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Preventative medicine Women's health

Breast screening

Last revised in May 2022

One in nine women will develop breast cancer, and it is more common in women over the age of 50 years.

Breast screening: Summary

  • Breast cancer is the most common type of cancer in women in the UK. About 1 in 8 women in the UK will be diagnosed with breast cancer during their lifetime.
  • The NHS Breast Screening Programme in England was set up in 1988 and provides 3-yearly routine breast screening to women. 
    • Breast screening uses mammography radiography to detect small changes in the breast before other symptoms or signs of breast cancer develop.
    • If breast cancer is found at an early stage, there is an increased chance of breast-conserving surgery and a better prognosis for long-term survival.
    • The NHS Breast Screening Programme saves around 1300 lives each year in the UK.
  • Invitations for routine mammography screening are sent out to women aged 50–70 years (from the age of 50 years up to their 71st birthday) in England, Northern Ireland, Scotland, and Wales.
    • In some circumstances, women outside of this age range are also screened as part of the programme either through self or GP referral, or they may be invited as part of a research trial. 
    • Not every woman will receive an invitation as soon as she is in the screening age range, but she should receive her first invitation for routine screening within 3 years of her 50th birthday. 
    • Women older than the maximum age for screening in their area are currently excluded from the routine screening programme; however, they can continue to receive breast screening by self-referral to a local breast screening service.
    • Women at increased risk of breast cancer (for example, those with a strong family history of breast cancer) may be eligible for breast screening before the age of 50 years. 
  • Women should be supported to make an informed decision about participation in the breast screening programme and should be given information on:
    • The benefits and harms of breast screening.
    • How breast screening is organized.
    • Where the mammogram is likely to be done.
    • Preparing for the mammogram.
    • What to expect during and after their appointment.
  • Benefits of breast screening include:
    • Early detection of breast cancer.
    • Reduction in breast cancer mortality.
  • Harms of breast screening include:
    • Over-diagnosis, leading to unnecessary treatment.
    • False-positive mammograms, leading to unnecessary further investigations.
    • False reassurance, due to missed cancer and incorrect diagnosis.
    • Pain and discomfort, due to mammography.
    • Psychological distress, such as anxiety following a false-positive result.

Have I got the right topic?

From age 47 years onwards (Female).

This CKS topic covers the NHS Breast Screening Programme.

This CKS topic does not cover breast screening in women with known breast cancer or other breast conditions, women at high-risk of breast cancer, or men with breast cancer. It also does not cover the management of suspected or confirmed breast cancer.

There are separate CKS topics on Breast cancer - managing FH and Breast cancer - recognition and referral.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

May 2022 — reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

Previous changes

December 2017 — reviewed. A literature search was conducted in November 2017 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has undergone minor restructuring. The Background information and Management sections have been amended in line with the current literature.

December 2011 — minor update. Text updated to include the extension to the age range for women eligible for routine breast screening through the NHS Breast Screening programme in England, in line with the Department of Health publication Improving outcomes: a strategy for cancer (2011). Information has also been added to the text on screening for people who are physically disabled or who have learning difficulties. Key references have been updated. 

August 2009 — minor update. Typographical correction to the section on Benefits and harms. 

June to December 2008 — this is a new CKS topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence. Issued in December 2008.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 May 2022.

HTAs (Health Technology Assessments)

No new HTAs since 1 May 2022.

Economic appraisals

No new economic appraisals relevant to England since 1 May 2022.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 May 2022.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 May 2022.

New policies

No new national policies or guidelines since 1 May 2022.

New safety alerts

No new safety alerts since 1 May 2022.

Changes in product availability

No changes in product availability since 1 May 2022.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Provide information on the NHS Breast Screening Programme, including the rationale, risks and benefits, and what to expect.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

No NICE quality standards were found for this topic.

Background information

What is the NHS Breast Screening Programme?

