Breast Cancer Screening
Cancer Screening Evaluation Unit (DoH)
Section: Section of Epidemiology
Screening by mammography has been demonstrated by a number of randomised trials to be effective in reducing mortality from breast cancer in women >50 years of age. The NHS Breast Screening Programme, introduced in 1988, covers over five million women in England, and costs in excess of £52 million per annum. A substantial proportion of the work of the Cancer Screening Evaluation Unit is focussed on breast screening.
Our current work involves:
- A cohort study of more than two million women to evaluate the effectiveness of the NHS Breast Screening Programme in reducing deaths from breast cancer in women invited and screened by the programme
- Other epidemiological studies of the NHS Breast Screening Programme (including international comparisons, surrogate outcome measures, interval cancer rates and screening of women >70 years)
- A randomised controlled trial studying the effectiveness of mammographic screening in young women
- Quality assurance and monitoring of the breast screening programme
- External quality assurance of pathology in the NHS Breast Screening Programme
A Feasibility Study of Using the National Breast Implant Registry to Study Outcomes Associated with Silicone Gel Breast Implants
SM Moss, J Warden, P Coulson
The Unit conducted a feasibility study of using the National Breast Implant Registry, to obtain information on the short- and medium-term outcomes associated with silicone gel breast implants and on patient experiences and level of satisfaction.
External Funding: Department of Health
Individual based evaluation of the effectiveness of the National Breast Screening Programme
LE Johns, SM Moss, RG Blanks, AJ Swerdlow, J Hemming
The Unit is conducting a large cohort study to address the question of the effectiveness of the NHS breast screening programme, as operated in recent years, in reducing the risk of death from breast cancer in women invited and screened by the programme. The study will link the individual breast screening histories of more than two million women with individual mortality and breast cancer incidence data held by the Office for National Statistics.
Source of external funding: Department of Health
Epidemiological studies of the National Breast Screening Programme
SM Moss, RG Blanks, DA Coleman, J Melia, R Bennett, D Muston
The Unit is conducting a number of studies as part of the epidemiological evaluation of the NHS breast screening programme. Data on pathological variables, which can be used as surrogate outcome measures, are being obtained from cancer registries and related to screening status with the aim of predicting breast cancer mortality. The Unit is also actively involved in work on international comparisons. Other work includes the collection and analyses of data on the rates of interval cancers occurring between screens. Modelling work is looking at the effectiveness and costs of extending screening to women >70 years.
External Funding: Department of Health
A Trial of Mammographic Screening of Women Starting at Age 40
SM Moss, I Thomas, M Waller, LE Johns, N Bixby, N Kingston; in collaboration with 23 breast screening centres in England and Wales
The effectiveness of screening for breast cancer in younger women remains the subject of considerable debate. The Unit is coordinating a multicentre trial to evaluate the effect of annual mammographic screening from age 40 on breast cancer mortality. 23 centres are included in the randomised trial, in progress since 1991, which has recruited 160,000 women. Fieldwork for the trial was completed in 2004. Detailed pathology data are being collected to allow the investigation of interim endpoints.
External Funding: Medical Research Council, Cancer Research UK, Department of Health
Quality Assurance and Monitoring of the NHS Breast Screening Programmes
RG Blanks, R Bennett, A Sanchez, N Kingston, SM Moss
Collating routine statistics from all screening offices and/or laboratories and Primary Care Organisations provides a national picture of screening performance and also facilitates comparisons of effectiveness of different screening protocols. Data are used to develop performance measures and targets and to inform the screening programme on comparative performance. Recent work has included the development of quality assurance methods to determine the significance of high or low proportions of specific smear results and to quantify cytology/history correlation with a view to detecting laboratory and unit low sensitivity. These methods may help determine underperformance in the cervical screening programme, over shorter time periods than is possible with traditional epidemiological techniques.
External Funding: NHS R&D
External Quality Assurance of Pathology in the NHS Breast Screening Programme
SM Moss, DA Coleman, S Kodikara; in collaboration with 500 UK pathologists
The NHS Breast Screening Pathology External Quality Assurance Programme was set up to promote high quality histological reporting on biopsies resulting from breast cancer screening. In addition to publishing guidelines, the programme organises the circulation of slides so that participants can carry out self-assessment. The Unit provides analysis of the histological reports in an anonymous form, using kappa statistics to assess observer variability. Similar work is carried out for the development of Quality Assurance in Pathology in European Breast Screening.
External Funding: NHS R&D
In the Section of Epidemiology
