Driving uptake of breast cancer screening to saving lives
With the right approach we can encourage more women to attend breast cancer screening appointments and save lives in the process.
It is widely recognised that early diagnosis is fundamental to reducing deaths from breast cancer. However, at present, too many women are choosing not to take up screening appointments when invited to attend.
To understand the factors preventing them from attending Hologic undertook a survey of 2000 women across the UK aged between 45 and 74). The results highlighted some key areas of consideration for those working within the health service and offered insights that, if acted upon, could increase breast screening attendance and save lives.
Breast screening: understanding and misconceptions
Results from the survey found that 96% of those questioned understood mammograms are an essential check for women.
Yet despite this, 21% of women did not plan to attend their breast screening appointment in the following months, if invited to attend. While 45% of women cited fears around COVID-19 as a key driver in non-attendance, we also found that 13% of women thought mammography is painful, while a further 10% did not believe it detects cancer accurately. These findings are concerning and highlight why it is so vital to tackle misconceptions if we are to turn the tide on breast cancer through earlier diagnosis.
How to drive better uptake of breast cancer screening
This starts with better education.
While most women understand the importance of breast screening, this is not translating to high enough attendance. However, there are steps that can help break through the misunderstandings and misinformation.
As ever, public education campaigns that emphasise the importance, effectiveness and ease of breast cancer screening are vital to boosting attendance. The more that women see their peers from their own communities attending appointments and benefitting from early diagnosis, the more likely they are to attend their own screenings.
We must also ensure that our screening programmes have access to the best and most innovative technology, to make the process of screening as simple, efficient and convenient as possible. In particular, if women are reluctant to attend screening, making technology available to reduce recalls and help avoid unnecessary appointments could help to improve the overall patient experience. Tomosynthesis, often called 3D Mammography ™, detects up to 65% more invasive breast cancers and reduces recalls of patients by up to 40% when compared to traditional 2D mammography.
Knowing the risks
While a family history of breast cancer is widely understood to be a risk factor in developing the disease, just 20% of women knew that having dense breast tissue is also a key factor, despite it being a greater risk than having two immediate relations who have had breast cancer. Furthermore, only 36% of women considered age a risk, even though the number one risk factor for breast cancer is being aged 65 or over.
In short, countless people are in the dark when it comes to their personal risk of developing the disease. That is why the healthcare sector needs to act now to improve awareness of risk factors to improve attendance at mammograms.
According to the charity Breast Cancer Now, over 700,000 people in the UK of breast screening age are at higher-than-average risk of developing breast cancer due to having a high breast density. It is therefore shocking that 86% of women have never had a formal cancer risk assessment to identify this.
More personalised care is essential to addressing some of the key challenges in breast screening. Offering risk stratification through the adoption of quantifiable breast density assessment would allow women with higher risk factors to be accurately identified and prioritised for screening. This would allow the screening interval for lower risk women to be extended, creating a more efficient and targeted breast screening programme.
As services continue to operate amidst the fallout of the pandemic, it is absolutely vital that as many women as possible feel comfortable attending a breast cancer screening appointment. Technology can go a long way to helping streamline the process and critically to improving patient experience. However, it must be supported by robust public education and a smart approach to service prioritisation; one that stratifies risk and unlocks screening for the women that need it most.
 Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014 Jun 25;311(24):2499-507.
 Rafferty E, Park J, Philpotts L, et al., Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography alone: Results of a Multicenter, Multireader trial. Radiology, 2013 Jan; 266(1):104-13. Epub 2012 Nov 20.
 Engmann NJ, Golmakani MK, Miglioretti, DL, et al. Population-Attributable Risk Proportion of Clinical Risk Factors for Breast Cancer. JAMA Oncol. 2017
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