Breast screening for women at increased risk

Author(s): Dr L S Wilkinson

Hospital: South West London Breast Screening Service

Reference: RAD Magazine, 40, 469, 21-22


National Health Service Breast Screening Programme (NHSBSP) offers three yearly mammography for women aged between 50 and 70 years. The aim of screening for breast cancer is to detect the disease at an early stage when treatment is more straightforward, more effective and improves mortality. Some women with screen detected breast cancer will still die of their disease, but others survive as a result of the intervention. On the other hand, some women are diagnosed with cancers that would never have become clinically apparent in their lifetime without the screening programme. This is known as overdiagnosis. An independent review by the Independent UK Panel on Breast Cancer Screening analysed evidence for screening and concluded that breast screening saves lives, but there are approximately three cases of overdiagnosis for every life saved in the UK.

The evidence for routine mammography remains a subject for debate but there are other cohorts of women who may also benefit from screening. A proposal to widen the age range for routine screening is the subject of a national pilot in which 50% of eligible women between the ages of 47-50 and 70-73 are called for routine NHSBSP screening. However, women at higher risk than normal warrant additional screening. This is mainly directed towards women with a family history of breast cancer, some of whom are identified to carry high risk gene mutations. Other women at risk include those with a personal history of breast cancer or biopsy showing abnormal breast tissue, and those with dense breasts on mammography. Women who present with concerns about their risk of developing cancer are offered risk assessment and alternative screening strategies where appropriate.

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