Overview-Breast cancer screening
About 1 in 8 women in the UK are diagnosed with breast cancer during their lifetime. If it's detected early, treatment is more successful and there's a good chance of recovery.
Breast screening aims to find breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they're too small to see or feel.
But there are some risks of breast cancer screening that you should be aware of.
As the likelihood of getting breast cancer increases with age, all women aged from 50 to their 71st birthday who are registered with a GP are automatically invited for breast cancer screening every 3 years.
In the meantime, if you're worried about breast cancer symptoms, such as a lump or an area of thickened tissue in a breast, or you notice that your breasts look or feel different from what's normal for you, do not wait to be offered screening. See a GP.
Why is breast screening offered?
Most experts agree that regular breast screening is beneficial in identifying breast cancer early.
The earlier the condition is found, the better the chances of surviving it.
You're also less likely to need to have your breast removed (a mastectomy) or chemotherapy if breast cancer is detected at an early stage.
The main risk is that breast screening sometimes picks up cancers that may not have caused any symptoms or become life threatening.
You may end up having unnecessary extra tests and treatment.
When will I be offered breast screening?
Breast screening is offered to women aged 50 to their 71st birthday in England.
But currently there's a trial to examine the effectiveness of offering some women 1 extra screen between the ages of 47 and 49, and 1 between the ages of 71 and 73.
You'll first be invited for screening within 3 years of your 50th birthday, but in some areas you'll be invited from the age of 47 as part of the age extension trial.
You may be eligible for breast screening before the age of 50 if you have a very high risk of developing breast cancer.
If you're 71 or over, you'll stop receiving screening invitations.
You can still have screening once you're 71 or over if you want to, and can arrange an appointment by contacting your local screening unit.
What happens during breast screening?
Breast screening involves having an X-ray (mammogram) at a special clinic or mobile breast screening unit. This is done by a female health practitioner.
Your breasts will be X-rayed 1 at a time.
The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate.
Two X-rays are taken of each breast at different angles.
Breast screening results
After your breasts have been X-rayed, the mammogram will be checked for any abnormalities.
The results of the mammogram will be sent to you and your GP no later than 2 weeks after your appointment.
After screening, about 1 in 25 women will be called back for further assessment.
Being called back does not mean you definitely have cancer. The first mammogram may have been unclear.
About 1 in 4 women who are called back for further assessment are diagnosed with breast cancer.
More information about breast cancer screening
For more information, the Breast Cancer Screening Programme has guides about:
- breast cancer screening
- breast cancer screening: an easy read guide
- breast cancer screening: an audio guide
Benefits and risks-Breast cancer screening
The NHS offers screening to save lives from breast cancer. Screening does this by finding breast cancers at an early stage, when they're too small to see or feel.
But it does have some risks.
Screening also does not prevent you getting breast cancer, and it may not help if you already have advanced stage breast cancer.
It's up to you to decide if you want to have breast screening.
Benefits of breast screening
Breast screening helps identify breast cancer early. The earlier the condition is found, the better the chances of surviving it.
You're also less likely to need a mastectomy (breast removal) or chemotherapy if breast cancer is detected at an early stage.
Risks of breast screening
Overtreatment
Some women who have screening will be diagnosed and treated for breast cancer that would never have otherwise caused them harm.
Unnecessary distress
Following screening, about 1 in 25 women will be called back for further assessment.
Being called back does not mean you definitely have cancer. The first mammogram may have been unclear.
Most women who receive an abnormal screening result are found not to have breast cancer. These women may experience unnecessary worry and distress.
About 1 in 4 women who are called back for further assessment are diagnosed with breast cancer.
Missed diagnosis
There's a small chance that you'll receive a negative (all clear) mammogram result when cancer is present.
Breast screening picks up most breast cancers, but it misses breast cancer in about 1 in 2,500 women screened.
Radiation
A mammogram is a type of X-ray, and X-rays can, very rarely, cause cancer.
During a mammogram, your breasts are exposed to a small amount of radiation (0.4 millisieverts, or mSv).
For comparison, in the UK, a person receives a dose of 2.2 mSv a year from natural background radiation.
But the benefits of screening and early detection are thought to outweigh the risks of having the X-ray.
Weighing up the possible benefits and risks of breast screening
There's debate about how many lives are saved by breast screening and how many women are diagnosed with cancers that would not have become life threatening.
The numbers below are the best estimates from a group of experts who have reviewed the evidence.
Saving lives from breast cancer
Screening saves about 1 life from breast cancer for every 200 women who are screened.
This adds up to about 1,300 lives saved from breast cancer each year in the UK.
Finding cancers that would never have caused a woman harm
About 3 in every 200 women screened every 3 years from the age of 50 to 70 are diagnosed with a cancer that would never have been found without screening, and would never have become life threatening.
This adds up to about 4,000 women each year in the UK who are offered treatment they did not need.
What this means
Overall, for every 1 woman who has her life saved from breast cancer, about 3 women are diagnosed with a cancer that would never have become life threatening.
Researchers are trying to find better ways to tell which women have breast cancers that will be life threatening and which women have cancers that will not.
