“All screening programmes do harm; some do good as well and, of these, some do more good than harm”. This is the leading statement in an article by Gray et al discussing the introduction of the UK national breast screening programme 20 years ago (BMJ 2008;336:480-3). To maximise the good - early detection - and minimise harm - unnecessary investigations - any programme has to have ongoing quality assurance to ensure minimum standards and set improvement targets. The quality of any service depends on the skill and experience of those running it, as well as the resources allocated, especially the equipment.
The UK scheme aims to detect 5 breast cancers for every 1 000 women screened and send less than 70 per 1 000 for unnecessary further testing. All women aged 50 - 70 years are offered screening every 3 years with 2 views now the norm, resulting in more than 18 million sets of mammograms since the programme's inception. It is estimated that 100 000 breast cancers have been detected with the saving of about 1 400 lives per year (Mayor p 527).
Multidisciplinary centres have replaced diagnostic clinics and employ radiography experts, pathologists, surgeons, radiotherapists and oncologists, resulting in better comprehensive services with faster turn-around times and improved data collation. Since the screening programme was introduced, breast cancer in the UK is no longer the most common cause of death from cancer in women.
