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Breast screening (mammography)

Breast screening is a way to detect breast cancer early on, usually before you or your doctor notice or feel any signs or symptoms. Breast screening uses an X-ray called a mammogram to check for changes in your breasts.

The NHS runs a national breast screening programme for women in the UK. You can also have a mammogram at an independent or private clinic.

How a mammogram is carried out
Mammography is an X-ray examination of the breasts

Details

  • The national breast screening programme The national breast screening programme

    In the UK, all women aged 50 to 70 are offered breast screening every three years. In England, the NHS screening programme is being extended to include women aged 47 to 73.

    You need to be registered with a GP to be invited for NHS breast screening. Your first invitation should arrive in the post before you turn 53. If you're 53 or over and haven’t received an invitation yet, contact your GP surgery. Although you may not be invited for breast screening once you’re over 73, you can still have a mammogram once every three years. You’ll just need to arrange this yourself by calling your local breast screening unit. You may also be able to have a mammogram at independent or private clinics.

    If you have a higher than average risk of developing breast cancer, you may be offered a mammogram once a year, from a younger age. Having a family history of breast or ovarian cancer may mean that you’re at increased risk. Speak to your GP if you’re worried about your risk of breast cancer – they may refer you to a genetic clinic for a risk assessment.

  • Making a decision Deciding on breast screening

    It’s your choice whether or not to have breast screening. To make an informed choice, you need to know the pros and cons. It’s worth talking to your doctor about any questions you have, to help you make a decision that's right for you.

    Pros

    • Breast screening picks up over eight out of ten breast cancers in women over 50.
    • Most cancers that are picked up during breast screening are at an early stage.
    • This means that treatment is likely to be simpler and more successful.
    • If breast screening doesn’t find anything wrong with your breasts, this can be reassuring.

    Cons

    • You may find having the mammogram uncomfortable.
    • Sometimes, screening finds breast changes that wouldn't have caused you any problems if they were left untreated. For example, some breast changes might not turn into breast cancer. This means you may end up having more treatment than you really need.
    • You will be exposed to a small amount of radiation during the mammogram.
    • You may be called back for more tests, but found not to have breast cancer. This can be stressful and upsetting.
    • No screening test is perfect and some cancers may be missed or not show up.

    Breast self referral

    If you are experiencing the symptoms of suspected breast cancer and have Bupa health insurance, there is usually no need for a GP referral. Call our team to speak to a specialist advisor or nurse.

    Excludes some company schemes. Subject to member’s underwriting terms and any pre-existing conditions. Eligibility checks are required for pre-authorisation.

  • Breast awareness Breast awareness

    Even if you’re having regular breast screening, it’s important to be ‘breast aware’. This means knowing what your breasts look and feel like normally, so you’re more likely to notice any changes.

    Check your breasts regularly for any change in size or shape, or in the way they feel. You should check your nipples too, looking for any discharge or changes in how they look.

    Most changes in your breasts or nipples won’t be signs of cancer. But contact your GP as soon as you can if you notice anything unusual for you, even if a recent mammogram didn’t find anything.

  • What happens What happens in breast screening?

    Breast screening uses a low-dose X-ray called a mammogram. If you’re having your mammogram through the NHS breast screening programme, you’ll have it at a special breast screening unit. This may be at a hospital, clinic or in a mobile unit. Your mammogram will be carried out by a radiographer – a healthcare professional who specialises in taking X-rays. Before your mammogram, they’ll ask you about your symptoms and history of breast disease (including cancer).

    The mammogram takes two views of your breasts, one from above and one from the side. Your breasts are X-rayed one at a time. The radiographer will help you flatten your breast between two X-ray plates. The plates press your breast firmly to take the X-ray. Flattening your breasts in this way makes the picture clearer. Your breasts are only pressed for a few seconds, but you may find this uncomfortable. You may feel a bit sore for a few days afterwards too. Around seven in 100 women find a mammogram painful.

    If your mammogram picks up anything abnormal, you’ll be asked to go to a breast assessment clinic for more tests. Around four in every 100 women are called back for more tests after having a mammogram.

  • Worried about breast lumps?

    Get a picture of your current health and potential future health risks with a Bupa health assessment. Find out more today.

  • Why aren’t younger women invited? Why aren’t younger women invited for NHS breast screening?

    Answer

    Breast cancer screening doesn’t work as well in younger women who haven’t gone through the menopause.

    More information

    The NHS breast screening programme invites women aged between 50 and 70 for a mammogram every three years; this is being extended to women aged 47 to 73 in England. If you’re under 47, you won’t usually be invited for breast screening. This is because mammograms don’t work as well in younger women who haven’t gone through the menopause (when your periods stop). The average age of the menopause in the UK is 51.

