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Breast screening in the UK - a brief history

Breast cancer is the most commonly diagnosed cancer in UK women, with over 44,000 new cases diagnosed in 2003.1-4

Breast cancer accounts for 17% of female mortality from cancer in the UK, with 12,500 deaths each year.5-7 There has been a dramatic reduction in breast cancer mortality since the late 1980s when over 15,000 women were dying each year8 (see Breast Cancer section).

This page is based on the CancerStats Report - Breast Screening - UK, published in 2003.

The benefit of breast screening by mammography has been demonstrated (see Mortality section). In all randomised trials of women aged 50 and over, mortality from breast cancer is reduced in those offered screening compared with unscreened controls (although the reduction is not statistically significant in all trials). However, controversy continues over the effectiveness of breast screening programmes (see Effect of screening ).

In 1986, the Forrest Report9 recommended the introduction of a National Health Service Breast Screening Programme (NHSBSP) offering three yearly mammography to women aged 50 to 64.

In 1988, the world’s first national breast screening programme was set up in England and more than 110,700 women between the ages of 50 and 64 were invited for screening.

It has been estimated that if 70% of eligible women attend screening, there would be a 25% reduction in breast cancer mortality rates in women invited for screening. The uptake target of 70% was included in the Health of the Nation White Paper in 1992 and remains the minimum standard for the NHS Breast Screening Programme.10

All UK women aged 50-64 who are registered with a GP are invited for screening every three years. Since 2004, this has been extended to include women aged 65-70 years. Women aged over 70 can request mammography once every three years, but currently they are not routinely invited.

The screening process is organised by dedicated professionals at special screening sites (either fixed or mobile units). Unlike cervical screening, there is no financial incentive for GP practices to achieve a high uptake.

Until 2004, women were offered two view mammography at their first screen (prevalent screen) and a single oblique view mammogram in subsequent screens (incident screens).Two view mammography is now used at every screen by the end of 2003.

All screened women are sent written results. For some women, the mammogram is inconclusive and they are invited for further tests at assessment centres run by the screening programme’s multidisciplinary teams. Further investigations may include another mammogram, clinical breast examination, ultrasound, core biopsy, fine needle aspiration (cytology) or surgical biopsy.

The NHS Breast Screening Programme is the first NHS programme to be based on rigorous quality standards, both for the programme as a whole and for each specialist group (for example, surgeons and radiologists). Copies of the standards can be obtained from the Cancer Screening Programme.11 Adherence to these standards has led to the high reputation of the breast screening programme.

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References for a brief hsitory of breast screening

1. Office for National Statistics, Cancer Statistics registrations: Registrations of cancer diagnosed in 2003, England.Series MB1 no.34. 2007, National Statistics: London.
2. ISD Online, Cancer Incidence and Mortality data. 2007, Information and Statistics Division, NHS Scotland.
3. Welsh Cancer Intelligence and Surveillance Unit, Cancer registrations 2003. 2007.
4. Northern Ireland Cancer Registry, Cancer Registrations in Northern Ireland 2003 2007.
5. Office for National Statistics. 2005. Mortality Statistics: Cause, England and Wales, 2005
6. ISD Online,2007
7. Northern Ireland Statistics and Research Agency Cancer Mortality in Northern Ireland, 2005
8. Statistical Information Team, Cancer Research UK
9. Forrest, A.P., Breast Cancer Screening: Report to the Health Minister of England, Wales, Scotland and Northern Ireland. London, HMSO. 1986.
10. The health of the nation: a strategy for health in England. London, HMSO. 1992.
11. NHS Breast Screening Programme: Publications.

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