Common questions about breast screening

Research has shown that taking hormone replacement therapy (HRT) for five years or more may slightly increase the risk of developing breast cancer. It is also thought that this increased risk lessens after five years of stopping taking HRT. However, HRT can have health benefits such as reducing the effects of menopause, for example osteoporosis. The benefits and possible risks to you of taking HRT need to be weighed up. You may want to talk to your GP about the benefits and risks to you personally of taking HRT.

If you are aged 50 or over, you should attend your regular breast screening appointments whether or not you are taking HRT. You do not need to have mammograms any more often if you are taking HRT. However, HRT makes the breast tissue slightly denser and can make breast problems more difficult to see on mammograms. So, it is important to be breast aware| if you are taking HRT.

You should tell your breast screening unit if you have had breast implants, as you will need to have your mammogram| at a screening unit where your mammogram can be looked at immediately. The mammogram technique used may need to be adapted to show as much breast tissue as possible on the x-ray. The pressure applied to your breasts during the screening is unlikely to damage your implants.

Mammograms for breast screening are not a check on your implants. If you think that there is a problem with your implants, please let the radiographer know.

If you have had all the breast tissue removed during a subcutaneous mastectomy and an implant put in, breast screening with mammography is not necessary for that breast.

Breast cancer is rare in women under 50|. At present, mammograms have not been shown to be as effective at detecting breast cancer in pre-menopausal women (women who have not had their menopause). The average age of the menopause in the UK is 50. After the menopause, the glandular tissue in the breast decreases and the breast tissue is increasingly made up of only fat. Fat shows up more clearly on the mammogram and makes interpretation of the x-ray more reliable.

Breast cancer is far more common in post-menopausal women and the risk of developing breast cancer increases as women get older.

If you are under 50 years of age and are concerned about a specific breast problem, you can ask your GP to refer you to a hospital breast clinic. This is not part of the NHS Breast Screening Programme; however, the same tests are used in both breast screening clinics and hospital breast clinics.

The breast screening unit will keep your mammogram for at least eight years. They can then compare your latest mammogram with those that you have had taken before.

The NHS Breast Screening Programme regularly reviews all screening records, including mammograms, as part of its aim to offer a quality service and to help increase the expertise of its specialist staff. This means that staff who work elsewhere in the health service will need to see your records. If a review of mammograms shows that you should have been cared for differently, you will be contacted and offered more information about the review of your case if you would like to have it.

The screening unit staff will do their best to reassure you and give you support during all stages of screening. Invitation and recall letters are carefully worded and give you the contact number of people to ring if you have any additional questions.

You will be sent a leaflet called 'Breast Screening: The facts', produced by the NHS Breast Screening Programme|, with your invitation letter. This leaflet is also available on their website, where it is translated into 18 languages. Some translations are available in audio format.

You will be given the number of the local breast screening unit and you can phone them or your own GP if you have any worries. You can also contact us| or Breast Cancer Care|.

Most breast cancers| occur in women. Fewer than one in a hundred (0.6%) breast cancers occur in men|. It is not clear exactly what causes breast cancer but many factors can slightly increase a woman's risk of developing breast cancer. These are mentioned below:

• The risk of breast cancer increases with age. Over 80% of breast cancers occur in women over 50.
• Having had breast cancer before.
• Having had certain types of benign breast disease (lobular carcinoma in situ or atypical lobular hyperplasia) in the past.
• Women who have never breastfed are slightly more likely to develop breast cancer than women who have breastfed for more than a year.
• Women who are taking hormone replacement therapy (HRT) or have recently been taking it have a slightly increased risk of breast cancer.
• Women who do not have children are slightly more likely to develop breast cancer than women who do.
• Women who start their periods early (early puberty) or have a late menopause have a slightly higher risk of breast cancer.
• Being overweight, once you have had your menopause, can increase the risk of breast cancer.

Drinking a lot of alcohol over many years can increase the risk.

Having a family history of breast cancer

About 5–10% of breast cancers are thought to be caused by inherited cancer genes|. Two breast cancer genes have been identified (BRCA1 and BRCA2) and others may be found in the future.

Breast cancer is a common cancer and about one in nine women in the UK will develop it during their lifetime. So if you have just one or even two elderly relatives diagnosed with breast cancer it does not mean that you are at a much increased risk yourself. However, if you have any of the following in your close family you might want to speak to your GP and be referred to a family cancer clinic:

• three close blood relatives from the same side of the family (your mother’s or your father’s) who developed breast cancer at any age, or
• two close relatives (from the same side of the family) who developed breast cancer under the age of 60, or
• one close relative who developed breast cancer under the age of 40, or
• breast and ovarian cancer on the same side of the family, or
• a male relative with breast cancer, or
• a close relative with cancer in both breasts.

Your close relatives are your mother, sister or daughter. They are sometimes called your first degree relatives.

If you are worried about breast cancer in your family our section, are you worried about breast cancer?| may be helpful.