Scottish Breast Screening Programme Research Articles

Breast screening uptake in Polish women in Scotland

We describe the uptake of breast screening in Polish women living in the Lothian region of Scotland 2010-13.This was done by matching Scottish Breast Screening Programme uptake data to Polish and other ethnicity (determined using OnoMAP). We calculated uptake rate in Polish women and compared this with the uptake in all other women. In 2010-13 553 Polish women were invited for screening in Lothian and 258 attended giving an uptake of 46.7% (compared with 70.7% for all other women). Breast screening levels in Polish women are considerably lower than for other women. While other ethnic minorities also have lower uptake, the dynamics and explanations of this may be different for Polish women. This low uptake in Lothian and the reasons for it are likely to be similar throughout the United Kingdom. These reasons, including the potential influence of the breast screening programme in Poland, require further investigation.

P002. Single-institution experience with an under age 40 symptomatic breast clinic

P002. Single-institution experience with an under age 40 symptomatic breast clinic

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

Upgrade of ductal carcinoma in situ on core biopsies to invasive disease at final surgery: a retrospective review across the Scottish Breast Screening Programme

To identify factors affecting upgrade rates from B5a (non-invasive) preoperative core biopsies to invasive disease at surgery and ways to improve screening performance. This was a retrospective analysis of 1252 cases of B5a biopsies across all six Scottish Breast Screening Programmes (BSPs), ranging between 2004 and 2012. Final surgical histopathology was correlated with radiological and biopsy factors. Data were analysed using basic Microsoft Excel and standard Chi-squared test used for evaluating statistical significance. B5a upgrade rates for the units ranged from 19.2% to 29.2%, with an average of 23.6%. Mean sizes of invasive tumours were small (3-11 mm). The upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion, or asymmetry, compared with micro-calcification alone (33.2% versus 21.7%, p = 0.0004). The upgrade rate was significantly lower with the use of large-volume vacuum-assisted biopsy (VAB) devices than 14 G core needles (19.9% versus 26%, p = 0.013); in stereotactic than ultrasound-guided biopsies (21.2% versus 36.1%, p < 0.001). Heterogeneity of data from different centres limited evaluation of other potential factors. Upgrade rates are lower for cases with micro-calcification as the sole mammographic feature with the use of VAB devices. Nevertheless, there is variation in practice across Scottish BSPs, including first-line biopsy technique and/or device; and it is of interest that a few centres maintain low upgrade rates despite not using VAB routinely for biopsy of micro-calcification.

Screening mammography uptake within Australia and Scotland in rural and urban populations

ObjectiveTo test the hypothesis that rural populations had lower uptake of screening mammography than urban populations in the Scottish and Australian setting. MethodScottish data are based upon information from the Scottish Breast Screening Programme Information System describing uptake among women residing within the NHS Highland Health Board area who were invited to attend for screening during the 2008 to 2010 round (N=27,416). Australian data were drawn from the 2010 survey of the 1946–51 cohort of the Australian Longitudinal Study on Women's Health (N=9890 women). ResultsContrary to our hypothesis, results indicated that women living in rural areas were not less likely to attend for screening mammography compared to women living in urban areas in both Scotland (OR for rural=1.17, 95% CI=1.06–1.29) and Australia (OR for rural=1.15, 95% CI=1.01–1.31). ConclusionsThe absence of rural–urban differences in attendance at screening mammography demonstrates that rurality is not necessarily an insurmountable barrier to screening mammography.

Breast cancer risk reduction--is it feasible to initiate a randomised controlled trial of a lifestyle intervention programme (ActWell) within a national breast screening programme?

BackgroundBreast cancer is the most commonly diagnosed cancer and the second cause of cancer deaths amongst women in the UK. The incidence of the disease is increasing and is highest in women from least deprived areas. It is estimated that around 42% of the disease in post-menopausal women could be prevented by increased physical activity and reductions in alcohol intake and body fatness. Breast cancer control endeavours focus on national screening programmes but these do not include communications or interventions for risk reduction.This study aimed to assess the feasibility of delivery, indicative effects and acceptability of a lifestyle intervention programme initiated within the NHS Scottish Breast Screening Programme (NHSSBSP).MethodsA 1:1 randomised controlled trial (RCT) of the 3 month ActWell programme (focussing on body weight, physical activity and alcohol) versus usual care conducted in two NHSSBSP sites between June 2013 and January 2014. Feasibility assessments included recruitment, retention, and fidelity to protocol. Indicative outcomes were measured at baseline and 3 month follow-up (body weight, waist circumference, eating and alcohol habits and physical activity). At study end, a questionnaire assessed participant satisfaction and qualitative interviews elicited women’s, coaches, and radiographers’ experiences. Statistical analysis used Chi squared tests for comparisons in proportions and paired t tests for comparisons of means. Linear regression analyses were performed, adjusted for baseline values, with group allocation as a fixed effect.ResultsA pre-set recruitment target of 80 women was achieved within 12 weeks and 65 (81%) participants (29 intervention, 36 control) completed 3 month assessments. Mean age was 58 ± 5.6 years, mean BMI was 29.2 ± 7.0 kg/m2 and many (44%) reported a family history of breast cancer.The primary analysis (baseline body weight adjusted) showed a significant between group difference favouring the intervention group of 2.04 kg (95% CI −3.24 kg to −0.85 kg). Significant, favourable between group differences were also detected for BMI, waist circumference, physical activity and sitting time. Women rated the programme highly and 70% said they would recommend it to others.ConclusionsRecruitment, retention, indicative results and participant acceptability support the development of a definitive RCT to measure long term effects.Trial registrationThe trial was registered with Current Controlled Trials (ISRCTN56223933).Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0156-2) contains supplementary material, which is available to authorized users.

