Standard mammogram X-rays, which are offered to just over 2 million middle-aged women each year, may be failing to spot as many as one in six tumours
Britain's NHS screening programme could be missing 3,500 cases of breast cancer each year, new research has warned.
Standard mammogram X-rays, which are offered to just over 2 million middle-aged women each year, may be failing to spot as many as one in six tumours.
A major trial has now found using 3D X-rays instead, along with ultrasound scans, would pick up tumours in thousands of women whose cancer had been missed by the standard mammogram scans.
Experts today called for an ‘urgent reconsideration’ of the NHS screening programme in light of the results – and said the evidence had the potential to ‘change the future of breast screening’.
While mammograms pick up 18,000 tumours every year, they often miss cancer in women who have ‘high density’ breasts.
Around one in every four women have dense breast tissue, which contains more glandular tissue and less fat.
Although it feels no different to touch, dense breast tissue contains many more cells that are likely to turn cancerous – meaning women are up to six times more likely to develop the disease.
To make matters worse, tumours in dense breast tissue are much harder to detect using standard mammogram scans.
As a result, these women are 18 times as likely to only discover they have cancer when they start seeing symptoms, rather than as a result of screening.
The current NHS screening programme, which is offered to all women between the age of 50 and 70, is credited with saving 1,400 lives each year by flagging up the cancer before it has spread.
But the new trial, presented today at the European Breast Cancer Conference in Amsterdam, suggests one in six tumours are being missed.
This means potentially hundreds of people dying early as a result.
Researchers from Australia and Italy carried out 3D ‘tomosynthesis’ X-rays, along with ultrasounds, on 3,000 Italian women with dense breast tissue whose mammogram results had come back negative.
They picked up an additional 24 cases of breast cancer that had been previously missed, 23 of them invasive.
If their findings are applied to Britain, an extra 3,500 cases of breast cancer would be picked up every year.
Professor Nehmat Houssami, of the University of Sydney, speaking in Amsterdam today, said: ‘These findings will have immediate implications for screening practice.’
She said there was almost no difference in rates of ‘false positives’ or misdiagnoses – problems that have beset Britain’s screening programme - even though the new methods were able to pick up smaller tumours which mammograms can miss.
Experts today called for an ‘urgent reconsideration’ of the NHS screening programme in light of the results – and said the evidence had the potential to ‘change the future of breast screening'
Anthony Maxwell, consultant radiologist at the Genesis breast cancer charity in Manchester, said because there is currently no additional screening for dense breast patients on the NHS, women are often not told they are at risk.
In many US states, in comparison, radiologists by law have to tell women if they have dense breasts, and usually offer extra checks.
‘This is a significant issue,’ Dr Maxwell said. ‘The problem is there’s no point telling a woman she’s got dense breasts unless you’re going to offer her additional screening. But at the moment we’re not in a position to do that.’
Samia al Qadhi, chief executive of the Breast Cancer Care charity, said: ‘These exciting findings confirm 3D mammography has the potential to change the future of breast screening.
‘It is much more challenging to detect cancer in dense breasts through traditional mammograms.
‘So it’s fantastic to hear further evidence showing that 3D mammography can pick up more cancers in women with dense breasts, and when the tumour is a small size.
'This means treatment may be more effective and could potentially save lives.
‘However more research is needed before we can expect any widespread changes to screening practices in the UK.’
Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: ‘We know mammography is less effective at detecting breast cancer in women with dense breasts.
'So this new evidence reinforces the urgent need to consider how these women can be best served by the NHS Breast Screening Programme.’
Jacquie Jenkins, Public Health England’s breast screening programme manager, said hospitals offer the best possible two-dimensional scans.
‘The NHS Breast Screening Programme in England currently offers digital mammography which captures high-quality digital images capable of detecting tumours even in women with denser breasts,’ she said.
‘This remains the best proven method for detecting cancers at an early stage when treatment is most effective.
‘In some occasional circumstances, women with dense breast tissue may be offered an MRI scan, in addition to mammography.’
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