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Extending the breast screening programme

3.5 The NHS Plan announced that the Government intends to extend routine invitations to women up to the age of 70. Pilot studies have demonstrated that women in this older age group can be screened effectively and will accept screening invitations. Women over the age of 70 will also be entitled to screening every three years on request. Evidence of the balance between the benefit and harm of screening is less clear in women over 70, but will be kept under close review.

3.6 Further improvements to screening technique are also to be introduced across the country. All women will have two views of the breast taken at every screening, instead of just at the first screening as at present. Research has shown that this could increase cancer detection rates by 43%. This improvement will be introduced across the country by 2003.

3.7 These changes to the breast screening programme will entail the biggest expansion to the programme since it was launched. They come at a time when the breast screening programme is already screening more women than ever before as those women born in the post-war baby boom reach their 50th birthdays. And the key screening staff - radiographers and radiologists - are in short supply. The government recognises that this expansion will need to be carefully managed to maintain the standards of the screening programme and to support the staff running it. In some cases, new screening facilities will be required.

3.8 As at the start of the breast screening programme in 1988, the extension to older women will be phased in over a period of three years. It is anticipated that the first breast screening programmes in England will begin inviting older women in 2001/ 02, with all programmes starting by 2004, benefiting 400,000 women each year. The National Co-ordinating Team will support Regional Screening Leads and Quality Assurance Directors in identifying which programmes are able to start in each year and in facilitating the roll out.

3.9 Funding for the roll out of the breast screening programme extensions, including investment to fund new equipment and facilities is included in the new funding for cancer announced in the NHS Plan.

Breast screening workforce

3.10 The main limiting factor to the roll-out will be the speed at which we can recruit sufficient radiologists and radiographers. Chapter 8 sets out plans to increase the numbers of both. In addition, the Royal College of Radiologists and the Society of Radiographers are working alongside the breast screening programme to develop new ways to staff the programme. A competency based approach, using occupational standards, will be used.

3.11 At present radiographers are responsible for taking mammograms, and radiologists - or in some cases breast clinicians - are responsible for reporting the mammograms to determine which women should be recalled for further assessment. (The breast screening process itself does not diagnose breast cancer.) Under the new arrangements this 'two tier' approach would be extended to four tiers:

3.12 These new arrangements will be tested from October 2000 in four development sites. They will be evaluated to ensure that quality standards can be maintained and to assess the training and preparation time needed. If these arrangements are successful they will offer new, alternative ways to meet the staffing requirements of the breast screening programme. They will also offer opportunities for individual practitioners to move from one tier to another.

3.13 New technologies may assist the screening process. The NHS Breast Screening Programme is soon to publish the results of a working party group which has reviewed Computer Aided Detection in breast screening. We are closely monitoring other new technologies such as digital mammography, on-site processing of mammograms and new innovative designs for screening vans and will refer them to NICE for appraisal, if appropriate.