NHS Breast Cancer Screening Programme. Carly Taylor Breast Screening Navigator Breast Cancer Screening Unit. Email: carly.taylor@mbht.nhs.uk Royal Lancaster Infirmary. Introduction.

Breast Screening Service. The North Lancashire and South Cumbria Breast Screening Service is part of the National Breast Screening Programme and provides a free breast screening service for eligible well women, serving residents in North Lancashire and South Cumbria. The NHS England Breast Screening Programme is a rolling one which calls women from GP practices in turn every 3 years from the age of 50-70. Not every woman will receive an invite as soon as she is 50, but each woman should receive her first invite before the age of 53. Some women outside this age group (47- 49 and 71 - 73) are also screened as part of an age extension trial. Extended appointments and pre appointment ‘tours’ of the screening unit are are available for women with learning disabilities. Women with breast implants are able to have a mammogram. Mammographers are always female. The earlier cancer is found, the earlier the woman can be treated with a higher chance of success. Breast screening is offered to eligible women registered with a GP between the ages of 50 to 70. Every eligible woman will receive their first invitation to Breast Screening before their 53rd birthday. The invitation for screening will occur every three years up to the age of 70. Some women between the ages of 47 – 49 and 71 – 73 will be invited under the age extension trial. (Note: This is a randomised study: 50% of women aged between 47-49 & 71-73 will be invited to screening). Prior notification is required for extended appointments and implants.

Screening. Mammogram Images. Mammogram procedure A mammogram is a special type of X ray, specific to the breast using a low dose of radiation. Four pictures are taken – two of each breast from different angles. (MLO= Medio Lateral Oblique & CC =Cranium Caudal). Following a mammogram, you will receive your results in 3 weeks time.

Mammogram Images. Not all lumps found by screening are palpable.

Following Screening. Most women will have a normal reading and be invited again in 3 years time. Some women – about 1 in 23 are called back for further assessment. Most women will not have breast cancer. Further tests may include: Clinical examination of the breasts and lymph nodes. Another mammogram. An ultrasound scan of the breast. Breast tissue biopsy. After screening, women should await contact from the breast screening service about the test results and any follow up required. Results should arrive within 2 weeks, and after this time the woman can contact the screening unit directly for results. If you are not called back for further assessment, then you will simply be recalled again for regular screening once every 3 years. It is very important to be breast aware during this time as Breast Cancer may still develop during the recall interim. Some women, about 1 in 23, are called back because their mammogram shows that more tests are needed. Most of these women will not have breast cancer. Depending on the mammogram results, some women are asked to attend a breast assessment at the Breast Care Unit for further tests after breast screening. The clinic staff will explain why you’ve been invited back and which tests you need. You may have some of these tests: Clinical examination – your breasts and lymph nodes are examined by a doctor or breast care nurse. A mammogram – an x-ray of your breasts. An ultrasound scan of the breast. Breast biopsy (stereotactic) – a small piece of tissue or cells is taken from any abnormal areas and sent to a laboratory for examination. You may get your results straight away or you may have to come back for them.

Breast Cancer Prevalence in the UK. Breast cancer is the most commonly diagnosed cancer in women in the UK. There were 54,900 cases of breast cancer in the UK in 2015, that works out at approximately 150 cases diagnosed every day. One in eight women in the UK will develop breast cancer at some point in their lifetime. Diagnosis Statistics for Women in the UK Facts. Breast Cancer is the biggest killing cancer of women, and second only to Lung Cancer, is the biggest killing cancer in the UK. 1 in 870 men will be diagnosed with breast cancer during their lifetime. According to CRUK, 13’400 cases of breast cancer could be prevented each year in the UK. Around 1400 lives are saved each year due to Breast Screening.

Breast Cancer Incidence

Risk Factors. Over weight or obese. Lifestyle factors – drinking alcohol, smoking, lack of exercise, high fat diet. Age – most breast cancer is diagnosed at 50+. Early menstruation. Late menopause. Late or no pregnancies. Prolonged use of HRT. Family history. Just by being women we all have breast cancer risk. Breast cancer risk is linked closely to exposure to the female hormone oestrogen – any factor which increases this exposure can increase the risk to breast cancer. Being a woman is the single biggest risk factor for developing breast cancer. Around 62,000 new cases of breast cancer are diagnosed each year in the UK, of which only about 390 are in men. After gender, age is the most significant risk factor for developing breast cancer – the older the person, the higher the risk. Most breast cancers (81%) occur in women over the age of 50. A family history is significant if there are a number of cases of breast and ovarian cancer in the family. Between 5%and 10% of breast cancers diagnosed are hereditary. Our genes and our lifestyle can all affect our risk of developing breast cancer. As with many other cancers, risk factors are varied. However, 27% of all Breast Cancers are linked to lifestyle factors. (CRUK) High fat diets and excessive consumption of alcohol have been linked to the development of Breast Cancer. It is exposure to oestrogen which increases a woman’s risk of developing the disease.

