Breast screening services – outline and rationale

Nuffield Health offers breast screening by mammography for women over 40 years of age at 30 hospital sites, a medical centre in London and at the Diagnostic Imaging Suite in Manchester.

All Nuffield Health mammography is carried out on Full Field Digital Equipment with images being read and stored electronically on a central PACS system. The clients are booked via our contact centre in Chichester and images are double read at our reporting centre in Cheltenham by NHS accredited film readers. Mammography is carried out by radiographers with additional qualifications in mammography or who have been signed off as competent by the Professional Head of Mammography. All mammographers undertake quarterly peer review and have clinical updates every 2 years.

Women should receive their results within 4 working days with normal results being posted to home addresses.  Any abnormal results are communicated by telephone by one of our health assessment doctors. Women with abnormal mammography results can be referred back to their GP for onward referral to an NHS breast clinic or they can elect to be seen privately in which case the HA doctor can make a direct referral.

History

After publication of the Independent Review of Breast Screening1 in the UK in 2011, Nuffield Health reviewed its own proposition. Giving women enough information to be able to choose to have a mammogram was a key finding of the report. All women wanting to book a mammogram are encouraged to read the information on our website2 and are sent literature in the post which outlines both the benefits and the harms of breast screening. In order to make an informed choice about breast screening we offer a link to an online breast cancer risk assessment tool3.  By asking a few simple questions the tool calculates a lifetime risk of developing breast cancer and compares this to a woman of a similar age. Women with a low risk may choose to opt out of mammography. 

Age and frequency 

We offer mammography to women over 40 years of age.  The incidence of breast cancer has been shown to increase sharply from age 35 and carry on increasing up to age 704.  There is conflicting evidence to show whether screening younger women can save as many lives as screening women over 50 but guidelines published by the Royal College of Radiologists5 suggests a mortality benefit of 17% for women screened 40-49 with the largest reduction in mortality when these younger women are screened every 12-18 months.  The sensitivity of mammography and the shorter cancer lead times are responsible for the reduced benefit of screening for the younger women. The Independent Review calculated a 20% reduction in mortality rate for women over 50.  With this in mind it is important that women are made fully aware of the risks of screening as well as the benefits.

The RCR go on to say that although the NHSBSP (NHS Breast Screening Programme) has a three yearly recall interval a more appropriate interval would be 2 yearly due to the cancer lead-time and evidence shown by interval cancers. This is the interval Nuffield Health recommends although if a woman chooses to she can ask for screening more frequently but not more than yearly.

Screening mammography is unsuitable for women under 40 as the breast tissue is too dense and small cancers can be missed. There is no evidence to show any reduction in mortality and there is evidence to show radiation induced cancers can occur in these younger women. For young women at a proven high risk of developing breast cancer NICE guidelines6 suggest MRI screening. Nuffield Health can provide breast MRI but for this specialist service a clinical referral is required.

Our breast screening service is audited monthly reviewing recall to assessment and technical recall rates. We have quarterly governance meetings where any issues, incidents and complaints are discussed and we have regular meetings with our reporting radiologists to review recall rates and any interval cancers 

Conclusion

The Nuffield Health breast screening service strives for excellence and follows NHSBSP guidance aiming to better their recall for further assessment and technical recall rates. Results should be with the client within one week and our unique abnormal results process makes the service more personal. 

References 

  1. Independent Breast Screening Review 2012 A report jointly commissioned by Cancer Research UK and the Department for Health
  2. https://www.nuffieldhealth.com/tests-scans/mammogram-breast-screening
  3. http://cancer.uvahealth.com/cancers-we-treat/specialty-programs-clinics/high-risk-breast-ovarian-cancer-clinic/gail-model-know-your-breast-cancer-risk
  4. Cancer Research UK  http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer
  5. Guidance on screening and symptomatic breast imaging  (third edition) RCR
  6. A clinical guideline for familial breast cancer, NICE 2013.

Other sources

  • Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years' follow-up: a randomised controlled trial by Moss, Sue M; Wale, Christopher; Smith, Robert; more...The Lancet. Oncology, 09/2015, Volume 16, Issue 9
  • Breast screening – set and maintain the round length. Public Health England 2008
  • Breast screening – a working party for higher risk screening 2015
  • Breast screening – organizing a breast screening programme 2002