No abstract

No abstract

No abstract

The effectiveness of breast screening in women aged 50-64 has been well established by randomised trials, and recent analyses have shown that screening in women aged 65-69 is probably as effective in terms of reducing mortality from breast cancer as screening in women aged 50-64 (Chen et al, 1995).The report of the Forrest committee (Forrest, 1986) in 1986, which led to the implementation of the NHS Breast Screening Programme in the United Kingdom, recommended that women aged 50-64 be invited for screening every 3 years, with women aged 65 and over being able to self-refer. The main reason for this distinction was concern over possible lower acceptance rates among older women, together with possible reduced costeffectiveness due to decreased life expectancy in older women.Population screening in a number of countries includes women up to age 69 or 70 (Shapiro et al, 1998). Some demonstration studies of inviting older women also showed that their uptake was only slightly lower than that for 50-64 year olds from the same locality, implying that reasonable uptakes could be achieved across the NHS as a whole (Hobbs et al, 1990;Hendry and Entwhistle, 1996;Horton-Taylor et al, 1996). The number of selfreferrals in women aged 65 and over had increased to 65 032 by 1998/9, 44 811 of these being aged 65-69.Demonstration studies at 3 sites were established by the Department of Health to determine the implications of extending the NHS Breast Screening Programme to women aged 65-69 by including this age-group in the routine invitation system. Findings from one of the sites after one year have previously been reported (Rubin et al, 1998). This paper presents the results of the evaluation of the full 3 years of all 3 sites. Decisions on the extension of the programme have been made on the basis of the results of these studies. METHODSThe demonstration studies were scheduled to run for 3 years at each of 3 sites, with appointments for women aged 65-69 intermingled with those of women aged 50-64 and self-referrals of older women. As for women aged 50-64, those aged 65-69 were sent by post an invitation to attend at a specific date/time for mammographic screening. Those with an abnormality detected on the mammogram were sent an appointment for further assessment, which could include clinical examination, further mammographic views and ultrasound.East Sussex, Brighton and Hove began screening for the study in May 1996, Nottingham in February 1997 and Leeds and Wakefield in April 1997. This timing means that women aged 65-67 had mostly been invited 3 years previously in the most recent screening round, but those aged 68-69 had mostly missed a round and would have been last invited 6 years previously.The principal screening process and outcome measures were already routinely recorded at each demonstration site as part of the NHSBSP; these measures were analysed by age and time since last screen. Comparisons with equivalent data for the whole of England for the age-group 50-64 have been made to determine the representativeness of t...

Between August 1988 and July 1990, 17,678 women in the Gateshead, Sunderland, South Tyneside and Durham districts attended the national breast screening programme. A total of 131 cancers were detected. The morphology of cancers detected by screening was compared with that of tumours in 71 patients presenting clinically in the same period. Screen-detected cancers included a higher proportion of tumours of more favourable histological grade and type, were smaller in size and had less axillary lymph node involvement than those detected clinically. Survival was predicted from the Nottingham Prognostic Index. Patients with screen-detected cancer had an expected survival advantage (95 per cent confidence interval) of 26.5 (12.3-40.6) per cent at 5 years, 26.5 (11.8-41.2) per cent at 10 years and 29.1 (14.5-43.7) per cent at 15 years. This survival advantage in screened patients expected at 5, 10 and 15 years is consistent with the 30 per cent reduction in mortality rate demonstrated in the Health Insurance Plan study and the Swedish two counties trial.