Breast Screening Guidance

Introduction

1.1 – Protocol Statement

The purpose of this protocol is to provide guidance for staff at Godiva Group of Practice’s in relation to the NHS Breast Screening Programme also referencing information from the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS) information. It aims to identify breast cancer at an early stage, increasing the chances of breast-conserving surgery and a better prognosis for long-term survival.

Breast screening is one of the NHS national population screening programmes available in England. To ensure the screening process remains ethical patients must receive:

  • Guidance to help them to make informed choices
  • Support throughout the screening process

It is the responsibility of all staff at this organisation to ensure they are aware of their individual and collective efforts to support the national screening programmes. This protocol must be read in conjunction with the referenced publications and NHS screening programme guidelines.

Protocol

2.1 – Aim

The NHS overview on breast cancer states that it is the most common type of cancer in the UK. Although most women diagnosed with breast cancer are over the age of 50, younger women can also have breast cancer. About one in eight women are diagnosed with breast cancer during their lifetime but there is a good chance of recovery if it is detected at an early stage.

In rare cases, men, trans and non-binary people can be diagnosed with breast cancer and the NHS overview on this area provides further accessible information. Breast cancer in those who are registered with their GP as male is out of scope for this protocol.

Staff are reminded that no screening test is 100% reliable and patients may receive false positive or false negative results. It is therefore imperative that they are advised to make an appointment to discuss any concerns they may have. This includes a family history of breast cancer and other associated symptoms.

2.2 – Patient Engagement

In line with NICE guidance, this organisation will provide appropriate information to all those registered as female with their GP from age 47 onwards. Early engagement on the screening programme will improve patients’ understanding and enable them to make informed decisions.

The available breast screening information leaflets include:

It should be noted that trans and non-binary people who are registered with their GP as female will be invited for breast screening. Trans and non-binary people who are registered with their GP as male will not be routinely invited for breast screening but can request screening. Further information can be found in NHS population screening: information for trans and non-binary people.

If the patient has a learning disability or does not have the mental capacity to decide, then they should offered An easy guide to breast screening.

2.3 – NHS Screening

Screening in England, Scotland, Wales and Northern Ireland is offered as below. It is to be noted that, in this section, where it states ‘woman’, this refers to ‘those registered as female with their GP’.

  • Woman aged 50-70 are invited for a mammogram every three years
  • In some circumstances, women outside of the age range could be screened either through self or GP referral
  • Women between the ages of 47-49 and 71-73 could be offered screening as part of the AgeX trial
  • Women older than the maximum age for screening in their area are excluded from the programme. Those in this range may continue to receive screening through self-referral

Note: Not all women will receive an invitation immediately. However they should receive their first invitation for the programme within three years of their 50th birthday.

Information on local breast screening services for the UK nations can be found below:

All eligible individuals will receive a letter by post inviting them to book an appointment by phone, email or to book online. In some cases, individuals may be given a pre-booked appointment.

Results

The mammogram (breast screening X-rays) procedure is usually completed in less than 30 minutes. Results are sent via letter to the patient within two weeks and copies are also sent to the patient’s GP. There are three types of result:

  1. Satisfactory – the mammogram showed no sign of cancer. The patient will be returned to routine three-year recall.
  2. Need further tests – the mammogram looks abnormal and may require physical examination, more mammograms, ultrasound scan or biopsy. Results in this category will usually be delivered within one week.
  3. Unclear – the mammogram is not clear enough to read (possibly due to technical problems). The patient will be invited to have a repeat mammogram.

If cancer is found, it may be either non-invasive or invasive. Further information regarding the types of cancer can be accessed here.

Opting out of Screening

This link provides information for health professionals about how, and in what circumstances, patients can opt out temporarily or permanently from breast screening.

Within the link there are also separate forms and letters that can be used should any patient wish to opt out. This includes the following:

The Role of Primary Care in Breast Cancer Screening

While the delivery of the NHS Breast Screening Programme does not directly involve primary care, this organisation can support the programme by promoting screening, providing information on the screening process and the need for the patient to attend repeat screening when invited.

Cancer Research UK advises that breast screening reduces the number of deaths from breast cancer by about 1,300 a year in the UK. Clinicians should not be over-reassured by previous normal screening results.