Who's at higher risk of breast cancer?
The causes of breast cancer are not fully understood, making it difficult to say why one woman may develop breast cancer and another may not.
But there are risk factors known to affect your likelihood of developing breast cancer.
Some of these you cannot do anything about, but there are some you can change.
When it's offered-Breast cancer screening
Women in England who are aged from 50 to their 71st birthday and registered with a GP are automatically invited for screening every 3 years.
But the NHS is in the process of extending the programme as a trial, offering screening to some women aged 47 to 73.
You'll first be invited for screening within 3 years of your 50th birthday, although in some areas you'll be invited from the age of 47 as part of the age extension trial.
If you want to change the appointment you have been given, contact the name and address on your invitation letter.
You may be eligible for breast cancer screening before the age of 50 if you have a very high risk of developing breast cancer.
If you're 71 or over, you'll stop receiving screening invitations.
But you're still eligible for screening and can arrange an appointment directly with your local breast screening unit.
How do I opt out of breast screening?
If you do not want to be invited for breast screening in the future, contact your GP or your breast cancer screening unit and ask to be removed from their list of women eligible for screening.
You'll need to sign a form to say you do not want to be invited anymore.
If you change your mind at a later date, you can simply ask your GP or screening clinic to put you back on the list.
If you have a family history of breast cancer
If you think you may have an increased risk of breast cancer because you have a family history of breast cancer (female or male) or ovarian cancer, talk to your GP so you can be referred to a hospital high-risk clinic.
The clinic may refer you for genetic testing if they feel it's appropriate.
Screening for women at high risk of breast cancer
If you have been found to have an increased risk of developing breast cancer, you may have yearly MRI scans or mammograms, depending on your age and your specific level of risk.
MRI scans are sometimes used instead of mammograms because they're better at detecting cancer if you have dense breast tissue.
Private breast screening
NHS screening programmes care for you throughout the whole screening process, including further treatment and care if you need it.
In the case of private screening, the care and treatment you may need after screening may not be available from the provider.
You can, however, be referred back into the NHS at any time should a private mammogram be abnormal.
What happens-Breast cancer screening
Breast screening involves having an X-ray (mammogram) at a special clinic or mobile breast screening unit. This is done by a female health practitioner called a mammographer.
You should call your breast screening unit (contact details will be on your invitation letter) before your appointment in certain situations:
- If you have a physical diasbility or find climbing steps difficult. This is so your screening unit can make any necessary arrangements for you.
- If you have breast implants. Mammography can be less effective in women who have breast implants because the X-rays cannot "see" through the implant to the breast tissue behind it. You'll usually be able to have a mammogram, but let the screening staff know beforehand. Read an NHS leaflet about breast implants and breast screening.
- If you have had a mammogram recently, or are pregnant or breastfeeding. You may be advised to delay breast screening.
What happens on the day
When you arrive at the breast screening unit, the staff will check your details and ask you about any breast problems you have had. You can also ask any questions you may have.
You'll need to undress to the waist, so it may be easier to wear a skirt or trousers instead of a dress.
First, the mammographer will explain what will happen. She'll then place your breast onto the mammogram machine and lower a plastic plate onto it gently but firmly to flatten it. This helps keep your breast still and ensures a clear X-ray.
The mammographer will usually take 2 X-rays of each breast – one from above and one from the side.
She'll go behind a screen while the X-rays are taken. You have to keep still for several seconds each time.
Most women find the procedure uncomfortable and it can occasionally be painful.
But the compression is necessary to ensure that the mammogram is clear. Any discomfort will be over quickly.
The whole appointment takes less than half an hour and the mammogram takes a few minutes.
Results
After your breasts have been X-rayed, the mammogram will be checked for any abnormalities.
The results of the mammogram will be sent to you and your GP within 2 weeks of your appointment.
Your results-Breast cancer screening
After your breasts have been X-rayed, the mammogram will be checked for any abnormalities.
You'll receive a letter with your breast screening results within 2 weeks of your appointment. The results will also be sent to your GP.
There are 3 types of results you can get:
Satisfactory result
This means the mammogram showed no sign of cancer. You'll be invited to screening again in 3 years.
Remember that cancer can still develop between mammograms, so tell your GP straight away if you notice any breast changes.
About 96 out of every 100 women screened get a satisfactory result.
Some women will need more tests because they have an abnormal result
The results letter may say you need more tests because the mammogram looks abnormal.
If you're called back for more tests, you may have a breast examination, more mammograms and ultrasounds.
You may also have a biopsy, which is when a small sample is taken from your breast with a needle to be checked under a microscope.
You'll usually get your results within a week.
One in 4 women with an abnormal screening result will be found to have cancer.
The rest won't have cancer and will go back to having screening invitations every 3 years.
Unclear result
Sometimes technical problems mean the mammogram is not clear enough to read.
If this happens, you'll be asked to have another mammogram to get a clearer picture of your breast.
If you have breast cancer
If breast cancer is found, it could be either non-invasive or invasive.
Non-invasive breast cancer
About 1 in 5 women diagnosed with breast cancer through screening will have non-invasive cancer.
