The National Health Service UK Breast Screening Programme (NHS BSP) was initiated in1988. All women in Scotland aged 50 and over are entitled to free mammography screening from the National Health Service. Women aged 50 to 70 will automatically be called for screening – women over the age of 70 are eligible but must request screening. Some women assume that as soon as they reach the age of 50, they will be called for screening. This is not the case. The Screening Programme operates over a three yearly cycle so some women will be approaching or just past their 53rd birthday before being called.
Whilst SBCC acknowledges the importance of the NHS BSP, it would be disingenous not to point out that there is great debate within medical circles regarding the efficacy of screening i.e. how many actual lives are saved by screening and at what cost to the individual woman and society?
The controversy surrounding screening surfaces periodically, often following publication of an article or the results of a trial in a medical journal. The debate is far from simple and it would be impossible to detail all of it here.
To read more about some of the conflicting evidence offered to women. Click here
The British Medical Journal (BMJ), in an effort to throw some clarity on the debate, asked Klim McPherson, an eminent professor of public health, to look at the evidence. He concluded that
“…there is no doubt that screening for breast cancer has limited benefit and some possibility of harm for an individual woman and marginal cost effectiveness for a community. ”
Both Professor McPherson and the BMJ have called for a “full and independent review” of the screening programme and, in the meantime, much more honesty from the NHS BSP when communicating with women about the uncertainties of screening for breast cancer.
SBCC neither promotes nor discourages screening and defends the right of every woman in Scotland to have access to screening services if she so desires. However, we also acknowledge the right of every woman in Scotland to make an informed choice on taking part in a national screening programme and in order to make an informed choice, women must be given clear, comprehensive and unbiased information on all aspects of screening.
The current leaflet produced by NHS Scotland – “Breast Screening: What you need to know” – falls far short of this remit and this needs to be reviewed yet again. (SBCC took part in the consultation process for the current, relatively new, leaflet. However, some of our recommendations and obversations were overruled.)
An alternative leaflet has been produced by the the Nordic Cochrane Centre, a totally independent research and information centre and this leaflet can be accessed at http://www.cochrane.dk/.
For the average woman, making an informed choice on screening is not easy and should not be taken lightly. Many factors will influence a woman’s decision to attend for screening e.g. a family history of breast cancer; a neighbour or friend whose cancer was picked up at screening; an unfounded but nevertheless very real anxiety of breast cancer which could be alleviated by an “all clear” screen; an overestimation of her risk of breast cancer.
Whatever personal decision is made on screening, it should be made with full knowledge of the facts and the utmost consideration of the consequenses. But this is a personal decision and only the individual woman can assess the risks and the benefits and arrive at that decision.
It is your responsibility to give your informed consent to screening; we would urge you to do this before your appointment to be screened drops through your letterbox.