Mammography in UK

karenG · Jul 22, 2005

we start mammograms at 50- its not thought to be a useful test to do in breasts that are 'active' thats to say, in a woman with hormones flying round!! the mammogram just comes out looking like a snow storm!

if she has a strong family history and I'm not sure a mother would count always- depends on the age her mother was etc, then she could be referred to one of the specialist centres but as one woman in 12 will develop breast cancer, its not always done. she would rather be advised on breast self awareness. if she found something suspicious, then the 2week cancer screening stuff would swing into action. In my area we have a 'one stop' clinic whereby the woman has all the investigations etc, sees the consultant and goes home with an answer all on one day. if cancer is found, treatment is started quickly.

not sure how it works in the states, but remember having to pay for your care means you tend to over investigate (or thats the impression I get) and over medicate a lot of the time!!

karen

sgent · Jul 22, 2005

not sure how it works in the states, but remember having to pay for your care means you tend to over investigate (or thats the impression I get) and over medicate a lot of the time!!
karen

A lot of stuff in the states leads to disparities in the best medicine vs. best for the hospital/doctor. Mammograms aren't one of them.

Unfortuantely this is a situation where the lack of radiologists and qualified technicians leads to screening fewer people than it should. The science is pretty good on this, and says 45 should be the latest a normal women is screened. The guidelines actually suggest 40.

Evidence From Randomized Trials of Breast Cancer Screening
The primary evidence supporting the recommendation for periodic screening for breast cancer with mammography derives from seven RCTs. Two of the trials took place in North America, one in Scotland, and four in Sweden. One additional trial is underway in the United Kingdom evaluating the benefit of beginning screening in a woman's early 40s.8 At the time of the previous guideline update in 1997, individual trials and meta-analyses of all trials combined showed statistically significant mortality reductions for women aged 40 to 69 associated with an invitation to screening.9-14 Since the last guideline review, updated results from several of the RCTs have been published.15-20
Long-term follow-up data from the UK Trial of Early Detection of Breast Cancer (TEDBC) and from the Edinburgh trial of breast cancer screening were published in the Lancet in 1999.15,16 The TEDBC is a nonrandomized study comparing observed versus expected breast cancer mortality in women aged 45 to 64 in eight centers, consisting of two mammography centers, two breast self-examination (BSE) centers, and four comparison centers. After adjusting for pre-trial mortality rates, breast cancer mortality was 27% lower in women aged 45 to 69 in the two centers in which women underwent mammography compared with the comparison centers. A 35% breast cancer mortality reduction was observed in cohorts aged 45 to 46 at entry into the study. Since the effect began to emerge after three to four years, it cannot be attributed to diagnosis after age 50 among women enrolled into the study in their 40s.15 In the Edinburgh trial follow-up, the investigators applied an improved method of adjusting for socio-economic status and censored breast cancer diagnoses more than three years after the conclusion of the study, since cases diagnosed after three years were unlikely to have been prior false negatives; 29% fewer breast cancer deaths were observed in the group invited to screening compared with an initial estimate of 13 percent.16 The investigators also reported that there was no significant difference in the observed benefit based on age at randomization.

This comes from the American Cancer Society Guidelines for Breast Cancer Screening: Update 2003.

karenG · Jul 22, 2005

I've learnt on this site that we here tend to use completely different guidelines to you in the states. we interpert evidence differently.

I guess its the differences that make it interesting!!

one of the oddest things I have found happens in the states is the use of morphine in children as an analgesic. it would never happen here. over here we give children paracetemol or ibuprofen as analgesia. Morphine is a controlled drug and not used routinely, yet talking to other NP's here, its used routinely in the states........ I nearly fainted! But its just one of many differences............

we do cervical smears from the age of 24.. regardless of whether a woman is sexually active before 24. we then do them 3yrly.........and we are looking at stopping them at 45.. I believe its totally different in the states? certainly my american patients are stunned at not having smears annually.

Karen

sgent · Jul 23, 2005

In the states its still all over the board. The US Preventative Task force recommends cervical smears q1 for high risk women, defined as age age of first sexual encounter and no later than 18. After age 30 if only one sex partners, they can go to q2 after two negative smears.

The USPTF puts out some of the most aggresive guidelines out there -- usually recommending something only after you have Class A studies or multipe Class B studies. Most things done (at least here) are not part of their guidelines.

skislalom · Jul 23, 2005

Just curious about something. My sis-in-law (British) is now 42; h/o breast cancer in her family (mother) and hasn't gone for a baseline mammo yet. She says that her doc recommends starting at age 50. With a h/o of breast cancer in her family, I get concerned about this. Here in the US I believe they would start with a baseline earlier than that. Any comments? Thanks!!!

I had my first mammo at 37. My mother died of b/c when she was 56, was diagnosed at 53. She also had a history of ovarian cancer. I had a hard time getting a doc in my 30's that would screen me for ovarian cancer because I was "too young" - even though my mom had a HUGE tumor removed in her mid 30's. I found a wonderful doc that had no problem screening me for ovarian and breast cancer. I get CA125's and ultrasounds as part of my annual exam, I get mammograms every 6 months because they are watching a couple spots and I have micro calcifications (which they would never have found so early if I hadn't had a baseline mammo when I did)...I'd have your sil think about finding a doc that is fully aware of the history and risk and is willing to begin "early" screening.

just my 2 cents worth

~T