A pilot telephone intervention to increase uptake of breast cancer screening in socially deprived areas in Scotland (TELBRECS): study protocol for a randomised controlled trial.

BackgroundBreast cancer accounts for almost 30% of all cancers and is the second leading cause of cancer deaths in women in Scotland. Screening is key to early detection. The Scottish Breast Screening Programme is a nationwide, free at point of delivery screening service, to which all women aged between 50 and 70 years are invited to attend every 3 years. Currently over three-quarters of invited women regularly attend screening. However, women from more deprived areas are much less likely to attend: for example in the 3 years from 2010–2012 only 63% of women in the most deprived area attended the East of Scotland Breast Screening programme versus 81% in the least deprived. Research has suggested that reminders (telephone or letter) and brief, personalised interventions addressing barriers to attendance may be helpful in increasing uptake in low-income women.Methods/DesignWe will employ a brief telephone reminder and support intervention, whose purpose is to elicit and address any mistaken beliefs women have about breast screening, with the aim that the perceived benefits of screening come to outweigh any perceived barriers for individuals. We will test whether this intervention, plus a simple anticipated regret manipulation, will lead to an increase in the uptake of breast cancer screening amongst low-income women who have failed to attend a first appointment, in a randomised controlled trial with 600 women. Participants will be randomly allocated to one of four treatment arms i.e. 1) Letter reminder (i.e. Treatment as usual: CONTROL); 2) Telephone reminder (TEL), 3) Telephone reminder plus telephone support (TEL-SUPP) and 4) Telephone reminder plus support plus AR (TEL-SUPP-AR). The primary outcome will be attendance at breast screening within 3 months of the reminder letter.DiscussionIf this simple telephone support intervention (with or without AR intervention) leads to a significant increase in breast screening attendance, this would represent a rare example of a theoretically-driven, relatively simple psychological intervention that could result in earlier detection of breast cancer amongst an under-served group of lower socio-economic women.Trial registrationCurrent Controlled trials: ISRCTN06039270. Registered 16th January 2014.

4.3: Upgrades of B5a (non-invasive) core biopsies to invasive disease at final surgery: a retrospective review across the Scottish Breast Screening Programme

Women with B5a (non-invasive) preoperative core biopsies upgraded to invasive disease at surgery have a high chance of needing further surgery. The average B5a upgrade rate across UK breast screening programmes is around 20%. Through this Scottish review, we aim to identify factors affecting upgrade rates and ways to improve our performance.

Customer focus in breast cancer screening services

The purpose of the paper is to demonstrate how a generic value chain and customer focused system as demonstrated by the Scottish and Irish breast screening programmes can be used to provide a high quality health service. Literature relevant to aligning the entire operating model--the companies' culture, business processes, management systems to serve one value discipline, i.e. customer intimacy, is reviewed and considered in the context of the NHS Scottish Breast Screening Programme in Edinburgh and BreastCheck--the National Breast Screening Programme in Ireland. This paper demonstrates how an emphasis on customer focus and operational excellence, as used in other service industries, can help to provide a better health service. It uses the Scottish and Irish breast screening programmes as illustrative examples. The paper applies the key requirements in the delivery of a quality service including an understanding of the characteristics of a service industry, the management of discontinuities involved in its delivery and the environment in which it operates. System failure is commonly the cause of quality failure in the health system. Breast screening programmes are designed to prevent such a failure. This paper promotes and describes the use of the generic value chain by using the knowledge gained in delivering a mammography-screening programme.

