Breast Screening

Breast Screening (Mammography) is an x-ray examination of the breasts and is a method of finding breast cancer at a very early stage. At your screening appointment, a female mammographer will explain breast screening to you and ask you a few questions. She will then take the x-ray by compressing your breasts, one at a time between two special x-ray plates. The compression only lasts a few seconds and there is no evidence this harms the breast. Compression is needed to keep the breast still, in order to get the clearest picture with the lowest amount of radiation.

A mammogram takes a few minutes, however your whole visit to the screening unit will take about half an hour. Some women find mammography uncomfortable and some find it painful as the breasts have to be held firmly in position and pressed to take a good x-ray. If you do experience pain it usually only lasts as long as the mammogram although it may continue for some time in a small number of women. Please do not use talcum powder or spray-on deodorant on the day you go for breast screening as this may affect the quality of your mammogram.

One in nine women will develop breast cancer at some time in their life. 80% of breast cancers occur in women over 50. The risk of breast cancer rises as women get older. This is why the breast screening programme only targets women in this age group.

Breast Screening can help to find small changes in the breast before there are any other signs or symptoms. Early detection may mean simpler and more successful treatment.

The NHS Breast Screening Programme is an effective part of the UK's efforts to reduce the death toll from breast cancer. The latest research shows the NHS Breast Screening Programme is now saving 1400 lives every year in England.

Your mammograms are reviewed and the results will be sent to you within two weeks. Your GP will also be notified of your results.

There are 3 possible results:

1. Normal

Your x-rays have shown no signs of cancer and you will be invited again in 3 years’ time for your next routine screen. If you will be over 70 then please contact us for an appointment nearer the time.

2. Technical repeat

The mammogram needs to be repeated for technical reasons only. The quality of the x-ray does not allow for all the breast tissue to be seen clearly. Approximately 3 out of every 100 women screened will be called back for a technical repeat to get a good quality mammogram. You will be invited to attend the screening unit at the Victoria Breast Centre at Macclesfield District General Hospital so your repeated x-rays can be checked for technical quality before you leave.

3. Assessment

Sometimes the mammograms do not give enough information and a further examination is needed before we can decide on a result. If this is the case you will receive an appointment to attend our assessment clinic at the Victoria Breast Centre at Macclesfield District General Hospital. This additional appointment is part of routine screening and for most women invited back nothing of concern will be found. Approximately 5 out of 100 women who have breast screening will be asked to come back to our clinic for a further examination. 4 of these 5 women will be found to have a normal result. Any women invited to an assessment clinic will be able to speak to a breast care nurse if they want more information before attending.

Why have I been invited back?

You have been invited back for further tests because your breast x-rays did not give us enough information and more detail is needed before we can decide on a result.

If the radiologist interpreting the screening mammogram images sees something that is questionable, unclear or abnormal on the images, they ask the patient to come back for further assessment.

This additional appointment is part of routine screening and for most women invited back nothing of concern will be found.

Can I speak to someone for more information before I come?

If you would like specific information about the reason you have been invited back you may find it helpful to speak to one of our breast care nurses. The breast care nurse will have access to your records and will be able to give more personal information.

How many women are invited back?

About 5 out of every 100 women who have screening will be invited back for this additional assessment. 4 out of 5 of these women will be found to have a normal result.

What will happen at the clinic?

On arrival, most women will meet a breast care nurse who will explain what is to happen during the clinic.

You may have some or all of the following tests:

• Breast examination: the doctor/practitioner will talk to you about your mammograms, will ask you some questions about your general health, and will then examine your breasts.
• Mammograms: most women will have further mammograms in order to show a particular part of the breast in greater detail.
• Breast ultrasound: ultrasound will be necessary for most women. An ultrasound scan uses sound waves to provide a picture of the breast tissue. It is harmless and pain-free and does not involve any x-rays
• Breast needle biopsy: it may be necessary for some women to have a small tissue sample taken from the breast. Local anaesthetic is always used to numb the area first.

