NHS Breast Screening Programme (NHSBSP)

1987 – Forrest report To detect early, non-palpable disease in WOMEN Mammogram Every 3 years 50 and over (47-73 from 2010 onwards)

Rolling invite – invites GP practices in turn (routine call and recall). Film mammograms not as effective in Pre- menopausal women > 70 years - no longer routinely invited but encouraged to request 3 yearly imaging

’08-’09 – 1.8 million women 45+ screened 14,116 cases cancer 11,212 = invasive 5,850 = 15mm or less (could not have been detected by hand) 1,250 lives saved/year (DoH Advisory Committee) 35% reduction in mortality (50-69 year olds) = 1 life saved/500 screened. Between 2 and 2.5 lives saved for every over-diagnosed case – Duffy et. al – 2010

Mammogram Results within 2 weeks 1 in 20 to clinic for further tests ( examination, LN biopsy, FNA, Core needle biopsy) 1 in 6 recalled have cancer

Scenario 38 year old female Mother develop breast cancer at 48 Mother’s Consultant advised her children would need screening from the age of 38

What questions would you ask? How would you manage this?

Has a genetic cause been established? No...Hx. – ( involving blood relatives on both sides) - the age at which any cancer was diagnosed? - where was the primary? - ? More than one cancer in same person (e.g. bilateral breast)

Ethnic background Ask about their hx.and FH - ?lump, COCP and >35, HRT Refer – Breast team – risk assessment (raised or high risk - - -> genetics testing)