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OBJECTIVE: To present results from the UK NHS breast screening programme (NHSBSP) for the six-year period from 1 April 1999 to 31 March 2005, and to compare these with targets. METHODS: Data are collected annually from all UK screening units on standard KC62 return forms. RESULTS: The prevalence of screen-positive cancer (cancer detection rate) has increased at both rounds during the six-year period. At the incident round, cancer detection rates increased by 24%, from 5.4 per 1000 in 2000 to 6.7 per 1000 in 2005 and the detection of small cancers (< or = 10 mm) has increased by 40%. Generally, quality measures in the programme continue to improve. However, while rates of recall at the incident screen decreased from 3.8% in 2000 to 3.6% in 2005, at the prevalent round, in 2005, 22% of units continued to recall more than 10% of women to assessment. CONCLUSIONS: The results suggest that the performance of the programme continues to improve. In the future, analysis of data on interval cancers will assist the interpretation of cancer detection rates. [ABSTRACT FROM AUTHOR]

Setting: The NHS breast screening programme (NHSBSP) in England currently invites women aged 50-70 every three years. Whilst screening is acknowledged as efficacious for women aged 50-69, several countries routinely invite women up to the age of 74. The NHSBSP in England is beginning to invite women up to the age of 73. Although the incidence of breast cancer increases with age, the possible benefits of screening older women must be balanced against shorter life expectancies and possible overdiagnosis. In England women can self-refer after reaching the invitation upper age limit., Objective: We examined the extent to which older women in England self-referred over a three-year period and studied the screening outcomes in these women., Methods: Routinely collected data from screening units in England were used to calculate screening performance measures for women who self-referred between 1 April 2005 and 31 March 2008. The tumour characteristics of all screen-detected cancers were examined by previous screening history and age group (71-74 and ≥75 years)., Results: During the three-year period 139,910 women aged over 70 self-referred; equivalent to 4% of the female population aged over 70 having been screened. The majority of women who self-referred had been screened within the previous five years (76% of those aged 71-74 and 65% of those aged 75 or over). Approximately 4% of these women were recalled for assessment and cancer detection rates were similar in both age groups., Conclusion: Only a small proportion of all women aged over 70 utilize the self-referral policy of the NHSBSP, and most such women are aged below 80.

Objective: The aim of this study was to examine the availability and quality of surrogate outcome measure data to enable the evaluation of the breast screening programme. As the observed effect on mortality of a screening programme occurs many years after the introduction of screening, surrogate outcome measures offer an attractive alternative, allowing estimates of the effect to be calculated earlier., Methods: The exercise was undertaken by the Oxford Cancer Intelligence Unit and the Cancer Screening Evaluation Unit in collaboration with cancer registries in England, Scotland and Wales., Results: The conclusion of the exercise was that, in general, the available data quality was insufficient to allow a precise estimate of the overall mortality reduction from breast screening to be made using surrogate measures., Conclusions: When a screening programme is started, it is vital that forward planning is undertaken to ensure that the necessary information is ready to be collected before the start of the programme. The use of surrogate measures is dependent on high-quality data in the uninvited group of women (pre-screening or from a staggered start over areas), and improving data quality over time after the start of the programme is of very limited value for a surrogate measures approach. The collection of appropriate high-quality information before the programme starts is, therefore, critical to measuring the success of the programme. Cancer registries and staff within the screening programme need to be ready to collect the appropriate data before the introduction of a screening programme. The exercise undertaken therefore has important implications where new screening programmes are being considered.

Objective: The size (number of women screened) of the 95 individual NHS breast screening programmes (NHSBSPs) varies by a factor of 10. This study investigates the impact of size on the performance of individual programmes., Method: Data were collated from the 95 United Kingdom screening programmes on the standard statistical returns for the past 5 years (1 April 1995-31 March 2000). Additional information was obtained from questionnaires. The number of women screened between 1 April 1999 and 31 March 2000 determined the size of a programme. The bottom 25% were defined as small, the middle 50% as medium, and the top 25% as large. On average large programmes screened about four times as many women as small programmes and medium programmes about twice as many. Performance was evaluated using cancer detection rates, referral rates for assessment, and positive predictive value (PPV) of assessment using PPV referral diagrams., Results: The performance of smaller programmes was shown to be marginally poorer than medium and large sized programmes in that they detected fewer cancers and had a lower PPV. The smallest 25% of programmes had an invasive cancer detection rate 13% less than the medium and large programmes. However, if these programmes had an equivalent detection rate to the medium/large programmes the national detection rate would only increase by about 2%. This is because the 75% of programmes described as medium and large screen about 90% of all women. It is therefore important to place the clinical importance of these findings in context when considering any envisaged possible solutions., Conclusions: Although the performance of smaller programmes was shown to be poorer than that of the larger programmes, it is not clear from this study exactly why this is so. A likely contributory factor based on experience of evaluating the NHSBSP is that performance problems in larger programmes have been easier to detect by quality assurance staff. The size of the small programmes and the few screen detected cancers (and inherent statistical instability in detection rates) mean that problems are difficult to identify. As a consequence small programmes which are genuinely performing marginally below specific standards are likely to receive less attention than larger programmes, and even under close scrutiny the causes are less likely to be found.