breast screening to those aged 47 to 49 and 71- 73 in England. It is currently expected that the age extension will be complete by 2016 (NHS Breast Cancer Screening Programme). Women older than 73 are encouraged to make their own appointments for screening every three years. For more information see our 'Resources' section.
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 units and hospital breast clinics for diagnosing breast cancer and many staff work in both settings (see Diagnostic mammograms).
Most of the women we spoke with were diagnosed with DCIS that was found after a routine mammogram they’d had on the NHS Breast Screening Programme. Many of them had heard of the Programme before they received their first invitation, though didn’t know what to expect of the actual mammogram.
Gillian is a married housewife with three adult children
Ethnic background / nationality' White British
I was called for a routine mammogram about two years ago and I went along to a breast screening unit outside our local shopping centre and I didn’t know what to expect because I’d never had a mammogram before and no-one had told me what to expect either. I found it quite, slightly painful but uncomfortable more than painful and I didn’t expect anything to appear on the mammogram or to hear anything further as regards to them finding something. I had no symptoms, no pain in my breasts or anything. No lumps, nothing.
Because the NHS Breast Screening Programme is a rolling one that invites women from GP practices in turn, not every woman will receive an invitation as soon as she reaches screening age, but she will receive her first invitation within three years. She will then be invited every three years until her 70th birthday. The NHS call and recall system holds up-to-date lists of women compiled from GP records, and registers levels of attendance and non-attendance.
Most women said they had received a letter through the post inviting them for a routine mammogram, though one woman said a nurse had arranged her mammogram appointment for her when she went for routine cervical screening.
One woman, who was invited for her first mammogram at 49 (this was before the age of screening in some areas was lowered to 47), said she nearly didn’t go because she thought she may have been invited by mistake. Several other women who had been invited at 49 said they felt lucky to have been invited sooner rather than later, especially with hindsight because their DCIS might have become more serious had they had to wait another three years to be screened.
A few women expected to receive an invitation at fifty and were concerned when it hadn’t arrived (this was before the age of screening was lowered to 47 in some areas). One person was disappointed at having to wait until she was fifty-three for the mobile screening unit to revisit her area.
I would say in about 1997 there was a lump on my breast, I could see it and I went to the GP about that and he had a look at it and he said there was nothing to worry about. And that he could actually remove it, you know, nothing to be concerned about, so, and I wasn’t concerned about it I suppose. And that was fine, sorted out.
I knew that when I was 50 I would be able to go and have a mammogram. And when I was 50 I contacted the Local Health Authority and they said that I was too late because of where I lived in a rural area. They only had, they only came out every three years then, so I would have to wait till I was 53. Which I did do, and it was in August 1999 that I had a letter to say would I go to [place name].
A few women said that, when they received their first invitation for routine screening, they were reluctant to go because they were scared, expected it to be painful or considered they were not at risk of breast cancer. However, they were glad they had gone. One said her husband persuaded her to go. Several others said they had postponed their appointments because they’d been busy at the time, though had always intended to go. A few women noted how easy it was to rearrange their appointment if they couldn’t attend on the date they’d been given.
Liz is a separated mature student with three children
Ethnic background / nationality' White British
I went for a mammogram in January of this year, in actual fact I had a letter through for the mammogram but I’d cancelled the appointments a few times because of commitments. And what happened then was I went for the mammogram and it was a local mammogram unit that was in the local shopping centre, so it was quite easy to get to and I went up there, had the tests done and waited.
So you were quite busy at the time, and you changed your appointment a couple of times?
Yes, I changed my appointment a couple of times because, for one reason or another, I think it was something to do with my son’s school or something, but I knew I was going to go, it wasn’t something that I was going to say, “Oh I won’t bother.” I knew that I should go because something was telling me to be honest that I didn’t, I mean it might be psychological and I didn’t feel as if I was actually unwell, but because I’d been quite depressed over the last year and a half, on and off, and I hadn’t been well, and I was getting quite a lot of discomfort in that particular breast, I did feel that maybe, I must go, and whatever happens, don’t keep putting it off, I must go.
Some women said they were ‘scared’ before going for their first mammogram, though others said they had not been concerned. One said she had felt confident that nothing abnormal would be found but went because she was curious about the process. Another said she ‘dreaded’ going when she was invited every three years. Many women who had been for more than one mammogram, though, said they had always attended when invited and never really thought about screening before or afterwards.
Maisie is a married child minder with four adult children.
Ethnic background / nationality' Jamaican
Well I got the letter in about September I think it was for me to go for… Well when you reach a certain age, I won’t say what that age is [laughs], between 40 and 60 [laughs]. I’ll say 45 and 55, they send you a letter to go and have a test for the mammogram and that’s when I went. I was, well I didn’t really want to go because I was scared – I can say shitless, can’t I? Right, I was scared shitless. But in the end I went [laughs]. I went and the lady there was very nice. She, you know, she put me at ease and we had a nice talk. And then she had a look, after the first mammogram. And I think maybe she found something but she wasn’t too sure what it was. And then she asked me to wait in the waiting room and I had to go back in after a while. And since she was satisfied.
