Intended for healthcare professionals


Cost of extending the NHS breast screening age range in England

BMJ 2019; 365 doi: (Published 10 April 2019) Cite this as: BMJ 2019;365:l1293
  1. Susan Bewley, emeritus professor of obstetrics and women’s health1,
  2. Mitzi Blennerhassett, medical writer2,
  3. Mandy Payne, freelance editor3
  1. 1King’s College, London, UK
  2. 2York, UK
  3. 3Rochester, Kent, UK
  1. Correspondence to: M Payne mpayne{at}

Susan Bewley and colleagues examine the clinical and ethical implications of Public Health England’s trial of widening the age limits for breast cancer screening

AgeX is the acronym for the UK government inspired and funded, cluster randomised controlled trial of extending the NHS breast cancer screening age range in England. The trial aims to assess the risks and benefits of extending mammography screening for breast cancer outside the current 50-70 year age range by offering one extra mammogram to women between the ages of 47 and 49 and up to three to those over 70. Announced as “likely to be the largest randomised controlled trial ever undertaken in the world,”1 during 2010-16 AgeX randomised three million women into the extended age groups and screened one million.2

Concerns have been raised over the adequacy of information on benefits and risks provided to women in the study, which carries risk of surgical and other harms to participants. Women learn of their inclusion in research through a letter with a prebooked screening appointment. We highlight the likely surgical burden for women aged 47-49 and consider whether extending breast screening is still appropriate as accumulating evidence challenges its assumed benefits.

Breast screening policy and controversy

Mammography screening aims to find breast cancer before a lump is palpable, giving the opportunity to start treatment earlier.3 The current UK screening programme, started in 1988, offers triennial mammography to all women aged 50-70. Of the 2.85 million women invited in 2015-16, 75% attended. In common with programmes worldwide, the screening age range was defined based on evidence of when mammography is most effective at detecting tumours in the breast.

The programme has been estimated to prevent 1300 deaths from breast cancer each year.4 But evidence suggests improvements in breast cancer survival rates since the introduction of mass screening …

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