  • Breast cancer is the most common type of cancer in women in the UK. About 1 in 8 women in the UK will be diagnosed with breast cancer during their lifetime [UK NSC, 2019; PHE, 2021].
  • The NHS Breast Screening Programme in England was set up in 1988 and provides 3-yearly routine breast screening to women [Marmot, 2012; PHE, 2016; NHS Digital, 2022].
    • Breast screening uses mammography radiography to detect small changes in the breast before other symptoms or signs of breast cancer develop.
    • If breast cancer is found at an early stage, there is an increased chance of breast-conserving surgery and a better prognosis for long-term survival.
    • The NHS Breast Screening Programme saves around 1300 lives each year in the UK [Marmot, 2012].
  • Invitations for routine mammography screening are sent out to women aged 50–70 years (from the age of 50 years up to their 71st birthday) in England, Northern Ireland, Scotland, and Wales.
    • In some circumstances, women outside of this age range are also screened as part of the programme either through self or GP referral, or they may be invited as part of a research trial. The AgeX trial has been looking at the effectiveness of offering some women one extra screen between the ages of 47–49 years and between the ages of 71–73 years.
    • Not every woman will receive an invitation as soon as she is in the screening age range, but she should receive her first invitation for routine screening within 3 years of her 50th birthday. 
    • Women older than the maximum age for screening in their area are currently excluded from the routine screening programme; however, a woman can continue to receive breast screening by self-referral to a local breast screening service.
    • Women at increased risk of breast cancer (for example with a strong family history) may be eligible for breast screening before the age of 50 years. See the CKS topic on Breast cancer - managing FH for more information on risk assessment and screening women at high risk.
  • Information on local breast cancer screening services in England, Wales, Scotland, and Northern Ireland (NI) are available from:

What are the benefits and harms of the NHS Breast Screening Programme?

  • Benefits of breast screening include:
    • Early detection of breast cancer.
    • Reduction in breast cancer mortality.
  • Harms of breast screening include:
    • Over-diagnosis, leading to unnecessary treatment.
    • False-positive mammograms, leading to unnecessary further investigations.
    • False reassurance, due to missed cancer and incorrect diagnosis.
    • Pain and discomfort, due to mammography.
    • Psychological distress, such as anxiety following a false-positive result.
  • See the sections on Benefits and Harms for more information.

Benefits of the breast screening programme

Early breast cancer detection

  • Breast screening uses mammography radiography to detect small changes in the breast before other symptoms or signs of breast cancer develop. If breast cancer is found at an early stage, there is an increased chance of breast-conserving surgery and a better prognosis for long-term survival.
  • In 2020–21 in England [NHS Digital, 2022]:
    • A total of 10,813 women aged 45 years and older had cancers detected by the screening programme, which represents a rate of 9.1 cases per 1000 women screened.
    • Detection rates were lowest for women aged 45–49 years (6.4 women with cancer detected per 1000 women screened) and highest for women aged 75 years and older (22.3 women per 1000 women screened). 
    • Amongst the core programme (women aged 50 years to under 71 years), the detection rate was 8.9 per 1000 women screened.
    • Of all women with cancers detected, 48.7% (7772 women) had invasive but small cancers (less than 15 mm in diameter), which are usually too small to detect by palpation on clinical examination.

