Intended for healthcare professionals


NHS breast screening programme

BMJ 1999; 318 doi: (Published 06 February 1999) Cite this as: BMJ 1999;318:397

Both extended age range and reduced screening interval are needed

  1. Heather Goodare, Chair,
  2. Margaret King, Vice chair
  1. Research and Treatment Committee, UK Breast Cancer Coalition, Horsham, West Sussex RH13 6DF
  2. Institute of Surgical Studies, University College London Medical School, London W1P 7LD
  3. Breast Study Centre and Department of Medical Physics, Mount Vernon Hospital, Northwood HA6 2RN
  4. MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2
  5. Department of Public Health, Instituut Maatschappelijke Gezondheidszorg, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam
  6. Centre for Cancer Epidemiology, University of Manchester, Manchester M20 4QL
  7. York Health Economics Consortium, University of York, York YO1 5DD
  8. Department of Public Health Medicine, West Pennine Health Authority, Oldham OL1 2PN

    EDITOR—“The cure for breast cancer,” said the American breast surgeon Susan Love, “is political action.” 1 There could not have been a clearer illustration of this point than the recent papers about breast cancer screening.24 Unfortunately, the authors do not estimate the cost of implementing both strategies for improving the breast screening service—that is, both extending the age range and reducing the screening interval to two years—but it seems that both policies will save lives and cost relatively little. Interval cancers tend to be faster growing and more life threatening,5 and older women do respond to screening invitations.4 The question should not be “Which is the best policy?” 3 but “How soon can we implement both policies?”

    In Australia, where free screening is provided from age 50 upwards at two yearly intervals and the life time risk of breast cancer is 1 in 11, mortality is only 28% of the current rate of incidence. In the United Kingdom, which has a similar life time risk, mortality is still 43% despite recent improvements. Though other factors undoubtedly contribute to poor survival rates in the United Kingdom, from an international perspective it is not “early days”2 as far as screening is concerned, and we should recognise that our screening programme needs updating.

    The costs of health care cannot be seen in isolation from other social costs. Though breast screening may not be “the best way of obtaining health benefit per billion pounds,”1 it is one way of saving the lives of women who not only deserve to survive in their own right but also, to take a purely utilitarian view, contribute crucially to our economy, either by doing paid work or as grandmothers offering free child care to working parents. “Retired” women also often look …

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