Government Response

The Government responded to this petition on Tuesday 15th May 2018

The Government is committed to helping detect, treat and reduce the number of lives lost to invasive breast cancer. Evidence for the effectiveness of screening women under 50 is limited.

We are very sorry to hear of your terminal breast cancer diagnosis. Breast cancer can be a devastating disease and the Government is committed to providing well-managed screening programmes based on the most current peer reviewed evidence to ensure the greatest benefit.

A screening programme is introduced following a robust process using peer reviewed evidence that shows the benefits to screen clearly outweigh harm and they are subject to central programme specifications and quality assurance. The English cancer screening programmes are internationally renowned for their rigour, standard of evidence, national implementation and quality assurance.

The NHS Breast Screening Programme (NHS BSP) in England offers all women between the ages of 50 and 70 the opportunity to be screened every 3 years for breast cancer, to help detect abnormalities and reduce the number of lives lost to invasive breast cancer. The NHS BSP aims to detect breast cancer early when there is a greater chance of cure.

Although early detection is the best way to reduce breast cancer mortality by giving the opportunity to offer women more treatment options, which may save lives, there are also risks. These include over-diagnosis (referring for unnecessary tests) and over-treatment (operating on disease that is unlikely to cause serious harm). For women under the age of 50, there is evidence that breast screening is less effective, as younger women have less fatty, denser breast tissue. Screening with mammography (x-rays) is the technique that is evidence-based and can detect cancers at an early stage. However, they are not very effective in diagnosing disease in younger women with dense breasts. Breast screening is offered from the age of 50 as the chance of developing the disease increases with age. Four out of five breast cancers develop in women over the age of 50. There is insufficient evidence to confidently offer breast screening to women at a much younger age as doing so will find many abnormalities which will be treated but would never have developed into a cancer. This can cause harm and anxiety. Not all breast cancers can be detected early when they are non-invasive and some women with non-invasive disease would never have cancer during their lifetime.

There are several trials in the Programme addressing these issues currently:
• Forget me not www.sloaneproject.co.uk/NonTreatmentStudy.htm
• Loris www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-comparing-surgery-with-active-monitoring-for-low-risk-dcis-loris
• Sloane www.sloaneproject.co.uk/.

The 2012 UK independent review of breast cancer screening (Marmot review) estimated that inviting women between the ages of 50-70 reduces mortality from breast cancer in the population invited by 20% and saves an estimated 1,300 lives a year. It also found that screening women outside the ages of 50 to 70 years could lead to over-diagnosis or over-treatment. The review can be found here: http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@pol/documents/generalcontent/breast-screening-report.pdf

In June 2015, the World Health Organisation’s International Agency for Research on Cancer (IARC) published the findings of a review on breast cancer screening in the New England Journal of Medicine. A group of 29 independent international experts from 16 countries, convened by the IARC, assessed the cancer-preventive and adverse effects of various methods of screening for breast cancer. The findings of the review support the current age at which women are first invited for breast screening in England and the 3 year interval period between invitations. The IARC’s review found limited evidence for the effectiveness of screening women in the younger age group of 40 to 49. Women over 70 are not routinely invited for breast screening as there is no evidence to support this, although they can self-refer every 3 years if they wish. You review can be accessed here: www.iarc.fr/en/mediacentre/pr/2015/pdfs/pr234_E.pdf

Women that are identified as being at high risk of the disease (e.g. due to a genetic mutation such as BRCA1/2 or having had supradiaphragmatic radiotherapy at a young age) can be referred into the programme at a younger age. However, for this younger cohort, screening is usually performed by magnetic resonance imaging (MRI) which is a more suitable screening test than mammography alone.
We encourage all women to be breast aware and anyone with concerns should discuss these with their GP.

Department of Health and Social Care