1. Breast Cancer screening in the NHS Dr D J Rohan Subasinghe

2. What is it? 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 one- and-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

3. Why 50-70 age group? Women under 50 are not offered routine screening – 1)mammograms are not as effective in pre- menopausal women. 2)Incidence of breast cancer is lower in this age group.

4. How does it work? 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

5. Why is it important? 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 55- 69 age group Saving 1,400 lives every year in England. Out of every 500 women screened, one life will be saved.

6. Latest stats - England In 2003-04 : 76% of women aged 50-64 invited for screening were screened. Over 1.4 million women of all ages were screened within the programme; of these, nearly 1.2 million were women aged 50-64. 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.

7. What do the critics say? the incidence of breast cancer in women who declined to participate in the NHS breast screening programme. 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. The risk of breast cancer in non-attenders is lower than that in the population targeted for screening. Targets must be revised.

8. Quality control Institute of cancer research 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