So, anything else you would like to add before I switch off…
Go. If you get a letter, go. I know you’re scared. As I said, I was scared shitless. But you have to go whether there is something or not. And during all the treatment, keep your spirit up because they’re doing what they can to help you. They’re doing the best for you. So I don’t really see a downside when everybody is trying to help you.
A few women said they were glad the NHS Breast Screening Programme was set up because they probably wouldn’t have paid to have a routine mammogram privately. Others said that, if they weren’t routinely invited by letter, there was a chance they could forget to arrange their own appointment every three years, so were grateful the programme existed. A 72-year-old woman said she was surprised and pleased to be invited for screening when she was 70 because she had assumed she was no longer eligible.
Mammograms before the age of 50
A few women said they’d had mammograms before the age of fifty through private healthcare schemes. Some had known of or heard about other women who’d had breast cancer, so were particularly keen to find out if they were healthy. One woman said that, whenever she was invited for a routine mammogram on the NHS, she had the x-ray done privately because she had health insurance and would see the same doctor she’d seen before for breast pain.
Some women who have a family history of breast cancer have regular mammograms before the age of fifty. One such woman had had mammograms since she was forty-one and went into the Breast Screening Programme at fifty.
Agnes is a married homemaker with two children.
Ethnic background / nationality' White European
I think the whole story started when we moved to [place name] in ’95. I was forty-one at the time and I didn’t have a mammogram ever before. I had breast cancer in the family on the side of my mother and on the side of my father. Both of their mothers had breast cancer. My auntie had breast cancer. And I had knowledge that mother had a breast operation. But I didn’t know at the time whether that was for cancer or not. As it happens, she died of cancer but not of breast cancer.
So I went to see my GP when we registered with the GP in [place name]. And I asked him if I could have a yearly mammogram because I was concerned. And he agreed to that. So I did have yearly mammograms between the age of forty-one and fifty.
When I turned fifty I was told that I’m out of the high-risk group. And they’re going put me back on three yearly routine mammograms. So I agreed to that. And then in January of 2008, I started these three yearly routine mammograms.
This woman had her first mammogram at the age of 43 as part of a clinical trial of breast screening.
Jacqui is a widowed teacher with two adult children.
Ethnic background / nationality' White British
My first experience with breast cancer was in 1995. I had a letter through the door saying I had been picked up at random from so many thousand women to take part in trials for mammograms. They asked me to go for a mammogram the following Thursday. I nearly didn’t go because I’d not had any symptoms, I had not felt any lumps or anything in my breasts. The only symptoms I had had at all was getting really tired, but I put that down to going to work, looking after the family and just generally thought nothing of it. However, I went on the Thursday and had the mammogram.
Most women we interviewed said they’d had no symptoms before they went for routine screening. One woman, though, said that both she and her husband had noticed changes in her breast but she didn’t see her GP because she thought the changes could be related to the menopause. She waited until she was invited for a routine mammogram to find out if anything was wrong. Women often feel worried if they have breast symptoms, but it is best to see a doctor straight away. Most symptoms, including lumps, turn out to be harmless. In terms of breast cancer, the incidence increases with age. The older the woman, the higher her risk. 80% of cases occur in post-menopausal women.
Beverley is married with two grown up children.
Ethnic background / nationality' Mixed Race
I did have a cyst about eight years ago. And went to the hospital and actually felt that the doctor was quite dismissive of it. He said to me, “Oh it's just a cyst.” Stuck a needle in and that was it. And I'd always had very, very lumpy breasts. And always laughed and said, “If I've got anything wrong with it, I'll never know because the things are just so damn lumpy.” And then I noticed some changes about eight months dreadfully before I actually had anything done. And I noticed that it had changed. It didn't seem quite the same. But I thought, ‘Oh well I was going through, getting towards the change. I thought, ‘Oh that's probably what it is and the whole of me is just changing.’ And ignored it.
But then by the spring of the next year, even my husband said, “There’s something not quite right about that breast, it’s weird.” [laughs] But I still didn't do anything about it. And I got a call out from, to have a mammogram. So I thought, “Well I must go and get it done, see if I can just check that there is nothing wrong with it.” And told the lady who was doing the mammogram that I suspected that things were not quite all right. And she just felt them and said, “I think they're going to want to do an ultrasound on you.
A few women we spoke with had been diagnosed with DCIS outside the NHS Breast Screening Programme because they were under fifty and had symptoms. They were referred to a breast clinic by their GP (see Diagnostic mammograms).