Diagnostic mammograms in the UK

Mammography is a technique for taking x-ray images (mammograms) of the breasts which can show breast cancers at an early stage. Mammography is used in the UK National Health Service Breast Screening Programme (NHSBSP) to look for breast changes in women who have no symptoms of breast cancer (screening mammograms). Mammograms are also used to diagnose breast disease in women who have symptoms. If a woman visits her doctor because of unusual breast changes, she will often be referred to a breast clinic to have a ‘diagnostic mammogram’. The same techniques are used in breast screening units and hospital breast clinics for diagnosing breast cancer and many staff work in both settings.

Some women we spoke with went for diagnostic mammograms because they’d had breast symptoms.

Before she was eligible for routine screening mammograms, Patricia had bleeding from her nipple…

Age at interview 64

Gender Female

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One evening I felt sort of discomfort around my left breast. When I got home and changed my top I noticed that there was blood in my bra. Obviously I was concerned, went to the doctors, who then sent me for a mammogram. Fortunately it turned out to be okay. It was just one of those things. From then on, I have gone periodically up to the age when you start having them every three years, to have them.

That very first time that you went for a mammogram, this was because there had been some bleeding?

Yes, from the left nipple.

Yes, and what were your thoughts at the time, were you worried or did you just think

No I was scared, because obviously it wasnt that long ago, it was many years back now, but obviously we all knew about cancer and we all thought if anything changes etc. Probably I was frantic at the time, but you do seem to forget as time goes on, your thoughts, you know, when it’s okaynbsp;

Yes. So you then quickly you got an appointment. First you went to your GP?

Yes. Who arranged quiteit was quite fast getting the mammography done.

Because you had private insurance?

No, not then. Not then, that was National Health.

So you quickly went for your first mammogram. Can you remember how old you were at that time? What was your age at that time?

Probably about twenty years ago. Because yes I was working for a careers office. I remember where I was working and that would have been about 20 years ago.

And you went for your first mammogram. Did you know what to expect?

No, no, not at all. No.

Had you spoken to anybody else?

Yes, my friend had been, for what reason I cant remember, and she told me that she didnt realise that your breast could be flattened to that degree. I then knew what she meant, you don’t realise that your breast could go as flat as pancakes [laughs].

So when you first went, did she tell what it was like beforehand?

Yes. Sort of, she said, it doesnt hurt, I remember her saying to me it doesnt hurt, it is just uncomfortable and it is.

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One woman, who had been for a routine screening mammogram when first invited at age 50, had decided not to go again because she had found the mammograms very painful (see ‘Reasons for not attending breast screening‘). Some years later she noticed an indentation in her breast. She was referred to a breast clinic by her GP and found to have breast cancer.

Shed been screened once but decided not to go again. Some years later she noticed an indentation…

Age at interview 68

Gender Female

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Well as far as I can remember, I think it must go back twelve years, because I went for a mammogram at the National Health place, and I found it extremely painful. And I was bent double when I came out. So I said I’m not going to have another one, which should have been every three years, and I didn’t go for it. And then of course I realised afterwards, well a few years I’d missed, obviously, and I found this indent in the breast, a breast indentation, whatever you call it;

I saw my GP. She referred me to the surgeon and it was a few weeks wait, and then I decided to go privately to a consultant, which I did, and he operated the next week.

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At the breast clinic, women with breast changes or symptoms can have various diagnostic tests, including mammograms, MRI’s, ultrasound scans, fine needle aspiration and other types of biopsy (see ‘Referral to a breast clinic‘).

Although breast cancer is most common in women after the menopause, younger women (under 50) who are not screened in the NHS Breast Screening Programme, may develop breast symptoms and be referred for a diagnostic mammogram by their GP.

The DMIST study has shown that digital mammography is better for screening younger women (under 50) and women with denser breasts, and is equally effective as film mammography in older women. Whereas conventional mammography captures images of breast tissue on x-ray film, digital mammography uses computer imaging. All services in the NHSBSP are now fully digital with no anologue machines used in the Programme.

Many women have a breast problem at some time in their lives. Breasts may become tender or painful, or a nipple discharge or lump may appear. More than nine times out of ten, breast problems are not caused by cancer (see ‘Benign breast problems’).
Some of the younger women we spoke with did have breast symptoms that turned out to be cancer. One had had three yearly mammograms before 50 as part of a research project on breast cancer and family history. Shortly after leaving the project, she had a sore and weepy nipple.