Initial experiences of using an automated volumetric measure of breast density: the standard mammogram form

Limitations of area based measures of breast density have led several research groups to develop volumetric measures of breast density, for use in predicting risk and in epidemiological research. In this paper, we describe our initial experiences using an automated algorithm (standard mammogram form, SMF) to estimate the volume of the breast that is dense from digitized film mammograms. We performed analyses on 3816 mammograms of 626 women, who were part of the Glasgow Alumni Cohort and had mammograms taken within the Scottish Breast Screening Programme between 1989 and 2002. Absolute volume of dense breast tissue (SMF volume) and the percentage of the volume of the breast that is dense (SMF%) were calculated. The median (interquartile range) of SMF volume was 66 cm3 (48 to 98), and of SMF% was 23.4% (18.6 to 29.7). SMF%, but not SMF volume, was positively related to a six category classification (SCC) of visually assigned area-based breast density (increase in ln(SMF%) per category increase in SCC: 0.04% (95% CI: 0.03-0.05). The SMF algorithm produced lower SMF volume for craniocaudal (CC) compared with mediolateral oblique (MLO) views, but CC/MLO differences for SMF% were small. The mean right/left difference for ln(SMF volume) was -0.027 cm3 (95% confidence interval (CI) -0.044 to -0.009) and of ln(SMF%) was 0.005% (95% CI -0.008% to 0.019%). We present these initial data as a background for future analytical work using SMF.

The Scottish breast screening programme's experience of monitoring interval cancers.

To present the Scottish interval cancer data from 1991 to 1995, compare the Scottish experience with results published by other programmes and trials, and document appropriate methodologies to achieve maximum ascertainment of interval cancers. Scottish breast screening programme (part of the UK National Health Service breast screening programme). Interval cancers were identified by linking breast screening data with registrations of invasive breast cancers from the National Scottish Cancer Register. The main outcome measures were the numbers, rates, and proportionate incidence of interval cancers, and rates of total and small (< 10 mm) screen detected invasive cancers diagnosed in this cohort of women. Women who attended the Scottish breast screening programme (Scottish NHSBSP) from 1 April 1991 to 31 March 1995. Interval cancer rates of 4.8, 12.1, and 12.1 per 10,000 women screened were calculated for the first, second, and third year after the last negative screen. Expressed as a proportion of the underlying incidence, the figures are 23%, 60%, and 59%. The Scottish data are comparable with those reported by other UK NHS breast screening programmes for the first and second years after the last negative screen. The interval cancer rate for the third year is appreciably lower. A longer follow up period would be of interest to provide greater evidence on which to base comparisons. Ascertainment of interval cancers depends vitally on the availability of complete, accurate, and timely national cancer registration data and highlights the value of national datasets.

Economic analysis of outreach assessment clinics in breast screening programmes.

A model is developed for the economic evaluation of outreach assessment clinics following screening and used to identify the cost-minimizing strategy for assessing women from three island communities in the Scottish Breast Screening Programme (SBSP). There are four options of interest depending on: whether the women are assessed on the mainland or at outreach assessment clinics; and whether all women have two view screening rather than only those being screened for the first time. The benefits of outreach assessment are assumed to be solely in terms of convenience to women and reductions in the time and travel costs of women recalled for assessment. The costs are modelled in order to compare outreach and no outreach options. The results show that for the numbers of women currently screened outreach assessment is the cost-minimizing strategy. The model provides useful guidance with respect to screening policy and is readily applied to the case of outreach assessment in mainland communities outwith major population centres and to breast and other screening programmes in other countries.

Scottish experience of double reading in the National Breast Screening Programme

The aim of this study was to assess and quantify the results of the double reading regime in the Scottish Breast Screening Programme for the years 1992–1996, and to use this information to make a recommendation as to whether this practice should be continued. This study is a retrospective data analysis of the Scottish Breast Screening Programme (part of the UK NHSBSP). Outcome data were analysed for all women attending the Scottish Breast Screening Programme from 1 April 1992 to 31 March 1996. The number of additional cancers detected by the second reader only and the number of additional women recalled by the second reader only were assessed. Double reading resulted in the detection of 259 additional cancers by the second reader in the 4-year period. This represents 10.5% of the total cancers detected in that time. The effect of double reading on the number of recalls can only be obtained for a subset of the data. Analysis of this subset showed that an additional 4616 women (27% of the total number of women recalled) were recalled to obtain 170 additional cancers (12% of total cancers). Double reading has increased the cancer detection rate of the Scottish Breast Screening Programme. Over 10% of cancers were detected only by the second reader. This improvement in sensitivity has been maintained over the 4 years reviewed. Using a second reader resulted in a 13% increase in the cancer detection rate, although this was associated with a 37% increase in recall rate. At present we find no reason to discontinue the practice of double reading, although this will be reviewed at intervals as technological advances are introduced.