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What happened to breast screening in England?

Credit: Adobe

Breast Cancer Now

4 min read Partner content

From one of the NHS’s biggest success stories to breaking point, Breast Cancer Now highlights what needs to happen to protect, recover, and invest in the breast screening programme, so we can turn the tide to save more women’s lives from breast cancer.

The breast screening programme can save women’s lives from breast cancer. It’s played a key part in breast cancer survival rates doubling in the last 40 years, and leaders across the political spectrum continuously praise and acknowledge its importance, calling on women to attend when invited.

Yet, after years of steady decline, the proportion of women taking up their screening invite in England during the pandemic plummeted to a record low of 62% (in 2020/21), and has not recovered, with over one million women having missed out on breast screening last year (2021/22). So how has the breast screening programme reached breaking point in England? And how can we turn it around?

It’s about choices

Breast screening uptake in England is the lowest in the UK, with the latest national uptake average of 62% being much lower than the national average uptake in Scotland, which reached 75% in 2021/22.

Changes to the way women are invited to attend breast screening in England will have played a big part. From the end of September 2020, most women were sent ‘open invitations’ requiring them to make their own appointment, rather than being given a set appointment – an approach which research has suggested reduces uptake. There was also no requirement for services to follow up with women who didn’t arrange an appointment, and some women experienced difficulties making appointments. This meant that while services could “catch up” inviting women for screening faster, a much smaller proportion of the women invited got screened.

Breast screening units were also given money to help them recover, but in some areas these resources were diverted away from screening, and since the start of the pandemic ring-fenced spending on public health services, like screening, has been removed. These decisions, combined with a chronic lack of staff, equipment, data, coordination, and functional IT, have left breast screening units struggling to recover.

All of this has seen breast screening become buried beneath the huge number of pressures facing the NHS. Prioritisation of other demands considered more urgent sees the significant achievements of breast screening taken for granted and heightens the burden of recovery on already strained screening teams. Meanwhile, a rapid bounce back in screening uptake seems unlikely since only 49% of women invited for the first time attended breast screening last year (2021/22), which research has suggested makes them much less likely to ever attend in the future.

Short-term thinking keeps screening stuck in the past

It’s short-term thinking that results in investment in prevention and public health programmes, like breast screening, falling down the priority list. Nearly four years since the Richards’ Review of Adult Screening Programmes, this approach has also led to many of the problems identified in the review remaining unaddressed and many opportunities to improve breast screening being missed.

Long-term thinking is essential for both the full recovery and future of the breast screening programme, particularly in delivering long overdue IT upgrades. The programme’s current digital systems and equipment are clunky, outdated, and prone to failures that are ultimately putting women’s lives at risk.

New IT infrastructure is also necessary to deliver the crucial improvements and efficiencies that will allow the NHS to harness innovations like AI screening tools and personalised risk-based screening. These developments in breast screening are on the horizon and could increase early diagnosis, save money, and prevent more breast cancer deaths – but only if breast screening units are supported now to harness these innovations in the future.

Available doesn’t mean accessible

Many women still face practical, financial, geographical, and social barriers to accessing breast screening. This puts them at much greater risk of being diagnosed with breast cancer at a later stage and of having lower survival rates.

We must urgently and actively work to remove the barriers to screening and make it more convenient to help reduce current inequalities in early diagnosis. We must also boost uptake in areas of higher deprivation and amongst women from certain ethnic minority communities.

The good news is that a national awareness campaign could have a huge impact, with NHS England recently running successful campaigns for bowel and cervical cancer screening. This is why we’re calling on NHS England to now deliver a national media campaign highlighting the importance and availability of breast screening, with targeted messaging that engages communities among whom we know uptake is lowest.

This is bigger than breast screening

Breast Cancer Now has produced a blueprint for how breast screening can be transformed by 2028 – delivering the accessible, equitable and effective breast screening women in England deserve.

We have also joined forces with four other leading UK cancer charities to call for cancer screening programmes to be prioritised and revolutionised to save more lives from cancer.

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