How Can The Benefits Of Breast Cancer Screening Be Extended?

August 07, 1998

(Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study)

(Routine invitation of women aged 65-69 for breast cancer screening: results of first year of pilot study)

(Extending the benefits of breast cancer screening. Still hard to know how large the benefits will really be)

The NHS breast screening programme, introduced in 1988, currently provides mammography for women aged 50-64 years every three years. But what if they were screened more often and what if the programme was extended to women of 69 years of age? These questions are tackled in a study reported in this week's BMJ by Rob Boer from Erasmus University in Rotterdam and colleagues from the UK.

The current breast screening programme reduces deaths from breast cancer by 12.8 per cent. The authors estimate that by extending the programme to women aged 69 it would reduce deaths by 16.4 per cent (at a marginal cost per life saved of £2990), while reducing the interval to two years would reduce mortality by 15.3 per cent at a marginal cost per life saved of £3545.

Boer et al conclude that either of these two options for extending the programme would reduce deaths substantially if only the budget for the NHS screening programme could accommodate it.

But if the programme was extended to older women (who are more likely than younger women to develop breast cancer), would they turn up for further screens? Yes, is the overwhelming answer, according to Dr Linda Garvican from the South East Institute of Public Health in Kent along with colleagues from Sussex and Surrey. In a short report published in this week's BMJ, the authors found that over 70 per cent those women who had previously attended for breast screening would continue to do so after the age of 64 years (even if they hadn't been invited for six years).

In a linked editorial Dr Ursula Werneke and Professor Klim McPherson from the London School of Hygiene and Tropical Medicine conclude that the two studies reported are important, but their findings may only have a limited validity. They argue that before any of the suggested changes to the current system are implemented, further discussion on the potential opportunity costs should be undertaken.


Rob Boer, Informatician, Department of Public Health, Institut Maatschappelijke Gezondheidszorg, Erasmus University, Rotterdam, Netherlands

Dr Linda Garvican, Principal Public Health Specialist, South East Institute of Public Health, Tunbridge Wells, Kent

Professor Klim McPherson, Professor of Public Health Epidemiology, Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London


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