She discusses what happened when she had a sore and weeping nipple.

Age at interview 48

Gender Female

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Well I’d gone with my daughter onto a sun-bed, which I have never done before, and it was just, I thought I would just go with her to see what it was like. And over the next few days my nipples seemed to be a bit sore, weeping. So, I went to my GP and she said to me “I think its eczema” and she gave me some cream;

I went back after a week and it hadn’t done any, well there was no change in my nipple, it was still sore. So, she said “I think wed better refer you to the hospital” and that took three months actually. I went back to her and I said, “I still haven’t got an appointment” and my nipple was changing quite a lot by that time, it seemed to be getting a lot worse. Then I got my appointment through at the hospital. I went to the hospital.

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Two young women described finding a lump while showering; they were referred to hospital for diagnostic mammograms and other tests. One woman presented what she thought was a lump to her GP who dismissed it as nothing, but found another lump which was suspicious and referred her to hospital.

She discusses finding a breast lump.

Age at interview 39

Gender Female

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What happened was I actually found the lump myself, I was in the shower at the time, and I found this lump because I did my own examinations, more or less every month I did them, it was a routine thing. I found the lump and I thought “oh my god,what is this”. When I came out of the shower, I asked my husband to check it as well. He couldn’t feel anything at all, so I went to work and I talked it over with a couple of girls. They basically just said “oh, could be a cyst and nothing more than that, but phone up the doctor and find out”. So I did.

I made an appointment, luckily I got an appointment very quickly with her, I explained to the receptionist what was going on. I went to the doctor explained that I had found a lump, she felt the lump and said “right, OK, well write a letter to the hospital”, which she did.

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She presented a lump to her GP who dismissed it as nothing but found another more suspicious one.

Age at interview 48

Gender Female

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I found what I thought was a lump. I was 39 and I thought what I’d do is just to wait a cycle or two to see if it disappeared and it didn’t. So I went to see my GP and she gave me an exam and she said “no that’s normal, theres nothing wrong, but I will give you a full exam” and she found a small lump under the nipple where, for some reason, I had never checked. I don’t know why but I decided somewhere along the line that this really didn’t need a special examination. I examined everywhere else but I kind of forgot to actually press underneath the nipple and she found something;

She said “it feels fine, don’t worry, most of these lumps are benign, but I am going to send you on to the local surgeon”;

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Women’s experiences of having a diagnostic mammogram at the breast clinic are similar to those of women attending for screening mammograms. However, women presenting with symptoms may be more anxious because they are expecting to find something wrong. Some women having mammograms as part of the NHS screening programme find the mammogram uncomfortable or painful. One woman presenting with symptoms, though, said she did not care about the discomfort of the mammogram because she was so distressed about what the results might be.

She didn’t care about the discomfort of the mammogram because she was so worried about what her…

Age at interview 43

Gender Female

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How did you find the mammogram? Did you know anything about…?

No, I’d just heard, I’d heard, because when, where I worked I had, was working with some mature ladies who had gone for mammograms and, you know, you hear stories, you hear, you know, all sorts of things. And it’s not comfortable, that’s the only way to put it. But at the time I think you’re so worried and distressed that that is nothing. It is a small price to pay because you think, well what’s a bit of discomfort if it’s going to give you peace of mind?

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Most women referred to hospital with breast symptoms have all their tests on the same day in so called one-stop clinics. If a biopsy is needed, this is usually done on the same day. Some women we talked to received the results of their tests on the same day, while others had to wait a few days.

She had all diagnostic tests done on one day but had to wait a few days to get the results.

Age at interview 39

Gender Female

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The doctor there that I saw, the Consultant, he did the ultrasound scan and he kept on saying “it doesn’t look good” and I think from there, I more or less knew that I had cancer. But I still didn’t want to believe it at the time, you know, he said “it just doesn’t look good, it doesn’t look good” and then he said “OK, I want you to go for a needle biopsy, a mammogram and see what they find there”.

But that couldn’t be done until the afternoon, so we had to go back in the afternoon to the hospital and they told us to go back on Thursday to have the results. When we went back on the Thursday, in the room was sitting the doctor, the Macmillan Nurse, and there were some medical students there as well and I just looked and I thought “no, something doesn’t seem right, it just doesn’t” you know “not right at all”. I spoke to my husband the day before on the Wednesday and I kept on saying to him “what do you think, what do you think?” and he was like, hes had an open mind all the way, you know, he wouldn’t believe it, he said “I’m keeping an open mind”.

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