News: Breast screening review

Report calls for improvements in breast screening programme

Clearer leadership needed in management of adverse events 

Picture of a mobile breast screening unit

A report on women in Scotland who were identified as having not been called for routine breast screening appointments has made a series of recommendations to improve the process.

The report – entitled ‘Review of the Scottish Breast Screening Programme December 2016’ – has been produced by Healthcare Improvement Scotland.

The report follows the identification of 3,831 women who had not been sent a routine invitation to be screened. National Services Division (NSD) is responsible for commissioning and performance managing the national Scottish Breast Screening Programme (SBSP).

The report states that it was unclear who was responsible for the handling of the issue and that clearer leadership is needed from NSD to ensure the appropriate management of adverse events.

The report concludes that the new IT system in place will help to address a number of issues, but it will require ongoing monitoring to ensure that any future risks are appropriately dealt with.  

All women identified as not being called for their routine appointment at their local breast screening centre have been contacted and offered the chance to make a fresh appointment. By November 2016, 41% of women had still to take up that offer. This is a significantly lower uptake than would be expected for breast screening in Scotland.

NSD, in conjunction with the Scottish Breast Screening Centres, have been asked by Healthcare Improvement Scotland to urgently review whether every reasonable step has been taken to enable this group of women the opportunity to attend a screening appointment. We have been informed by NSD that they have established an adverse events team to ensure that every reasonable step has been taken to enable these women to have the opportunity to attend breast screening.

The breast screening programme is for women aged between 50 and 70 years and runs on a 3 year rolling cycle. Women aged 71 and over are able to attend through self referral to their local screening centre. If any women are unsure if they should have been invited for an appointment, they should contact their nearest breast screening centre.

The report makes five recommendations for NSD and SBSP and cover the following areas:

  • an adverse event management team should be established to urgently review whether every practical step has been taken to offer the women identified the opportunity to attend a breast screening appointment within a reasonable time frame
  • the need for effective governance arrangements to ensure roles, responsibilities and lines of accountability are clear
  • a clear and structured adverse event management process with supporting guidance should be put in place
  • a mechanism should be established to manage ongoing IT issues
  • improvements should be made to the current risk management arrangements.

Healthcare Improvement Scotland will continue to monitor how NSD follows up with this group of women.

Professor Stephen W. Duffy, Chair of the Review Group and Professor of Cancer Screening at the Wolfson Institute of Preventive Medicine, said: “Effective and timely breast screening for women is crucial in the early diagnosis of breast cancer. Clearly the vast majority of women in Scotland receive their invitation to be screened in a timely manner, but it’s important that all women are given the opportunity to be screened at the earliest opportunity. This report clearly demonstrates that more needs to be done to ensure that this happens for every woman eligible for screening in Scotland.”

Claire Sweeney, Interim Director of Quality assurance for Healthcare Improvement Scotland, said: “In Scotland we are working hard to develop a culture where people receive the best possible care every time they encounter our health and social care system, and that when issues occur there is an open culture of learning. We are encouraged by the response of NSD to our report’s findings and recommendations. Although the new IT system will help ensure that every woman eligible for screening is invited to attend, ongoing monitoring will be required to ensure that the system is working effectively for all women. We will continue to closely track the situation.”

More information

Published date: 21 December 2016