Reduced breast cancer mortality 

  • The Independent UK Panel on Breast Cancer Screening reviewed the benefits and harms of the NHS Breast Screening Programme [Marmot, 2012]:
    • A meta-analysis of 11 randomized trials showed that the relative risk of breast cancer mortality for women invited to screening compared with controls not invited was 0.80, which is a relative risk reduction of 20%. This equates to [Marmot, 2012]:
      • One breast cancer death prevented for every 235 women invited for screening.
      • One breast cancer death prevented for every 180 women who attend screening.
      • About 1300 breast cancer deaths prevented every year.
      • Forty-three breast cancer deaths prevented for every 10,000 women aged 50 years invited to screening for the next 20 years.
    • The panel noted that different meta-analyses in the literature are based on different trials, durations of follow-up, definitions of outcome, and methods of analysis, and therefore estimates of benefits and harms from breast screening vary widely.
  • A large systematic review (n = 616,641) assessed the benefits and harms of breast cancer mammography screening for women at average risk of breast cancer [Canelo-Aybar, 2021]:
    • The evidence showed that mammography reduced breast cancer mortality in women aged 50–69 years (high certainty) and women aged 70–74 years (high certainty), with smaller reductions in women aged under 50 years (moderate certainty).
    • Mammography also reduced stage IIA+ breast cancer in women aged 50–69 years (very low certainty) but resulted in an overdiagnosis probability of 23% in women aged under 50 years and 17% in those aged between 50–69 years (moderate certainty). 
    • Mammograph was associated with 2.9% increased risk of invasive procedures with benign outcomes (low certainty).

Harms of the breast screening programme

Overdiagnosis

  • Overdiagnosis refers to the detection of low-risk or non-progressing breast cancers through screening that would not have been diagnosed without screening, and would not have been life threatening [Barratt, 2015].
  • The Independent UK Panel on Breast Cancer Screening reviewed the benefits and harms of the NHS Breast Screening Programme [Marmot, 2012]:
    • A meta-analysis of three trials identified by the panel showed that:
      • For every 10,000 UK women aged 50 years invited to screening for the next 20 years, 129 cases of breast cancer (invasive and non-invasive) would be over-diagnosed, which equates to 19% of breast cancers in this group of women.
      • Of the 307,000 women aged 50–52 years who are invited to begin screening each year, just over 1% would have an over-diagnosed cancer in the next 20 years.
    • The panel noted that different meta-analyses in the literature are based on different trials, durations of follow-up, definitions of outcome, and methods of analysis, and therefore estimates of benefits and harms from breast screening vary widely.
  • A Cochrane systematic review on mammography screening concluded that the benefits of universal mammography are 'uncertain' and that it leads to over-diagnosis and unnecessary interventions [Gotzsche, 2013].
  • If breast cancer is diagnosed through screening, treatment is recommended to all women to reduce the risks of recurrence and breast cancer mortality, as it is not possible to distinguish non-progressive from progressive disease, due to the lack of reliable prognostic markers. Breast cancer treatments, such as radiotherapy, chemotherapy, and hormonal treatments, may have associated risks [Barratt, 2015].

 False-positive mammograms

  • False-positive mammograms could lead to unnecessary further investigations, including clinical examination, further mammography, breast ultrasound, and fine-needle aspiration and/or biopsy.
  • A systematic review of seven studies concluded that the experience of having a false-positive screening mammogram can cause breast cancer-specific psychological distress that may persist for up to 3 years and reduce the likelihood that women will return for their next round of mammography screening compared with women with normal mammogram results [Bond, 2013].
    • The level of distress was associated with the degree of invasiveness of subsequent assessment.
    • There were, however, limitations in the design of the included observational studies; significant heterogeneity was noted, which precluded a meta-analysis.
  • In 2020–21 in England, 7.3% of women (47,198 women) aged 45 years and older who were attending for the first time were referred for further assessment following their initial mammogram. Of the women referred for assessment, 47.8% underwent fine-needle aspiration cytology and/or core biopsy [NHS Digital, 2022].

False reassurance due to missed cancer and incorrect diagnosis

  • A Canadian systematic review of 16 qualitative studies (n = 690) examining women's experiences of inaccurate breast cancer screening results found that [DeJean, 2016]:
    • Some women who had experienced false-negative results lost confidence in the screening process, but they recognized that some cancers were detected through mammography and were willing to see themselves as exceptions to an otherwise beneficial service at a population level.
    • All women who had experienced a false-negative test result indicated that they would continue to participate in mammography screening.

