A personal view of the approach to breast cancer screening in the UK

Abstract

emerged from these schemes probably mainly due to difficulties in case follow-up. This is an inevitable consequence when women with a suspected abnormal mammogram are referred elsewhere for assessment. Some of the schemes were well controlled, high-quality services, but others were far from this, with abysmal standards of mammography, and mammographic interpretation which was in some instances so poor as to be positively dangerous to the users of the schemes, with high numbers of false positives and, with possibly even worse effects, false negatives. One suspects that financial reward was a major objective of some of the organisations and individuals who initiated some of these early breast screening schemes. The NHS activity at this stage was limited to a few centres undertaking mammography of symptomatic women with only a handful of these involved with trials of breast screening. A multi-centre UK trial of early detection had been in progress since 1979, designed to test the relative values of various screening methods,’ but a report on the preliminary findings was not due until 1988. The public, lead by women’s organisations and supported by a sprinkling of enthusiastic professionals, was beginning to press for breast cancer screening as a part of the NHS. The health ministers, however, were rightly cautious. They, perhaps more than anyone, were aware of the less than optimal service which had resulted from the over-hasty, largely uncontrolled development of the Cervical Cancer Screening Programme, initiated on a wave of political enthusiasm as a result of women’s pressure groups.