When will I get the results?

Before you leave the clinic the breast care nurse will talk to you about your results. In most cases, the doctor will tell you the results of the tests on the same visit. If a needle sample is taken, the nurse will make an appointment for you to receive your results.

How long will I be at the clinic?

Your appointment may take between 1 to 3 hours. As you are likely to be in the clinic for some time, you may wish to bring a friend or relative to sit with you while you wait.

We appreciate that it may be worrying to be invited for a further appointment but please remember that the majority of women (4 out of every 5) that come back to this assessment clinic are found to have a normal result.

Anxiety

Every effort is made to minimise women's anxiety at all stages of screening. Invitation and recall letters are carefully worded and include a contact telephone number for women who have questions. We try to minimise the number of women who are recalled for further investigation. Less than ten per cent of women screened for the first time and less than seven per cent of those screened for a second or subsequent time should be recalled.

Informed choice

To enable women to decide whether or not to come for breast screening, all eligible women now receive a leaflet, 'Breast Screening The Facts' with their invitation. This can be printed or downloaded by by clicking here. The leaflet explains the benefits and limitations of breast screening.

The leaflets have been produced in Braille and on tape in English and translated into 19 languages: Gujarati, Punjabi, Urdu, Bengali, Cantonese, Hindi, Somali, Polish, Greek, Ukrainian, Arabic, Italian, Spanish, Portuguese Vietnamese, French, Farsi and Kurdish.

X-rays

Any x-ray involves radiation but mammograms only require a very low dose. It is about the same as the dose a person receives by flying from London to Australia and back. The risk that such a low dose could cause a cancer is far outweighed by the benefits of early detection of breast cancer. The radiation dose delivered by breast screening x-rays is continually monitored to ensure that it remains as low as possible while still providing a good quality image.

Overdiagnosis

Some of the cancerous tumours and conditions which are thought to lead to cancer (e.g. DCIS) that are found by screening grow very slowly and may not cause harm during the woman’s lifetime. Since it is not possible to tell the difference between the harmless and dangerous changes all of them are treated.

False alarm

If the X-ray shows something that might be cancer, the woman is recalled for additional investigations. In many cases, this finds only innocent changes. Some of these women however, undergo needle biopsies or even small operations to remove breast tissue or lymph nodes before a diagnosis is reached.

Reduction in breast cancer mortality

It has long been known that the chance of surviving breast cancer improves if the disease is caught early. Large international studies were therefore performed in the 1970s and 1980s to look at the effect of regularly screening a population of women by mammography.

Based on the findings of two of these studies Sir Patrick Forrest concluded in his report to the Government in 1986 that a 30% reduction in breast screening mortality could be achieved through breast screening. Consequently, the NHS Breast Screening Programme was established in the late 1980s and early 1990s.

More recently the independent review in 2012, estimated a 20% reduction in mortality from breast cancer in women invited to breast screening.

Putting together benefit and overdiagnosis, the independent panel estimated that for 10,000 UK women invited to screening from age 50 for 20 years, about 681 cancers will be found of which 129 will represent overdiagnosis, and 43 deaths from breast cancer will be prevented. In round terms, therefore, for each breast cancer death prevented about three over-diagnosed cases will be identified and treated.

The best estimate is that the breast screening programmes in the UK, inviting women aged 50-70 every three years, prevent about 1300 breast cancer deaths a year.

1. Know what is normal for you
2. Know what changes to look and feel for
3. Look and feel
4. Report any changes to your GP without delay
5. Attend for routine breast screening, if you are over 50

Breast awareness is about becoming familiar with your own breasts and how they change. It is important to know how your body normally looks and feels. Being breast aware is about knowing the usual shape and feel of your breasts and being able to recognise any changes.

There is no such thing as a standard breast and what is normal for one woman may not be for another. Your breasts will also look and feel different over time depending on the time of the month and your age. If you find any changes from what is normal for you go to your GP without delay.

