One in eight women in the UK will develop breast cancer at some point in life (Breast Cancer Care – February 2015). Mammography is a technique for taking x-ray images (mammograms) of the breasts that can show breast cancers at an early stage. Mammograms are used in the NHS Breast Screening Programme to look for breast changes in women (aged 50-70) who have no symptoms of breast cancer. These are called screening mammograms. The NHS Breast Screening Programme is being gradually extended in England to women aged 47 to 49, as well as to those aged 71 to 73 as part of a trial.
In the past the NHS Breast Screening Programme did not include women under fifty because mammograms are less effective in pre-menopausal women, and because the density of the breast tissue in younger women makes it more difficult to detect problems. The incidence of breast cancer is also lower in younger women (see Healthtalk Breast screening site).The average age of the menopause in the UK is 52. The NHS Breast Screening Programme is currently extending the age range for breast screening in England to include women aged 47-73. Age extension will mean that women in England will receive their first screening invitation by the time they turn 50.
Studies have shown that digital mammography is better for screening younger women (under fifty) and women with denser breasts, and is equally effective as film mammography in older women (see ‘Diagnostic mammograms in the UK’ and the DMIST study). Younger women (under 47) who develop breast symptoms – pain, skin thickening, nipple discharge, or a change in breast size or shape – can be referred to a breast clinic by their GP where they may be given a mammogram. A mammogram used to diagnose breast disease in women of any age with breast symptoms is called a diagnostic mammogram. Breast symptoms can include:
- A painless lump in the breast
- a change in the size or shape of a breast
- dimpling of the skin of the breast
- a thickening in the breast tissue
- a nipple becoming inverted (turned in)
- a lump or thickening behind the nipple
- a rash (like eczema) affecting the nipple
- a bloodstained discharge from the nipple (this is very rare)
- a swelling or lump in the armpit
A doctor explains why screening and diagnostic mammograms are taken.
Some women we spoke with said they’d had diagnostic mammograms before they were eligible for routine breast screening. They had had breast symptoms and, after seeing their GP, were referred for a mammogram and, a few women, for other tests. Many women have a breast problem at some time in their lives. Most breast problems are not caused by cancer (see ‘Benign breast problems‘ on the Healthtalk Breast Screening site).
Sue found a lump when she was in her early thirties which turned out to be a cyst.
Jane had surgery to remove two benign lumps well before she was invited for routine screening.
One woman said that, when she had breast pain she was particularly concerned because her mother had had breast cancer. She was referred to a breast clinic and given a diagnostic mammogram, which showed that the breast pain was harmless. Another woman said her father had had breast cancer so she was given her first mammogram at forty. She then had her next one at the age of 51 when she was invited in the NHS Breast Screening Programme.
Some of the younger women we spoke with had diagnostic mammograms for breast symptoms that turned out to be DCIS.
Bleeding from Jos nipple was dismissed by doctors when she was pregnant and later when she was…
Tests to find out why Felicity was having breast pain led quickly to a diagnosis of DCIS.
Women’s experiences of having diagnostic mammograms 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.
Kath was anxious because her breast felt different, but wondered whether she was just imagining…
Some women find mammograms uncomfortable or painful (see the Healthtalk Breast Screening site). One woman presenting with symptoms, though, said she did not care about the discomfort of the mammogram because she just wanted to know what was wrong.
More experiences of diagnostic mammograms can be found on the Healthtalk Breast Screening site.