Pain and discomfort 

  • A Cochrane systematic review (n = 1671) reported that about 35% of women experiencet pain during and after the mammogram procedure [Miller et al, 2008]. The review found that giving women information before the procedure may reduce pain and discomfort.
  • A second systematic review reported that 25–46% of non-attendees cited pain at previous mammogram as the reason for non-attendance at subsequent screening appointments [Whelehan, 2013].

Psychological distress

  • Recall for assessment, such as repeat mammography and/or ultrasound, is associated with significant anxiety, particularly as most women have had no previous indication of a breast problem [PHE, 2016].

Management

Scenario: Breast screening

From age 47 years onwards (Female).

What information should I give a woman about breast screening?

Women should be given appropriate information on breast screening to enable them make an informed decision about participation in the programme.

  • Explain the breast screening process.
    • Explain that:
      • An invitation for breast screening will arrive by post. If the time and place are inconvenient, the appointment can be rearranged.
      • The screening unit may be mobile, hospital-based, or permanently based in a convenient location, such as a shopping centre, and the appointment should last about 30 minutes.
      • Mammography requires removal of clothes from the top part of the body, including the bra if the woman is wearing one. Advise that women should avoid the use of talcum powder or spray-on deodorant on the day of breast screening as this may affect the mammogram.
      • Each breast is placed in turn on the machine and gently but firmly compressed with a flat, clear, plastic plate. Some women find this uncomfortable or painful, as the breasts have to be held firmly in position and pressed to get a good-quality image.
      • After screening, women should await contact from the breast screening service about the test results and any follow up required.
      • About 1 in 23 women are called back because their mammogram shows that more tests are needed. Most of these women will not have breast cancer.
    • Provide written information, such as:
  • Explore the woman's beliefs and expectations about breast screening, and give information on the benefits and harms.
  • Explain to women with breast implants that:
    • Mammography is the most accurate method of early detection of breast cancer, although some of the breast tissue in women with implants is obscured by the radiopaque implant during routine mammography.
      • Detection of breast cancer at an early stage is therefore more difficult due to the impaired view of the breast tissue.
      • Additional screening images may be taken at the initial mammography appointment, to visualise as much breast tissue as possible and improve cancer detection rates. This may be performed at a hospital screening unit.
      • The NHS leaflet on Breast implants and breast screening may be helpful.
  • If a woman has a physical disability that may make breast screening difficult, such as limited mobility in the upper body or she cannot support her upper body unaided:
    • Advise her to contact the local breast screening service to get advice on whether mammography is technically possible and where the best place would be to attend for a mammogram (such as a static rather than a mobile unit).
    • Explain that:
      • She has to be positioned carefully and hold that position for several seconds.
      • If a mammogram is not technically possible at a particular time, she should still remain in the call and recall programme, as any change in her condition or in screening procedures may allow for screening at a later date.
    • Advise her to contact the local breast screening service to get advice on whether mammography is technically possible and where the best place would be to attend for a mammogram (such as a static rather than a mobile unit).
  • If a woman has a learning disability or lacks mental capacity to make an informed decision about breast screening:
    • Assess whether she has fluctuating mental capacity, in which case, the decision about participating in screening should be delayed until the woman is able to decide for herself.
    • If she has ongoing lack of mental capacity to make an informed decision, make a best interests decision on her behalf.
    • The NHS leaflet on An Easy Guide to Breast Screening and the British Medical Association (BMA) Mental capacity toolkit may be helpful sources of information.

Consent issues

  • If a woman lacks mental capacity to make an informed decision about undergoing breast screening, take into account the following issues when discussing with her family, close friend(s), or carer to enable a 'best interests' decision to be reached:
    • The woman's risk of developing breast cancer. See the CKS topic on Breast cancer - managing FH for more information.
    • What the screening process involves.
    • What further tests or treatment she might need if she received an abnormal result.
    • Whether she has expressed views in the past about screening or whether she would want to know if she had a disease.
    • Whether she has declined screening in the past.
    • What the woman would have wanted herself.
    • That permanent mental incapacity is not usually a barrier to screening.

