Breast screening: beyond the invitation

Breast cancer is the most common cancer in women in the UK and poses a significant health burden. Around 59,400 new invasive breast cancers are diagnosed each year. In fact, according to Cancer Research UK, 1 in 7 women will have breast cancer in their lifetime. It is the fourth most common cause of cancer death among women in the UK with approximately 11,200 deaths from the disease annually as stated by CRUK. Breast cancer also occurs in males, but this is less common. Early detection and diagnosis remain a crucial part of improving outcomes.

For GPs, Breast Cancer Awareness Month provides an opportunity to look beyond the screening invitation itself. It is also a chance to consider what screening entails, who may benefit from it and key information you might want to highlight during a counselling consultation.

A bit about the breast screening programme

The NHS Breast Screening Programme instituted in 1988, was set up to detect breast cancer at an early stage. In England, women are routinely invited every three years from age 50 until their 71st birthday. Women over the age of 71, although not routinely screened, can continue to self-refer to local breast screening services.

Screening uses mammography, with two X-ray images taken of each breast. Most women receive a normal result, while about 4% are recalled for further assessment as reported by CRUK. However, a recall does not mean a cancer diagnosis but further imaging and, where necessary, biopsy may be used to establish the diagnosis.

NHS data shows that in 2024–25, 70.6% of the 2.75 million women aged 50 to under 71 invited for screening took up their invitation, up from 70.0% the previous year. Overall, 2.15 million women aged 45 and above were screened, with 19,291 cancers detected, equivalent to 9.0 per 1,000 women screened.

While screening has clear benefits, including earlier diagnosis and reduced mortality, it is not without risks. Mammography can miss some cancers, particularly in women with dense breasts, while screening can also identify cancers that may never cause symptoms during a person's lifetime, leading to anxiety. The procedure may also be painful. NICE therefore recommends that the screening service discusses potential harms with the patient, including overdiagnosis, false-positive results, missed diagnosis and radiation exposure, where appropriate.

Who needs more than routine screening?

The standard programme does not provide the same surveillance for everyone. NHS guidance states that women at very high risk may be offered screening from an earlier age, with enhanced surveillance such as MRI depending on their age and genetic risk. A significant family history or a known genetic predisposition can place someone at increased risk of breast cancer.

'It is therefore important that we take an up to date family history where clinically relevant, for example before prescribing hormone replacement therapy or where a patient presents with a breast related symptom such as a lump.'

Breast awareness still matters

Screening should not replace the emphasis on breast awareness. This is mainly because breast cancer can develop even after normal mammograms, and patients should be encouraged to report any new or unusual changes.

It is also important to distinguish between breast awareness and breast self-examination (BSE). Recent evidence shows no difference in breast cancer mortality between women who perform regular breast self-examination and those who do not. Instead, women doing regular BSE are two times more likely to undergo a breast biopsy for benign breast lumps, leading to anxiety.

Instead, patients should be encouraged to become familiar with what is normal for them and report any new or unusual changes. A simple guide is the "Breast Cancer Now's 'TLC'" which stands for:

• Touch your breasts
• Look for changes
• Check any new or unfamiliar changes with the GP.

Changes to look out for as guided by the NHS include a new lump or swelling, alteration in size or shape, skin dimpling or other skin changes, nipple inversion, a new rash, and nipple discharge, particularly if bloody.

Making every consultation count

For GPs, perhaps the most important message is that screening and symptomatic assessment are two different pathways. NICE recommends suspected cancer pathway referral for people aged 30 and over with an unexplained breast lump. Therefore beyond routine breast screening, our role includes recognising symptoms, understanding individual risk and helping patients make informed decisions about participation.

Inequalities in screening uptake are also a barrier according to government research, we must look out for in ethnic minority groups and patients experiencing socioeconomic deprivation. Asking whether a patient has attended, checking that contact details are up to date, and intentionally addressing informational barriers may look like small interventions, but they form an important part of equitable preventive care.

Breast Cancer Awareness Month is therefore an opportunity to look beyond the invitation because screening can detect breast cancer early, but it does not prevent it, and a normal mammogram does not mean a patient should ignore a new breast change. So, let's make every consultation count by keeping screening, risk assessment and breast awareness part of the conversation.