This means there are cancer cells in the breast, but they're only found inside the milk ducts (tubes) and haven't spread any further. This is also called ductal carcinoma in situ (DCIS).
In some women, the cancer cells stay inside the ducts. But in others, they'll grow into (invade) the surrounding breast in the future.
Doctors can't tell whether non-invasive breast cancers will grow into the surrounding breast or not.
Invasive breast cancer
About 4 in 5 women diagnosed with breast cancer through screening will have invasive cancer.
This is cancer that's grown out of the milk ducts and into the surrounding breast.
Most invasive breast cancers will spread to other parts of the body if left untreated.
FAQs-Breast cancer screening
I have not been called for breast screening even though I'm over 50. Do I need to contact anyone?
You do not need to contact anyone, but you might like to ask your local breast screening unit when women in your area are next due for screening.
I have found a lump in my breast. Can you tell me how I can get a mammogram?
The NHS Breast Screening Programme is a population screening programme that invites all women from the age of 50 to their 71st birthday as a matter of routine.
It's not aimed at women who already have symptoms.
If you have found something that worries you, do not wait to be offered screening. See a GP.
They'll decide whether or not you need to be referred for further tests or treatment.
My sister lives abroad and she gets more frequent breast screening. Why does this not happen in the UK?
A large research trial in 2002 concluded that the NHS Breast Screening Programme has got the interval between screening and invitations about right at 3 years, compared with more frequent screening.
The trial was organised through the United Kingdom Co-ordinating Committee on Cancer Research (UKCCCR) and was supported by the Medical Research Council, Cancer Research UK and the Department of Health and Social Care.
I'm worried that breast screening will hurt because of the size of my breasts.
Do not worry. The mammography practitioners are used to screening women of all sizes and will do their best to minimise any discomfort.
Research has shown that for most women it's less painful than having a blood test and compares with having blood pressure measured.
For women with very large breasts, additional pictures are sometimes needed to make sure all the breast tissue is included.
Can I walk into the mobile breast screening unit and request a mammogram?
No. The NHS Breast Screening Programme does not operate on a walk-in basis.
It invites women in the target age group (from 50 to their 71st birthday) for routine breast screening every 3 years.
If you're concerned about your breast health, see a GP.
Why does breast screening stop at 70?
It does not stop at 70.
Although women aged 71 and over are not routinely invited for breast screening, they're encouraged to call their local breast screening unit to request breast screening every 3 years.
Can women with a physical disability be screened?
If you have a disability, contact the breast screening unit before your appointment.
Mammography is a procedure that's technically difficult. You have to be carefully positioned on the X-ray machine and must be able to hold the position for several seconds.
This may not be possible for women with limited mobility in their upper bodies or who are not able to support their upper bodies without help.
If you have a disability, your breast screening unit should be able to tell you if screening is technically possible, and about the most appropriate place to be screened. This will usually be at a static unit.
If a mammogram is not technically possible, you should still remain in the call and recall programme, as screening may be easier if your mobility gets better in the future.
If a woman cannot be screened, she should be advised on breast awareness.
I'm a carer looking after someone who lacks the mental capacity to make their own decisions about screening. They have been invited for breast screening. How should I deal with their invitation?
If the person you care for is not able to make their own decisions about screening, then you, as their carer, should make a "best interests" decision on their behalf.
You'll need to weigh up the benefits of screening, the possible harm to them, and what you think the person would have wanted to do themselves.
You can speak to a GP for advice if the person you care for does not have the capacity to give their consent.
For example, this means if they're not able to:
- understand the screening process
- make a decision about being screened
- communicate their wishes
The GP will have access to the person's medical records and knowledge of their overall medical health.
You can ask them about the person's risk of developing the cancer in question and how screening might affect them.
You should also consider what you think the person themselves would want.
For example:
- did they used to go to screening, or express an opinion about it?
- did they express more general views about their health and whether they'd want to know if they had a disease or condition?
- did they refuse screening in the past?
Paid carers in particular should get advice from family members or friends about the person's views.
If, after all this, you consider that screening is in the best interests of the person you care for, you're within your rights to help that person to be screened.
I'm in the process of changing from a man to a woman. I'm over 50. Am I entitled to breast screening?
People who are having male to female gender reassignment may be screened as a self-referral at the request of a GP.
If you have a symptom of breast cancer, you should see a GP in the usual way.
If you're having male to female gender reassignment and are registered as male with a GP, you will not be invited for breast screening.
But if you have been on long-term hormone therapy, you may be at increased risk of breast cancer. Talk to a GP about getting a referral for a mammogram.
I'm changing from a woman to a man. Will I still be offered breast screening?
If you're going through female to male gender reassignment, you'll continue to be invited for breast screening as long as you're registered as female with your GP practice, unless you ask to be removed from the programme or have had both breasts removed.
What happens to my mammograms after screening?
The NHS Breast Screening programme will keep your mammograms for at least 8 years. These are saved securely.
The screening programme regularly checks records to make sure the service is as good as possible.
Staff in other parts of the health service may need to see your records for this, but your records will only be shared with people who need to see them.