https://phescreening.blog.gov.uk/2018/02/06/breast-screening-performance-report-shows-we-are-detecting-cancers-early-but-uptake-is-falling/

Breast screening performance report shows we are detecting cancers early but uptake is falling

Breast screening reduces the number of deaths from breast cancer by finding signs of disease at an early stage. We aim to detect breast cancer before it can be felt by hand or seen, in order to give women the best chance of successful treatment.

NHS Digital publishes annual reports of breast cancer screening performance in England. Its latest report, published on 31 January, covers the year 1 April 2016 to 31 March 2017.

Headline figures

Key facts taken from the NHS Digital report
Infographic from the NHS Digital report

During those 12 months, the NHS Breast Screening Programme invited just under 3 million women for screening and we screened 2.2 million, an increase of 1.3% on the previous year. Of those screened, just over 18,402 women were diagnosed with breast cancer, which equates to 8.4 cancers for every 1,000 women screened.

Recent media coverage has focused on the fact that breast screening uptake has fallen. Uptake measures the proportion of women invited who actually attend and are screened within 6 months of their invitation.

The programme’s acceptable standard for uptake is 70%. This continues to be achieved but there has been a disappointing decline over recent years. Uptake in 2016 to 2017 was 71.1%, which was a reduction of 1% on the previous year. In women invited for the first time, uptake fell by around 2% to 60.3%.

The good news is that most women (around 88%) who have previously attended screening in the past 5 years continue to take up the offer. We believe this reflects satisfaction with the service from our regular attenders.

National and local initiatives

We are continually investing in initiatives to address declining uptake and help ensure equality of access to screening. It is important that the information we give women before we offer screening helps them make an informed decision by discussing the known benefits as well as the possible risks. Our new breast screening: easy guide, along with local initiatives such as text and GP reminders, are among the ways we are getting the information through to women so they can decide whether screening is right for them.

We also offer second timed appointments to women who have previously not attended. These are second appointments, with a date and time, for women who do not attend their initial appointment.

Breast screening is a 2-stage process. Women attending have mammography (breast x-rays) and for the majority (96 out of every 100 screened), no abnormalities are found by the professionals who interpret the images.

The other 4 out of every 100 women screened are invited for further tests at an assessment clinic. Of women attending assessment, just under half will have needle biopsies to confirm whether or not they have cancer. We now detect virtually all cancers (97.8%) at this stage without women having to undergo a surgical biopsy under general anaesthetic. This:

  • minimises the number of surgical procedures women need
  • reduces anxiety
  • allows earlier treatment planning

Benefits of early diagnosis

During 2016 to 2017, of all cancers detected that were invasive – and therefore had the potential to spread to other parts of the body – just over half (52.4%) were detected when they were small (<15mm in diameter).

It is good news that disease is being detected at this early pre-clinical phase. This finding is supported by an audit which looked at the stage of presentation of breast cancer from stage 1 (being early in the disease progression) to stage 4 (most advanced stage of disease progression at diagnosis).

Of all women presenting with early stage disease (stage 1), 51% presented through the breast screening programme, where the stage was known. In comparison, 37% of women with stage 1 disease were diagnosed following a 2-week wait referral appointment from their GP.

Most women attending breast screening have been screened in the previous 5 years, so this makes the diagnosis of later stage disease less likely within the programme. Of all women presenting with later stage disease (stage 4),  7% of women were diagnosed through screening compared to 45% diagnosed following a 2-week wait appointment organised through their GP. For more information see the National Cancer Intelligence Network (NCIN) website.

As the national programme manager, I strongly urge women aged between 50 and 70 to read our Helping you decide information leaflet so they can make an informed choice as to whether to attend.

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6 comments

  1. Comment by Kiwicelt posted on

    I would suggest that the uptake is falling because more women are becoming informed and exercising their right to decline an elective screening test. Many do not want to risk the significant over diagnosis and overtreatment. The success of these programmes must no longer be judged on uptake rates. Why is it necessary to tackle falling uptake. Most women know about screeening
    mammography thanks to all the "awareness" campaigns, pink ribbon charities and people with vested interests. In fact many women believe that they are at much greater risk of breast cancer than they actually are.
    No woman should have to explain a decision not to have a screeening test, a simple "no thanks" should be sufficient.

    Reply
    • Replies to Kiwicelt>

      Comment by Andrew Anderson posted on

      With regard to your comment about uptake rates, the invitation women receive makes it clear that breast screening is a choice and allows for them to decline.
      We know that the number of women who actively decline their breast screening appointment is less than 1%. That means there are still a lot of women who have not declined and yet are not being screened.
      We know that they are most likely to be those at risk, as we have evidence that uptake is lower in women from poorer backgrounds who may be less likely to be aware of factors which increase their risk of cancer.
      We are concerned that such women, who are not screened, may not have really made an informed choice not to be screened. It is therefore important we strive to ensure that all women are given a choice.
      I hope this is helpful
      Jacquie

      Reply
  2. Comment by Yasmeen posted on

    The Breast Screening Performance report (on the website) provides an excellent representation of data to show uptake of screening at both regional and national level for breast screening units. The new visual interactive BSU data is both useful and easy to navigate. The data overall demonstrates a low uptake (first invitations), but does not explain why this might be. Does the data analysis explain this? Are there any trends identified in low uptake?

    Reply
    • Replies to Yasmeen>

      Comment by Jacquie Jenkins posted on

      Thank you for your comment and questions.
      We are constantly looking at breast screening data for trends and the reduction in uptake is most pronounced at the prevalent screen. We are developing an inequalities strategy to help examine why women aren’t attending and exactly who isn’t attending so we can focus resources most productively to tackle falling uptake. We aim to ensure consent for screening is informed and we therefore have to explain to all women the potential benefits and dis-benefits inherent in any screening programme.

      Reply
      • Replies to Jacquie Jenkins>

        Comment by Kiwicelt posted on

        Jacquie by " dis benefits" don't you mean harms? There are significant harms associated with mammography screening, overdiagnosis and overtreatment being the most common.Why not tell it like it is.

        Reply
        • Replies to Kiwicelt>

          Comment by Andrew Anderson posted on

          Thank you for your comment. The benefits and risks of screening are clearly identified in our national leaflet “Helping you decide” which accompanies every invitation to breast screening for all women in England.
          There was a thorough consultation exercise with key stakeholders before the leaflet was published, including women’s groups. It was found to be helpful in allowing women to make an informed choice of whether or not to attend for breast screening.
          Thanks, Jacquie

          Reply

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