After having a routine mammogram in the NHS Breast Screening Programme, most women receive a results letter about two weeks later. About 95 per cent of women have a normal result from their first mammogram and are invited for screening again three years later (NHS Choices). About four in every 100 women screened, though, are called back for further tests. Out of these 4 women, 1 will be found to have cancer. About 1 in 5 women diagnosed with breast cancer through screening will actually have DCIS (NHS Breast Screening leaflet May 2017).
Women who are recalled after a routine mammogram are referred to an assessment clinic for more mammograms and further tests if needed. Individual women react differently to being referred to an assessment clinic. Feelings can range from not worrying at all to extreme anxiety.
Many women we spoke with talked about their thoughts and feelings when they were recalled after a routine mammogram. For some, being recalled caused no concerns at all and they carried on with life as normal.
Several women assumed the x-rays wouldn’t be clear for technical reasons and, because they’d had no symptoms, felt they were not at risk. A few said that they hadn’t felt at all concerned because there was no history of breast cancer in their family. Less than 1 in 10 breast cancers are thought to be linked to an inherited breast cancer gene (Macmillian Cancer Relief August 2015). Our genes store the biological information we inherit from our parents. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Other genes have been identified, but they only slightly increase the risk. If a woman has one relative who was diagnosed with breast cancer at an older age, it’s not likely that the cancer is due to an inherited breast cancer gene.
A few women said they’d had cysts or other harmless (benign) breast conditions in the past and thought they may have been recalled because another such condition had been found. Because they weren’t anxious and didn’t think it would be anything serious, many of these women went to the breast clinic by themselves, though some did go with a friend or partner.
Some women, though, did feel concerned, worried, panicked or frightened when they were recalled. One said she was ‘devastated’ when she received the recall letter because she’d had a lot of ill health in the past and didn’t want any more health problems. There should always be a contact number for the assessment clinic that women can call if they are particularly anxious about their appointment so they can speak to a suitably qualified member of staff, such as a breast care nurse.
For several women, waiting to attend the hospital appointment was an extremely worrying time and, for a few, the worst time because of the uncertainty. Not knowing whether there is a problem or how serious it might be can cause a great deal of anxiety. One woman, whose mother had had breast cancer in the past, said she felt frightened and phoned the hospital for more information, though the receptionist was unable to give her any.
At the hospital, more tests are carried out. These may include a clinical examination, more mammograms at different angles or with magnification, an ultrasound scan and biopsies (see Diagnostic tests: Mammogram
; Ultrasound scan
Many women attending the clinic will be offered a triple assessment. However, not all the tests which form the triple assessment are appropriate for everyone. The triple assessment will involve:
- clinical breast examination
- further mammograms and / or ultrasound scan
- needle biopsy
The combination of tests which are carried out depends on the nature of the abnormality. In most cases, all of the tests are carried out during the same appointment. Occasionally, it may be necessary to carry out a needle biopsy on a different day. The results of a needle biopsy should be available within a week of the procedure.
Many hospitals have a ‘one stop’ breast cancer clinic, which means that all the tests and results can be given on the same day. In other hospitals some of the tests might be carried out at a later date and it may take longer for the results to come through.
Most women said that doctors told them while they were carrying out the tests why these needed to be done. Some women said they wished the recall letter had told them more about what would happen. One said she wasn’t worried about being recalled but didn’t expect to have all the tests done on the day of the recall appointment.