Breast Screening: frequently asked questions
The following are a selection of the most common questions GPs and their patients have about breast screening. If you need to answer a question, which does not appear here, please contact the OBIC office.
Can members of the Primary Care Team visit the OBIC?
We believe it would be very useful to your patients for you to have seen the mammography and assessment procedures at first hand.
We are very keen for doctors and staff who have not seen mammography in action, or who would like to attend the Assessment Clinic, to contact us to arrange a visit.
Who is eligible for Breast Screening?
All women aged between 50 and 70 years of age are eligible for screening. In addition to, we we have rolled out last September the Age Extension Randomization Trial, in which half of the women aged 47-49 or 70-73 will be selected for screening. The Age Extension Randomization Trial is expected to last two screening rounds.
Women under 47 will not be offered screening, even on request.
How will a woman be invited for screening?
The invitation for screening will be sent to the client from the OBIC screening office.
The invitation letter will offer a specific appointment time together with clear instructions on how to re-arrange the appointment if necessary.
The invitation letter will include a leaflet explaining what Breast Screening is all about.
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What about Symptomatic Patients?
The NHS Breast Screening programme is a service for well women.
Women of any age who present to you with breast problems should be referred to the Symptomatic Breast Clinics at the John Radcliffe and Churchill hospitals via the specialist breast surgeons.
What happens to patients who don't attend?
All non-attendees are sent a letter offering them the opportunity to make another appointment.
Practices receive notification of all non-attendees. GPs, Practice Nurses and Health Visitors are in an ideal position to discuss breast screening when the patient next attends the Practice.
If non-attendees wish to be screened we are able to offer them an appointment up to six months after the date of their first appointment.
What are the possible results of the initial screening test?
All mammograms will be classified as either 'normal' or 'abnormal'.
Some mammograms may need to be repeated for technical reasons before being classified.
What happens if the result is 'normal'?
A client with 'normal' results will be informed by letter within two weeks of her screening.
She will be re-invited for screening in three years time providing she is still eligible.
Practices will be notified of all 'normal' results by the screening office.
What happens if the result is 'abnormal'?
If some abnormality is detected the client will be invited to attend the Assessment Centre within a few days of the initial screening.
The appointment will be made for a date as soon as possible, in order to minimise the potential for anxiety.
Practices will be notified of all clients called for assessment.
GPs will be informed of the results for all clients attending for assessment.
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What about patients with disabilities?
The mobile unit is entered by a set of steps. If a patient is likely to have difficulty managing these, an appointment can be made for screening at the Churchill Hospital, at a special clinic where help is available.
Such hospital-based screening appointments are available for any client who would prefer to come to the Churchill Hospital at Oxford rather than be screened on the mobile unit in their locality. They will need to arrange this by telephoning the OBIC office on receipt of their invitation.
What about patients who have breast implants?
Women who have had bilateral reconstruction implants following complete mastectomy do not require mammography. If a women has one reconstruction implant that side does not need mammography, but the other breast should be screened in the usual way.
What if a patient has had breast cancer?
A client who has had breast cancer prior to the screening invitation can attend for her screening appointment, if she has not had a mammogram within the last six months anywhere else. Clients with any questions or concerns about this should telephone the OBIC office for a confidential discussion.
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What if a client has a family history of breast cancer?
At present we do not offer more frequent mammography to patients with a inherent genetic risk of breast cancer. A patient aged between 35-50 years deemed by a geneticist to be at risk can be screened two-yearly. This service is separate from the NHS BSP.
Does taking HRT change the screening procedure?
Taking HRT does not at present require additional screening.
What if a client experiences difficulty with compression during mammography?
The mammography process requires that each breast is compressed between plastic plates for a few seconds while the X-ray is being taken. This procedure is explained to clients by the radiographer. Some clients find the procedure uncomfortable although most women find the pressure acceptable.
A client who is unable to tolerate the compression can request the examination to be terminated at any time. In this case, she will have the necessity for the compression explained again and the decision to proceed is hers. An ultrasound examination instead of mammography is not a technically viable option.
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Is there any danger in having a dose of radiation every three years?
Radiography of all kinds offers a theoretical risk, which needs to be balanced against the positive effects of the procedure. Mammography uses low-dose radiation in which the risk is minimal.
The Royal College of Radiologists provide the following statement:
"The risk of radiation-induced breast cancer as a result of mammography is mainly theoretical and is so small as to be negligible when compared with proven benefits of early detection of the disease. At worst the risk of developing breast cancer as a result of undergoing mammography has been calculated as one chance in a million."
It may help your patients to put this in perspective if you tell them that this level of risk of dying is the same as:
- breathing the air in New York or London for two days
- driving a car 300 miles
- flying 1000 miles in a jet
- being a man aged 60 for 20 minutes (Stephen Feig, 1989)
Since the radiation risk is age-related, the risk from mammography for women aged 35 years and over is considerably lower and approaches zero.
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