[BMA, 2020]

Basis for recommendation

These recommendations are largely based on the Public Health England guidelines Clinical guidance for breast cancer screening assessment [PHE, 2016] and Screening women with breast implants [PHE, 2017], the NHS Digital publication Breast screening programme: England, 2020–21 [NHS Digital, 2022], an evidence review by the Independent UK Panel on Breast Cancer Screening [Marmot, 2012], and on expert opinion in a review article [Barratt, 2015].

Supporting evidence

This CKS topic is largely based on the Public Health England guidelines Clinical guidance for breast cancer screening assessment [PHE, 2016] and Screening women with breast implants [PHE, 2017], the NHS Digital publication Breast screening programme: England, 2020–21 [NHS Digital, 2022], an evidence review by the Independent UK Panel on Breast Cancer Screening [Marmot, 2012], and on expert opinion in a review article [Barratt, 2015].

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of breast screening, with additional searches for evidence in the following areas:

  • Risks of mammography
  • Breast awareness
  • False-negative mammography rates

Search dates

November 2017 - March 2022

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp mammography/, mammography.tw, mass screening/, breast screen$.tw, exp breast/
  • exp risk/, risk.tw, mammography/ae [adverse effects]
  • Breast self-examination/, aware$.tw.
  • False negative reactions/, false negative.tw.

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Barratt, A. (2015) Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality. British Medical Journal, 1-5. [Abstract]
  • BMA (2020) Mental Capacity Act toolkit. British Medical Association. http://www.bma.org.uk [Free Full-text]
  • Bond, M., Pavey, T., Welch, K. et al. (2013) Psychological consequences of false-positive screening mammograms in the UK. Evidence-Based Medicine 18(2), 54-61. [Abstract]
  • Canelo-Aybar, C., Ferreira, D. S., Ballesteros, M. et al. (2021) Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: A systematic review for the European Commission Initiative on Breast Cancer. Journal of Medical Screening 28(4), 389-404. [Abstract]
  • DeJean, D., Krahn, D. and and Giacomini, M. (2016) Women's experiences of inaccurate breast cancer screening results: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser 16(16), 1-22. [Free Full-text]
  • Gotzsche, P.C. and Jorgensen, K.J. (2013) Screening for breast cancer with mammography (Cochrane Review). Issue 6. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Marmot, M.G., Altman, G., Cameron, D.A. et al. (2012) The benefits and harms of breast cancer screening: an independent review. Lancet 380(9855), 1778-1786. [Abstract]
  • Miller, D., Livingstone, V. and Herbison, P. (2008) Interventions for relieving the pain and discomfort of screening mammography (Cochrane Review). The Cochrane Library. John Wiley & Sons, Ltd. http://www.thecochranelibrary.com [Free Full-text]
  • NHS Digital (2022) NHS Breast Screening Programme, England 2020-21. NHS Digital. http://digital.nhs.uk [Free Full-text]
  • PHE (2016) NHS Breast Screening Programme. Clinical guidance for breast cancer screening assessment. Public Health England. http://www.gov.uk/government/organisations/public-health-england [Free Full-text]
  • PHE (2017) NHS Breast Screening Programme. Screening women with breast implants. Public Health England. http://www.gov.uk/government/organisations/public-health-england [Free Full-text]
  • PHE (2021) Breast screening: programme overview. Public Health England. http://www.gov.uk [Free Full-text]
  • UK NSC (2019) Adult screening programme: Breast Cancer. UK National Screening Committee. http://www.gov.uk [Free Full-text]
  • Whelehan, P., Evans, A., Wells, M. et al. (2013) The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. Breast 22(4), 389-394. [Abstract]
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