Government Response

The Government responded to this petition on Thursday 1st October 2020

We’re committed to reducing lives lost to breast cancer; a devastating disease affecting all ages. Currently, the UK National Screening Committee recommends women aged 50 -71 are screened.

Breast cancer can be a devastating disease, affecting people of all ages and genders.

The Government recognises your concerns and is committed to the early detection and treatment of breast cancer as part of our commitment to detect 75% of cancers at stage 1 or 2, and for 55,000 more people to survive cancer for five years in England each year from 2028, as detailed in the NHS Long Term Plan.

As you rightly identify, population screening programmes are crucial to detecting cancer as early as possible and therefore increasing the likelihood of survival through early treatment. The NHS Breast Screening Programme (NHS BSP) in England offers all women aged between 50 and their 71st birthday the opportunity to be screened every three years for breast cancer, in order to detect abnormalities.

Breast screening is offered from age 50 because the chance of developing breast cancer increases with age: four out of five breast cancers develop in women over 50. The 2012 UK independent review of breast cancer screening (the Marmot review) estimated that inviting women aged 50-70 reduces mortality from breast cancer in the population invited by 20% and saves an estimated 1,300 lives a year. You can read the review here: http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@pol/documents/generalcontent/breast-screening-report.pdf

The UK National Screening Committee (UK NSC) advises the Government and the NHS on all aspects of screening. The UK NSC will only recommend a screening programme when it can be demonstrated that the benefits of the programme clearly outweigh any harm they may cause, for example from false positives or overtreatment. You can find the criteria here: https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programme.

There is little evidence to show that regular mammograms for women below the current screening age would result in reduced deaths from breast cancer. The Marmot review found that screening women outside the ages of 50-70 years could lead to over-diagnosis (referring women for unnecessary tests) and over-treatment (operating on women with disease which is unlikely to cause serious harm to them). Not all breast cancers can be detected early when they are non-invasive, and some women with non-invasive disease would never develop cancer during their lifetime. Abnormalities that would never have developed into a cancer would be found and treated, potentially causing unnecessary harm and anxiety.

The UK NSC recognises that screening programmes are not static and over time may need to change to be more effective. They are constantly assessing the latest evidence and change their advice accordingly. Changes to a programme can be submitted to the Committee for consideration throughout the year: https://www.gov.uk/government/publications/uk-nsc-evidence-review-process/uk-nsc-evidence-review-process

There is a great deal of research currently being undertaken to better understand the early onset of cancer and the extension of screening to ages beyond the scope of the current programme. There are several trials in the NHS BSP that are seeking to understand the early development of conditions that can lead to breast cancer (https://www.gov.uk/guidance/breast-screening-the-sloane-project; www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-comparing-surgery-with-active-monitoring-for-low-risk-dcis-loris). There is also a trial currently underway that is investigating whether extending screening to those aged 47-49 and 71-73 would be effective. It is the biggest trial of its kind ever to be undertaken and will provide robust evidence about the effectiveness of screening in these age groups, including the benefit and harms. The UK NSC will review the publication of the age extension trial when it reports in 2026. You can read more about the trial here: https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-to-evaluate-an-age-extension-of-the-nhs-breast-screening-programme

There is substantial international evidence on the effectiveness of breast screening. A group of 29 independent international experts from 16 countries, convened by the World Health Organization’s International Agency for Research on Cancer (IARC), assessed the cancer-preventive and adverse effects of various methods of screening for breast cancer in 2015. The findings support the current age at which women are first invited for breast screening in England and the three-year interval period between invitations. The IARC review found that the evidence for the effectiveness of screening women in the younger age group of 40-49 was limited. The review can be found here: https://www.researchgate.net/publication/277782023_Breast-Cancer_Screening_-_Viewpoint_of_the_IARC_Working_Group.

Department of Health and Social Care