The mean glandular doses (MGD) to samples of women attending for mammographic screening are measured routinely at screening centres in the UK Breast Screening Programme (NHSBSP). This paper reviews a large representative sample of dose measurements collected during screening in the NHSBSP in 2001 and 2002 for 53 218 films, using 290 X-ray sets, for 16 505 women. The average MGD was 2.23 mGy per oblique film and 1.96 mGy per craniocaudal film; similar to those found previously in the NHSBSP for the years 1997 and 1998. Increasing use of sophisticated units with automatic beam quality selection has reduced the radiation dose received by large breasts, with only 2% of oblique mammograms having doses in excess of 5 mGy. The increasing use of large format film has also reduced the doses to this sub-group. However the total dose per woman has increased due to the introduction of two view screening at every visit. The MGD to the standard breast was found to vary from 0.76 mGy to 2.29 mGy, with 97% of units below the recommended upper limit of 2 mGy, illustrating the benefit of strict quality control. A reduction in dose of 3% was observed between the age bands 50-54 years and 60-64 years. This study has confirmed that the proposed national diagnostic reference level (NDRL) of 3.5 mGy for 55 mm thick breasts is an appropriate value to identify systems giving unusually high doses, with just 3.5% of systems exceeding this level. In most cases these higher doses were explained by the design of one particular make of X-ray set and its mode of operation. Average doses for oblique views of average sized breasts were fairly well correlated with the dose to the standard breast, and typically 42% higher. This highlights the need for a revised definition of the standard breast used in the UK to better reflect the exposure factors and doses received in clinical practice.

The mean glandular doses (MGDs) to samples of women attending for mammographic screening are measured routinely at screening centres in the UK Breast Screening Programme (NHSBSP). This paper reviews the data collected during screening in the NHSBSP in 1997 and 1998 for 23,752 films, using 171 X-ray sets, for 8745 women. Average MGD was 2.03 mGy per oblique film and 1.65 mGy per craniocaudal film, similar to the MGDs found previously in the NHSBSP for the years 1994 and 1995. MGD was found to increase with compressed breast thickness where the tube potential was selected manually, so that the average dose for 10 cm thick breasts was 2.7 times the average for all breasts. For large breasts (> 70 mm) the use of X-ray sets such as the IGE DMR, which automatically select the beam quality for each breast, resulted in lower doses compared with sets using manual tube potential selection. MGD to the standard breast was found to vary from 0.7 to 2.2 mGy and to be correlated with the average MGD per mediolateral oblique film for the women screened on that system (R = 0.79). No correlation between age and MGD was found within the invited age range of 50-64 years.

A survey of radiation dose and compressed breast thickness was conducted in samples of women undergoing mammography in the United Kingdom National Health Service breast screening programme. The aims were to determine the average value and distribution of dose and thickness, and to identify technical difficulties in carrying out such a survey. Values of breast thickness and mean glandular dose, calculated from exposure factors and measured X-ray beam parameters, were collected for 4633 women in 92 screening units in 1994 and 1995. The median (lower quartile, upper quartile) dose per film was 1.7 (1.2, 2.4) mGy for the mediolateral oblique view (mean thickness 57 mm) and 1.4 (1.1, 2.0) mGy for the craniocaudal view (mean thickness 52 mm). The median dose per woman was 1.8 (1.3, 2.5) mGy for a one-view examination and 3.3 (2.3, 4.6) mGy for a two-view examination. The dose per film showed an exponential relationship to breast thickness, but no relationship was found between median dose and median breast thickness in the different screening units, possibly because of errors in breast thickness measurement. The values of breast thickness and dose were generally consistent with those in other published surveys, allowing for differences in radiographic technique. No relationship between breast dose and standard optical density was demonstrated. Some recommendations for the conduct of future surveys of breast dose in the UK are proposed.

Measurements of compressed breast thickness during mammography is necessary for the calculation of breast dose. In theory, it should be possible to calculate breast thickness from the separation of images of radio-opaque markers attached to the compression paddle. Such a technique has been evaluated on two models of X-ray set using simulated and real breasts. The results show that breast thickness at a given position can be determined with an average error of about 2 mm by this method, which is likely to be adequate for dosimetry.

Background Many women who are at increased risk of breast cancer due to a mother or sister diagnosed with breast cancer aged under 40 do not currently qualify for surveillance before 40 years of age. There are almost no available data to assess whether mammography screening aged 35–39 years would be effective in this group, in terms of detection of breast cancer at an early stage or cost effective. Methods A cohort screening study (FH02) with annual mammography was devised for women aged 35–39 to assess the sensitivity and screening performance and potential survival of women with identified tumours. Findings 2899 women were recruited from 12/2006–12/2015. These women underwent 12,086 annual screening mammograms and were followed for 13,365.8 years. A total of 55 breast cancers in 54 women occurred during the study period (one bilateral) with 50 cancers (49 women) (15 CIS) adherent to the screening. Eighty percent (28/35) of invasive cancers were ≤ 2 cm and 80% also lymph node negative. Invasive cancers diagnosed in FH02 were significantly smaller than the comparable (POSH-unscreened prospective) study group (45% (131/293) ≤ 2 cm in POSH vs 80% (28/35) in FH02 p < 0.0001), and were less likely to be lymph-node positive (54% (158/290, 3 unknown) in POSH vs 20% (7/35) in FH02: p = 0.0002. Projected and actual survival were also better than POSH. Overall radiation dose was not higher than in an older screened population at mean dose on study per standard sized breast of 1.5 mGy. Interpretation Mammography screening aged 35–39 years detects breast cancer at an early stage and is likely to be as effective in reducing mortality as in women at increased breast cancer risk aged 40–49 years.