Results from the UK NHS breast screening programme 1994–1999

Abstract

Objective-To present results from the NHS breast screening programme (NHS-BSP) from 1994 through to 1999 and to examine the extent to which interim targets are being achieved. Methods-Data were collated from all screening programmes in the UK on standard statistical returns. Performance of the screening programme was evaluated using calculated targets based on comparison with the Swedish two counties (STC) randomised controlled trial. Results-In the early years of screening (1988-1993), the NHS programme was detecting more DCIS but considerably less invasive cancers than expected, based on the STC trial. Since the screening year 1993/94 (1 April to 31 March) the standardised detection ratio (SDR) measure of the detection of invasive cancers has increased by 36% from 0.83 to 1.13. The SDR has been greater than 1 since 1996/97 suggesting that the NHSBSP has only been screening as eYciently as the STC trial since this date. Uptake for screening has been relatively stable over time at approximately 75%. Conclusions-The NHSBSP has made considerable advances in performance since its inception in 1988 and screening uptake and age standardised invasive cancer detection rates are (by 1999) well in excess of targets. The early years of screening were characterised by good uptake but a low sensitivity for the detection of invasive cancers. It is anticipated that the screening programme will have an increasing impact on breast cancer mortality, particularly in the 55-69 year age group over the coming years.

Ductal carcinoma in situ of the breast, a population-based study of epidemiology and pathology

“…Other countries have observed increasing incidence of DCIS, sometimes three-to four-fold, with increasing mammographic screening (Ernster et al, 1996;Levi et al, 1997;Zheng et al, 1997;Barchielli et al, 1999;Blanks et al, 2000). This increase has stopped in NSW and we would expect further increases only with growth in BreastScreen participation beyond 53 -54% in 199853 -54% in -200053 -54% in (Estoesta et al, 2000Productivity Commission, 2002) or resurgence in mammographic screening reimbursed by Medicare.…”

The Effect of Mammographic Screening and Hormone Replacement Therapy Use on Breast Cancer Incidence in England and Wales

“…Approximately 20% of the breast cancers detected in the NHSBSP are in situ cancers (9). Detection of in situ disease should result in a decrease in the incidence of invasive disease; however, this effect is likely to be small and difficult to observe in population trends (17).…”

“…The NHSBSP largely relies on such measures to monitor performance, both of the program as a whole and of individual screening units (9). Trends in incidence rates will also be affected by other factors besides screening.…”

Impact of NHS breast screening on advanced disease and mortality from breast cancer in the North West of England

“…This is the first report of long-term outcomes from breast cancer in women invited for NHS screening and shows a significant difference in the rate of advanced disease between two programmes with different cancer detection and attendance rates. Cancer detection rates have improved throughout the NHS breastscreening programme and now commonly exceed those seen in Wigan during this study, but routinely collected statistics do not allow us to assess whether the high proportion of regular attenders observed in Wigan has been replicated elsewhere within the programme (Blanks et al, 2000b). If this proportion varies between individual programmes, then comparisons between programmes with different proportions of regular attenders may provide a means for evaluating the impact of NHS breast screening.…”