Breast Screening

Referral to a breast clinic

Some women (about four in every houndred that are screened) are called back because the x-ray indicates that more tests are needed (NHS Breast Screening Programme- "Helping you decide" leaflet July 2013). Most of these women (3 out of 4) will have no problems. Women should not be surprised if they are called back and then tests show that there is nothing to worry about (see 'False positive results'). 

At the breast clinic, more tests are done. These may include a clinical examination, more mammograms at different angles or with magnification, examination using ultrasound or an MRI. A core biopsy, which removes a small sample of breast tissue under local anaesthetic is often taken for analysis and should not cause more discomfort that a blood test. Fine-needle aspiration cytology (FNAC) may also be done. This involves drawing off some breast cells or fluid through a fine needle for laboratory analysis, but a core biopsy is more commonly used.

Together, the breast examination, mammogram/ultrasound and core biopsy/ FNAC are called 'triple assessment'. For most women a full assessment will show nothing more serious than a specific benign breast condition (see 'Benign breast problems'). Of those recalled for further investigation, only around one in four will be found to have cancer (NHS Breast Screening Programme- 'Helping you decide' leaflet July 2013). Women who have breast symptoms, either between three year screens or otherwise, may also be referred to a breast clinic by their GP. The same tests are done to find out if there is a problem (see 'Diagnostic mammograms').

Some women were recalled for more tests after having a routine mammogram on the NHS breast screening programme. Being recalled for tests can cause anxiety. Some were not worried as they assumed the x-rays weren't clear for technical reasons and they didn't think there would be anything wrong. Others had felt slightly anxious. A few were frightened. Some said they couldn't believe it was happening to them, while one said she wasn't surprised. Some women's recall letter arrived on a Saturday morning and they were often angry because they had the whole weekend to worry about it and couldn't contact the screening unit or their GP to discuss it.

Several people who were recalled told us that their mammograms were retaken and no problems were found (see 'False positive results').

Some women who were recalled after having a routine mammogram, discussed further tests that were carried out to find out if there was a problem. In addition to having more mammograms, several women described having ultrasound scans, which use high-frequency sound waves to produce an image of the breast. Ultrasound scans are painless and quick.

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Some women had a fine needle aspiration (FNAC). Many did not find it painful. One woman who did find it painful, also said that it was a quick procedure.

A core biopsy uses a larger needle to obtain a sample of tissue. Some woman discussed being given a local anaesthetic to numb the area. One woman who described having a core biopsy didn't find it painful. For several other women, however, having a core biopsy did cause pain. One woman found it extremely distressing. A few women found that their breasts ached afterwards and were bruised. One woman took painkillers to ease the pain.

Many women said that they had not known what to expect of the core biopsy and would have liked more information beforehand. One woman had her tests done privately and wanted to know what all the tests would involve and to have a copy of the report. Another said that the core biopsy was painful but she recognised that it had to be done to find out what was wrong, because all her other tests had proved inconclusive. One woman (who turned out to have breast cancer) said the core biopsy was actually more painful than her mastectomy.

Where possible, women are given the results of their tests on the same day, although some have to wait. Women often said that they became more anxious the more tests they needed and the longer they were at the assessment clinic. One woman, who felt that she might have breast cancer, found being recalled and waiting for her test results extremely worrying. However, some women we talked to had to go back on another day either to complete all the tests or to be given the results. Waiting for the results of a core biopsy can take a few days, causing anxiety in several women. One woman, who worked in cervical screening, explained how she insisted on having her core biopsy results as soon as possible. She felt that, ideally, all test results should be available to women on the same day or overnight if that was impossible. A couple of women had to come again for an open biopsy, which involves having a larger sample of tissue removed surgically under a general anaesthetic.

Many women found the staff at the assessment clinic nice and friendly. A few said that a member of staff had an off-putting manner or didn't explain enough about what they were doing during tests.

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Last reviewed March 2016.

Last reviewed March 2016.


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