The breast screening error, announced in May, was caused by a lack of clarity around the age at which women should be invited for their final screening appointment.
In May 2018, the Government announced an error in which women had not been invited to their final routine breast screening appointment. The Government commissioned an independent review to investigate the incident and make recommendations to prevent future errors.
It was initially announced that up to 450,000 women may have been affected by the error, but the review has revised this figure down to 67,000.
When the error was initially announced, it was believed to be caused by an IT failure connected to the AgeX breast screening trial, launched in 2008. However, the review found that this was not the case and the error was in fact linked to a misunderstanding around the age at which women should stop receiving routine invitations to breast screening appointments.
In 2013 new specifications were introduced as part of wider reforms to the health service, which said that a woman should be invited to her final breast screening appointment in the 36 months before her 71st birthday – that is, when she is 68, 69, or 70 years old.
These new specifications were not meant to change how the screening programme worked, so no change to specifications was communicated to screening units. The specifications did not match up with existing screening practices, so in many areas women continued to be invited by their year of birth, rather than according to the new specifications. This meant that some women were invited for their final screen when they were 67, because they would be turning 68 that year.
This means that, although these women were not screened in line with the 2013 specifications, they were screened in line with the general expectation that their final screen would be in the three years before they turned 70.
The mismatch between the specifications and what was happening in practice was the cause of the breast screening error. However, this was not known when the error was announced.
How did this happen?
Responsibilities for the screening programme are divided between several different bodies – NHS England, Public Health England (PHE), the Department for Health and Social Care (DHSC), local providers, the National Screening Committee. There is ambiguity over who is accountable for making sure the screening service is running as it should.
IT systems used in the screening programme are dated and unwieldy, which make it difficult to analyse who is being invited for screening.
What key recommendations does the review make?
- DHSC and NHS England should develop clear guidelines on when a woman should receive her final invitation to routine breast screening, and should ensure that these guidelines are followed.
- Public information should be updated so women can easily understand when they should receive their last invitation to breast screening.
- PHE and NHS England should urgently review existing IT systems to ensure they are fit for purpose.
- In the long-term, it must be clear who is responsible for making sure IT systems work together and are functioning as they should be.
- The upcoming review of all cancer screening programmes, led by Professor Sir Mike Richards, should consider how the breast screening programme can be best governed.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
After months of uncertainty, it is totally unacceptable – and extremely concerning – to learn that hundreds of thousands of women have been unnecessarily caused such significant distress.
This has been nothing short of a system failure, precipitated by a lack of clear ownership and strong leadership of a world-leading programme. It highlights a continued inability, amid structural confusion, to monitor what is happening in the screening service.
We are incredibly fortunate to have such a dedicated workforce, who at crisis capacity themselves have stepped up so impressively to support those affected – including in diagnosing some breast cancers earlier through catch-up screening. But major lessons must now be learned, and it is clear that responsibility for the Screening Programme is too divided between different bodies.
The NHS Breast Screening Programme remains critical to early diagnosis in this country, preventing 1,300 deaths from breast cancer each year – and it must not be left on the shelf. We need to do everything we can to make the most of it, including by improving attendance. We simply cannot let bureaucracy or a lack of leadership stall our progress on breast cancer, whether in adopting research advances or in ensuring a world-class early detection programme.
Amid concerns that some women affected are still struggling to arrange catch-up screening, we urge NHS England to ensure all women are provided with the screening they need. It’s also vital that guidance is established to clarify the ages at which women should be invited for routine screening and when women can self-refer to screening.
We hope the UK National Screening Committee, and the upcoming review of NHS cancer screening programmes, will now unpick and resolve this issue once and for all. With breast cancer incidence continuing to rise, we need to invest in new technology, IT infrastructure, and in recruiting and training new experts, to enable NHS services to cope with increasing demand over the next decade.