    Before you reach the menopause, your breasts are made up of glandular milk-producing tissue. They don’t contain much fatty tissue, so your breasts tend to be dense (solid). If your breasts are dense, a mammogram is more likely to miss any changes that could be a sign of cancer. It’s also more difficult for doctors to read the mammograms correctly.

    After the menopause, your breast tissue changes and the amount of fat in your breast increases. This makes it easier to see small, subtle changes in your breast on a mammogram.

    If you have a higher than average risk of developing breast cancer, you may be offered screening at a younger age. You may be at a higher risk if a close family member has had breast cancer (especially at an early age) or if you have an inherited faulty gene. You may also be offered screening using an MRI scan as well as a mammogram. An MRI scan uses magnets and radio waves to produce images of the inside of your body.

    It’s always important to contact your GP if you notice any changes in your breasts, no matter what age you are.

  • Do breast implants affect breast screening? I have breast implants. Will this affect breast screening?

    Answer

    Yes, breast screening using mammography might not work as well if you have breast implants. But there are a number of things your radiographer can do to make the results more accurate.

    More information

    If you have breast implants for breast reconstruction after a mastectomy (removal of your natural breast tissue), you shouldn’t need to have a mammogram. But if you still have some of your natural breast tissue, as well as an implant, you will need to have breast screening every three years.

    A breast implant can affect your breast screening results. This is because X-rays can’t pass through an implant to the tissue behind it, so some of your breast tissue can be hidden from view.

    If you have breast implants, tell your breast screening unit when you receive your invitation in the post. You’ll need to have your mammogram at a screening unit where the X-ray can be looked at straight away. The radiographer may need to change their technique to make sure the X-rays show as much breast tissue as possible. The staff will want to check that your breast tissue can be seen clearly.

    During a mammogram, your breast is placed between two special plates on the X-ray machine. This is unlikely to damage your implants. A breast screening mammogram won’t check the state of your implants. So if you’re worried about your implants at all, it’s important to tell the radiographer.

  • Other helpful websites Other helpful websites

    Sources

    • Breast and endocrine surgery. Oxford handbook of clinical surgery (online). 4th ed. Oxford Medicine Online. www.oxfordmedicine.com, published March 2013
    • Breast disease. Oxford handbook of General Practice (online) 4th ed. Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
    • Breast cancer. Oxford handbook of oncology (online). 3rd ed. Oxford Medicine Online. www.oxfordmedicine.com, published June 2011
    • Breast cancer screening. PatientPlus. www.patient.info/patientplus, reviewed 25 July 2014
    • Definite breast cancer risks. Cancer Research UK. www.cancerresearchuk.org, updated 12 August 2014
    • Breast cancer screening in the UK. Cancer Research UK. www.cancerresearchuk.org, updated 29 December 2014
    • Familial breast cancer. National Institute for Health and Care Excellence (NICE) Guidance CG164. www.nice.org.uk, reviewed June 2013
    • Mammography. PatientPlus. www.patient.info/patientplus, reviewed 23 January 2014
    • Mammograms in breast screening. Cancer Research UK. www.cancerresearchuk.org, updated 29 December 2014
    • What happens at an NHS breast screening unit? NHS Breast Cancer Screening Programme. www.cancerscreening.nhs.uk, accessed 12 August 2015
    • Are women screened over the age of 70? NHS Breast Cancer Screening Programme. www.cancerscreening.nhs.uk, accessed 12 August 2015
    • Why are women under 50 not routinely invited for breast screening? NHS Breast Cancer Screening Programme. www.cancerscreening.nhs.uk, accessed 12 August 2015
    • Breast Cancer. PatientPlus. www.patient.info/patientplus, reviewed 13 June 2012
    • Breast anatomy. Medscape. www.emedicine.medscape.com, reviewed 26 February 2015
    • Menopause and HRT. PatientPlus. www.patient.info/patientplus, reviewed 21 October 2013
    • Magnetic Resonance Imaging. PatientPlus. www.patient.info/patientplus, reviewed 15 January 2013
    • Lavigne E, Holowaty EJ, Pan SY, et al. Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ 2013; 346:f2399. doi:10.1136/bmj.f2399
    • Common questions about breast screening. www.macmillan.org.uk, reviewed 31 August 2014
    • Plastic surgery. Oxford handbook of clinical surgery (online). 4th ed. Oxford Medicine Online. www.oxfordmedicine.com, published March 2013
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