Screening
What is screening?:
This is the application of a test to individuals who have no symptoms of a particular condition in order to pick up early signs of that condition. This can allow for early and more successful treatment and possible cure.
What screening test is used?:
Breast screening is with a special type of x-ray called a mammogram. It is offered to all those registered as female with their GP every 3 years from the age of 50 -71 years old. It can pick up early breast cancers which can be treated and hopefully cured. As a result of screening, the death rates in the over 50s from breast cancers have been reduced in the UK. Although you will not be offered a screening mammogram after your 71st birthday, you can request a screening mammogram 3 years after the last one by simply phoning the local screening centre.
The mammogram appointment:
Currently the details of the appointment time and place are sent to patients by post and you just turn up on the day. The invitation letter is available in many languages, and you can request that future correspondence is written in a specific language. Translated versions are available on the Gov.uk website. However, some patients decline these screening mammograms or do not attend. The x-ray only takes 5 minutes and appointments can be re-scheduled for an evening or on a weekend by simply phoning the telephone number on the invitation letter to rearrange.
What happens during the mammogram?
Mammograms are done in a special centre. This is in a private, all-female environment which is usually situated away from the main x-ray or hospital departments. You will be in a room with a female radiographer and you will be asked to remove your top clothes including your bra. The radiographer will then position your breasts between two plastic x-ray plates. The plates then slowly move closer together and the breasts are gently squeezed. There may be some discomfort whilst this happens and some find this painful. However this will only last about 5 secs. Two x-rays of each breast are taken.
What happens in those with small or large breasts?
Anyone with breasts can get breast cancer and the size of the breasts does not matter. Breast cancer develops in the milk duct glandular system of the breast which is present in all breasts. Therefore everyone who is called for a screening mammogram should attend. Those with larger breasts have more fatty tissue in the breasts than those with smaller breasts , but all need screening. Technically mammography may be more difficult in those who have very small or very large breasts but radiographers are trained to manage these differences.
The Results:
The mammogram is read and interpreted by radiologists who are doctors specifically trained in this area. The results are sent to you currently through the post. About four out of a hundred women are called back for further tests after a screening mammogram but only one of these will be found to have breast cancer.
In some countries such as the USA a breast density score is reported as well. This gives an indication of the amount of glandular tissue compared to fatty tissue that is seen on the mammogram. Breast density is not a disease and does not cause any symptoms. It is something that is seen on the mammogram. However having more dense breasts may mean there is an increased risk of developing breast cancer in that person. Currently breast density scores are not reported in the UK.
It is important to remember that if your screening mammogram is normal you should still see your GP/a doctor if you develop concerning symptoms. Screening mammograms in the UK are every three years and some breast cancers can develop in the interval between times.
If a patient has had a mammogram for clinical reasons and is then called for a routine screening mammogram, they will usually be allowed the screening mammogram if it is one year since the last mammogram.
Screening in transgender women and men
Your gender is documented on your GP record. All those designated as female on their GP records will be called for a screening mammogram once they are 50 years old.
Transwomen will not be called unless they have changed their gender marker to female on their NHS records at their GP surgery. They may be taking oestrogen supplements which may increase their individual risk of developing breast cancer. Hence screening mammograms are really important. You can request a screening mammogram even if you have not changed your gender marker by asking your GP to refer you to the local hospital.
Transmen may still be registered as female on their GP records and will be called once they reach 50 years old. In those who have not had top surgery it is important to have screening mammograms. In those who have had top surgery mammograms are not necessary but it is important to remain breast aware and to check yourself regularly. In trans men, top surgery may be done to improve the chest contour but this may not completely remove all the breast tissue. Trans men often take testosterone however as yet the effect of long term testosterone on breast cancer risk is not known. Therefore it remains important for trans men to remain breast aware and to check themselves regularly. Mammographic screening is not currently recommended for those who have had top surgery.
Transgender individuals can ask to have an appointment at the beginning or the end of a clinic.