Download New Surveillance Screening Programme for Women at Higher Risk

New Surveillance Screening Programme for Women at Higher Risk
of Developing Breast Cancer
Information for health professionals
Start date
The Northern Ireland Breast Screening Programme is undertaking the surveillance
screening of women at higher risk of breast cancer from April 2013.
Eligibility criteria
Only women who have a significantly increased risk of breast cancer (× 8 the normal
risk and higher) will have their surveillance screening managed by the Breast
Screening Programme.
Women can be at such risk because they have an identified genetic defect (most
often BRCA1 or BRCA2) or because they had supradiaphragmatic radiotherapy, with
a breast dose of greater than 4 gray, under the age of 30 (usually for Hodgkin’s
lymphoma). The appendix identifies the specific groups of women who are at higher
(x8+) risk of developing breast cancer. It is only women in these risk categories that
will be eligible for this surveillance screening programme.
There will be no change to the management of women who are at greater than
normal risk, but less than x8 normal risk, and who do not fit into one of the specific
higher risk groups.
Role of the Breast Screening Programme
The Breast Screening Programme will manage the surveillance screening of these
women. It will ensure that eligible women receive digital mammography and/or
breast magnetic resonance imaging (MRI) according to national standards and
protocols.
The Breast Screening Programme will not be responsible for identifying eligible
women. Women who have already been identified as being at higher (x8+) risk (and
who have not had prophylactic, risk reducing surgery) should have their details
passed to the screening programme for inclusion on the National Breast Screening
System (NBSS) IT system. This system will be used to generate invitation letters to
women according to the agreed protocols shown in the appendix. The women will
remain under the care of their referring clinician. Their clinical care will not be
transferred to the Breast Screening Programme.
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Numbers Involved
It is expected that there will be around 150-200 women with x8, or higher, risk of
breast cancer in Northern Ireland.
Service Location
In order to meet the national standards for screening surveillance of higher risk
women it is necessary to concentrate the breast imaging, and MRI biopsy, expertise
at a single location. The Antrim Area Hospital Breast Unit was selected as the
Regional Higher Risk Breast Imaging Unit following a recent tendering exercise.
Screening Surveillance Process
Once referred to the Breast Screening Programme eligible women will be invited to
attend Antrim Area Hospital for digital mammography and/or breast MRI according to
the national protocols. It is expected that if both digital mammography and breast
MRI are required they will be performed on the same day.
Women and their GPs will be informed of the results of the breast imaging in the
same way that the results of breast screening are communicated. Women whose
breast imaging is negative (normal) will be recalled for routine surveillance screening
according to the national protocol.
Women who have a positive (abnormal) result will be invited to attend the
assessment clinic at Antrim Area Hospital for further investigation. If the assessment
is negative the woman will be recalled for routine screening surveillance according to
the national protocol.
If the assessment is positive she will be able to choose to have treatment and follow
up at her local cancer unit or at Antrim.
Identifying Eligible Women
The main source for obtaining information on women at x8, or higher, risk of breast
cancer has been the HSC Trusts. These data have been cross checked with
information from the regional genetics service (for women at higher genetic risk) and
from the Northern Ireland Cancer Registry and the Cancer Centre (for women who
had supradiaphragmatic radiotherapy below the age of 30).
Each general practice was also contacted and asked to provide information on any
eligible women known to them.
If you are aware of any woman who is in one of the higher (x8+) risk categories
please contact the Breast Unit in Antrim Area Hospital to ensure that her
details are on the breast screening IT system.
Please call 028 94 424428.
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Appendix
Surveillance protocols for women at higher risk of breast cancer
Ref
Risk
Age
Surveillance Protocol
1
a) BRCA 1 or
20-29
not applicable
b) BRCA 2 carrier or
30-39
MRI
Annual
c) Not tested, equivalent high risk*
40-49
MRI + Mammography
Annual
50+
Mammography + MRI
Annual
20-29
MRI
Annual
30-39
MRI
Annual
40-49
MRI + Mammography
Annual
50+
Mammography+ MRI
Annual
2
TP53 ( Li-Fraumeni)
Frequency
Notes
Review MRI annually on basis of
background density.
Review MRI annually on basis of
background density.
3a
Ataxia-telangiectasia (A-T)
homozygotes
25+
MRI
Annual
No mammography.
3b
Ataxia-telangiectasia (A-T)
heterozygotes
40-59
Mammography
18 monthly
Routine screening from 50.
50+
Mammography
Routine screening (3 yearly)
30-39
MRI
Annual
40-49
MRI + Mammography
Annual
50+
Mammography + MRI
Annual
4
Supradiaphragmatic radiotherapy irradiated below age 30.
*Untested but equivalent high risk would be as defined by a Geneticist
This protocol is available at http://www.cancerscreening.nhs.uk/breastscreen/high-risk-surv-imaging-protocols.pdf
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Surveillance commences at 30, or
8 years after first irradiation,
whichever is the later. Review
MRI annually on basis of
background density.