The Minster Practice, Lichfield

The mobile unit is back in Lichfield. Women aged 70 or over are still entitled to breast screening - indeed they have a higher incidence of breast cancer. However, the local Primary Care Trust does NOT send out invitations. You have to telephone the Breast Screening Office for an appointment 01543 576235. If the van is still in Lichfield (currently on the Co-op/Turnpike car park on Boley Park), your appointment should be on the van.

In 2004 the South East Staffordshire service based at Queen's Hospital Burton merged with the Mid Staffordshire service and moved offices to Cannock Chase Hospital Brunswick Road Cannock WS11 2XY. Telephone 01543 576235 Fax 01543 576236. The way the service operates is unchanged  with women aged 50-64 being invited for screening on a 3year cycle depending on when the mobile unit is serving your practice. So if you reach 50 shortly after the unit has left Lichfield your invitation will be for when the unit returns 3 years later.

Although most people now believe that mammography screening does reduce breast cancer mortality (at least in women older than 50), the magnitude of benefit remains controversial. Swedish and Dutch investigators assessed breast cancer mortality rates in 2 observational studies.

Tabar L et al. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 2003 Apr 26; 361:1405-10.
Otto SJ et al. Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: A systematic review.
Lancet 2003 Apr 26; 361:1411-7.

In the Swedish study, which involved 210,000 women (age range, 20-69), deaths from breast cancer that was diagnosed before screening programs were implemented (1958-1977) were compared with those from breast cancer that was diagnosed after screening was introduced (1978-1997). Only women aged 40 to 69 were invited to be screened. In an analysis adjusted for age and other confounding variables, risk for death from breast cancer after 1977 was significantly lower than pre-1978 risk among women older than 40, both for screened (RR, 0.56) and unscreened women (RR, 0.84). In the 40- to 49-year-old subset, mortality was reduced significantly in screened women only (RR, 0.52). Women who were younger than 40 exhibited no breast cancer mortality differences in adjusted analyses.

In the Dutch study, data from 27,948 women (age range, 55-74) who died from breast cancer from 1980 through 1999 were grouped into 93 geographic clusters. The time trends of breast cancer mortality, before and after implementation of screening in each locality, were analyzed. With 1986-1988 as a baseline, breast cancer death rates were significantly lower after 1997 (–7%) and were 20% lower by 2001. The pre-screening annual 0.3% increase in death rate was reversed, by 2001, to annual declines of 1.7% among 55- to 74-year-old women and 1.2% among 45- to 54-year-old women. The analysis also suggested that changes in the mortality trend were related to screening rather than to introduction of adjuvant systemic therapy.

Comment by Sir Brian Jarman, PhD, FRCP, FRCGP, FFPHM, FMedSci, and Allan S. Brett, MD  Published in Journal Watch May 13, 2003

These findings support the view that mammographic screening reduces breast cancer mortality, but observational studies have inherent limitations. Both groups attempted to show that reduced mortality was related primarily to screening and not to improvements in treatment (the first by showing that mortality was lower in screened than in unscreened women and the second by showing that reduced mortality was temporally related to the introduction of screening rather than of adjuvant therapy). Nevertheless, it remains possible that these analyses are confounded by treatment and other unmeasured variables.

Note added by Dr Causer

This information added to earlier papers by Danish researchers (Lancet 2000; 355:129-34 & Lancet 2001; 358:1340-2) so the WHO International Agency for Research on Cancer set up a group of 24 experts from 11 countries to consider the papers along with the original research on which the mammography programme was based. The conclusion was published in August 2003: In women aged 50-69. mammography reduces the chance of dying from breast cancer by about 35%. there is only a slight benefit in younger women. The UK NHS service does not start until age 50.

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