Abstract
The NHS Cancer Plan of October 2000 announced two major changes to the NHSBSP. These were the introduction of two views to all screens and the expansion of the programme to include women aged 65–70. These changes together amounted to a 40% increase in workload and were to be introduced by the end of 2003 and 2004, respectively. In order to cope with this expansion, new ways of working were developed. Many services already have assistant practitioners taking mammograms and radiographers undertaking elements of advanced practice, some of the latter are operating fully as advanced practitioners. A new computer system has been introduced and there has been a major re-equipping of the service. All but a handful of screening programmes are now taking two views at each screen, and four out of 10 have expanded to include 70 year olds. With the exception of only a few, the rest should all be working to the new target age range by the end of this year. Round length is now the most vulnerable area of the screening programme. Services are sometimes struggling to cope with delivering a high-quality expanded programme and maintaining 3-yearly screening.
Highlights
Neoplastic tissue contains elevated levels of choline-containing metabolites [1,2]
We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers
The results suggest that applying compression does not ensure breast thickness reduction and observing physical changes does not guarantee that breast thickness has been minimised
Summary
Neoplastic tissue contains elevated levels of choline-containing metabolites (tCho) [1,2]. The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306). When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?
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