You are not wasting anyone's time.

It is important to know that most changes are not cancer. But, reassurance and advice will always help, and the sooner a possible cancer is reported, the more simple treatment is likely to be. Changes to look for:

• A change in size or shape
• A lump or thickening
• Puckering or skin dimpling
• Nipple becoming drawn or changing direction
• Bleeding or discharge from the nipple
• Rash on or around the nipple
• Sudden roughness of the skin
• Swelling under the armpit or around the collar bone
• Constant pain in one part of your breast or in your armpit

• www.healthtalkonline.org.
  • This site now has a section focusing on ductal carcinoma in situ (DCIS)
• www.breastcancercare.org.uk Information and support on breast health and breast cancer
  • Interpreting service available
• www.cancerscreening.nhs.uk
  • The National Cancer Screening website
• www.cancerbackup.org.uk/Aboutcancer/Screening/Breastscreening
  • Cancerbackup
• www.patientopinion.org.uk
  • Not for profit organisation collecting patient opinions on NHS services

• NHS Breast screening Helping You Decide
  • A leaflet about making the decision to go for mammography in different languages
• NHS Breast screening 71 or Over?
  • A leaflet about mammography if you are over 71 and how to arrange your appointment
• Easy Guide to Breast Screening
  • A leaflet about mammography for people with learning disabilities
• Breast Implants and Breast Screening
  • A leaflet about mammography for people with breast implants

I am disabled, how do I arrange my screening appointment?

Please contact us to discuss your screening appointment, as we would like to allocate more time for your appointment. Your appointment will be made at Macclesfield Hospital where we have larger rooms and disabled access. We are also able to provide a pictorial pathway of a breast screening appointment. We can also send this out in the post to you. If you would like us to do this, please call us on 01625 66 1157 and we will arrange this.

I don’t want to be screened, what do I do?

We respect your decision not to be screened, although we would encourage all women to attend for breast screening when invited. However, if you choose not to take up your invitation please contact the screening office so your appointment is not wasted. If you change your mind at any point in the future please contact us. We will be happy to make you another appointment.

I have been invited to have a mammogram, but I have had a mammogram within the last year, do I still need to come?

Please call the screening office on 01625 661157 to discuss your invitation

I have been screened elsewhere shall I still keep my screening appointment?

Please contact the screening office on 01625 661157 to establish if it is advisable for you to attend this screening appointment.

I have moved house what happens to my screening appointment?

If you have notified your practice of your new address you will be invited for screening when your practice is invited. If this is likely to be over three years since your last invitation you will be invited separately from your practice to ensure you are screened on time. If you have moved house and fear you may have missed a screening appointment please contact us.

I have had breast cancer in the past do I still need to come?

If you have had breast cancer in the past and you are currently under the care of your breast team (follow-up), your breast team will arrange a mammogram for you, on a yearly basis. It is always best to stay with the mammograms that your surgeon sends you for. If you are unsure of which appointment is best, please telephone the unit on 01625 661157.

I have breast implants will this affect my mammogram?

Breast implants appear as a solid white area on a mammogram. This may hide some of the breast tissue preventing it from being seen on the x-ray. The film readers will only be able to report on the breast tissue that they can see on your mammogram. If you have implants and have been made an appointment at the mobile screening unit please contact the screening unit on 01625 661157. Your appointment will need to be changed to the static unit at Macclesfield as the films will need to be processed immediately after the mammogram being taken.

I have a pacemaker, can I have a mammogram?

Yes, it is safe for you to have a mammogram. It is helpful if you can tell the mammographer where your pacemaker is sited. Your pacemaker may hide the small area of breast tissue behind the pacemaker, preventing it from being seen on the x-ray. The film readers will only be able to report on the breast tissue that they can see on your mammogram

I have a family history of breast cancer, do I need to have mammograms more often?

If you think you are in a high-risk group, you should discuss this with your GP. Your GP can advise you further and may refer you to a family history clinic at your local Breast Unit.