A GP must be seen if any of the following symptoms are experienced: Symptomatic. Most breast lumps (90%) aren't cancerous, but it's always best to have them checked by your doctor. A GP must be seen if any of the following symptoms are experienced: •A new lump or area of thickened tissue in either breast. •Changes in the size or shape in one or both breasts. •Blood-stained discharge from either of your nipples •A lump or swelling in either of your armpits •Dimpling on the skin of your breasts •A rash on or around your nipple •A change in the appearance of your nipple, such as becoming sunken into your breast

Breast Awareness. Breast cancer has been a major cause of death from cancer among women for some years. However, the development and promotion of breast screening and the need for awareness of the risks has produced a significant drop in the number of deaths from breast cancer in the general population. Women have been encouraged to examine their breasts, be aware of changes in them, and to seek medical help if they have any concerns. It is believed that more than 90 per cent of breast lumps are found by women themselves and promptness in finding lumps, mostly through breast awareness, is essential as survival rates in breast cancer are directly related to disease stage at diagnosis. Most breast lumps (90%) aren't cancerous, but it's always best to have them checked by your doctor. A GP must be seen if any of the following symptoms are experienced: •A new lump or area of thickened tissue in either breast. •Changes in the size or shape in one or both breasts. •Bloodstained discharge from either of your nipples •A lump or swelling in either of your armpits •Dimpling on the skin of your breasts •A rash on or around your nipple •A change in the appearance of your nipple, such as becoming sunken into your breast

Ways we can reduce our risk. Be aware of your alcohol consumption. https://www.drinkaware.co.uk/tools/app/ Be more physically active. Make healthier food choices. Take notice of how much you are drinking. Alcoholic drinks are also very calorific. Above is a free phone app which works out units and calories. There is no ‘safe’ limit for drinking alcohol, but current recommendations are to stay within 14 units per week for both men and women. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate - and vigorous-intensity activity. (WHO, 2011) Eat a healthier diet – fresh fruits, vegetables, etc

Barriers to Breast Screening. Family commitments. Work Commitments. Location. Illness. Lack of awareness. Previous bad experience. Invasive procedure. Typical barriers to breast screening according to telephone research – if awareness is increased it is likely that women may be much more likely to increase efforts to attend. Work commitments – outside hours appointments offered…

Uptake rates for screening. Uptake Levels During the three year period from 2013-2016 out of the 125’299 ladies invited for screening 32,533 failed to attend their breast screening appointment. 26% of women do not attend. Uptake levels over the whole geographical area are slightly higher than the national average, however, it is within the Blackpool and some Preston areas of Lancashire where uptake rates are at the lowest levels. In the screening round 2012 – 2015, average uptake rates achieved in Blackpool was 62% and in Preston, also 62%. The national average uptake rate for breast screening is 70%. Some GP practices in Blackpool have very poor uptake rates for breast screening with attendance as low as 38%.

Blackpool residents focus group findings. Discussions during some focus groups revealed a lack of awareness around both the breast cancer screening programme and breast cancer risk. Some women had little or no knowledge of the programme regarding eligible age, the age extension trial and how often you should be screened. Many women amongst these groups believed that family history was the most significant risk factor – believing themselves to be low risk without family history. Little or no awareness of lifestyle factors as breast cancer risk. Lack of knowledge regarding symptoms and breast awareness. Some research has been carried out to try to establish reasons for poor attendance to screening appointments in Blackpool – common themes as above highlighting the importance of effective health promotion.

GP Endorsement. How you may be able to improve uptake in your practice. How many eligible patients do you have? What % of your patients have not responded to Breast Screening invitation? What can you tell the patient about Breast Screening? Who in your practice team can manage these activities? Can your practice send letters? Make telephone calls? Advise patients as they come into contact with practice. Text reminder service – Mjog. Display screening information. * Information found at NCIN – GP Practice Profile: https://fingertips.phe.org.uk/profile/cancerservices This information can be used to contact patients, encourage them and offer them further advice/signposting. Consider checking how your practice’s uptake and coverage compares with local and national averages. Encourage staff to promote health/screening to patients – Cancer champions. The fingertips tool contains data on cancer services at GP and CCG level collated by the National Cancer Registration and Analysis service. (NCRAS) The profiles are for commissioners and health professionals when assessing the impact of cancer on their local population and making decisions about services. They include data on cancer screening, Two Week Wait referrals, diagnostic services, emergency presentations and admissions. Mention Newsletter given out.

Questions? Questions.