Guidance

NHS Breast screening programme screening standards valid for data collected from 1 April 2017

Updated 4 May 2023

Applies to England

BSP-S01: coverage

Description

The proportion of women eligible for screening who have had a test with a recorded result at least once in the previous 36 months.

Rationale

This standard is needed to make sure that the eligible population previously invited aged 53 to 70 has been adequately identified and invited in a timely manner by the screening service.

Definition

Numerator: number of eligible women aged 53 to 70 registered with a GP with a screening test result recorded in the past 36 months

Denominator: number of eligible women aged 53 to 70 registered with a GP

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Women who are ineligible for screening due to having had a bilateral mastectomy will be removed from the numerator and denominator.

There are a number of categories of women in the eligible age range who are not registered with a GP and subsequently not called for screening as they are not on the Breast Screening Select (BS-Select) database.

Screening services have a responsibility to maximise coverage of eligible women in their target population and should therefore be accessible to women in this category through self-referral and GP referral.

Performance thresholds

Acceptable level: greater than or equal to 70.0%

Achievable level: greater than or equal to 80.0%

Caveats

Screening services should have the outcomes of women recorded and finalised within 6 months of their screening episode. If this is not done, it will adversely impact on rates of coverage.

Screening services may have large numbers of women populating screening batches (for example with confederated GP groups) which may mean that closing screening episodes within the required 6-month interval is difficult.

Some patient treatment regimens may expand beyond 6 months (for example where neo-adjuvant therapies administered) which will mean some patient episodes will not be closed within 6 months.

If screening services have any screening slippage (all women not invited within 36 months of their previous screen), it will adversely impact on rates of coverage. Further, it will invalidate many performance measures which are based on a 36-month screening interval.

Data collection and reporting

Data source: Breast Screening Select (BS-Select)

Responsible for data quality and completeness: screening services

Responsible for submission: Exeter, NHS Digital

Reported by: screening service, upper tier Local Authority and GP practice

Published by: upper tier Local Authority

Reporting period

Collected annually 6 months in arrears.

Review dates

Date standard introduced: April 2005

Date standard last updated: July 2019

BSP-S02: uptake

Description

The proportion of eligible women invited who attend for screening.

Rationale

The expected effectiveness of the breast screening programme in reducing breast cancer mortality requires uptake to be maximised.

Definition

Numerator: number of eligible women with technically adequate screen (within 6 months of date of first offered appointment).

Denominator: number of eligible women with date of first offered appointment within the period.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The uptake standard counts appointments not women. If a woman is invited more than once during a year, she will have more than one screening episode counted during the period. Second timed appointments are not counted as a second screening episode.

The standard relates to uptake at all screens. However, uptake can be calculated at the prevalent (Table A, 45 to 52) and incident screens (Table C1, 50 to 70) for information.

Performance thresholds

Acceptable level: greater than or equal to 70.0%

Achievable level: greater than or equal to 80.0%

Caveats

Data on this indicator will only be accurate 6 months after the end of the reporting period. Care should be taken when reviewing provisional quarterly data due to the proportion of open episodes where women have yet to attend an appointment.

Data collection and reporting

Data source: national breast screening system (NBSS) (KC62 report: Tables A-C2 aged 50 to 70)

Responsible for data quality and completeness: screening services

Responsible for submission: screening services

Reported by: screening service

Published by: screening service

This standard is also the key performance indicator BS1.

Reporting period

Quarterly (provisional data) produced 4 weeks in arrears.

Annually (definitive data) produced 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2005

BSP-S03: uptake: screening round length

Description

The proportion of eligible women whose date of first offered appointment is within 36 months of their previous episode.

Rationale

Delivering and maintaining round length is important to help achieve the desired mortality reduction. This is achieved by detecting incident screen cancers as early as possible and minimising interval cancers (cancers presenting in between screening episodes) and reducing the negative consequences of inviting women too frequently.

Definition

Numerator: number of eligible women aged 50 to 70 years with date of first offered appointment within 36 months of their previous episode. The episode refers to date of screening for women who attended or date of first offered appointment in the case of non-attendance

Denominator: number of eligible women (50 to 70 years) invited

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

This excludes self and GP referrals and women being offered screening for the first time.

Performance thresholds

Acceptable level: greater than or equal to 90.0%

Achievable level: 100.0%

Caveats

BS-Select was introduced in July 2016. This has replaced the National Health Applications and Infrastructure Services system (NHAIS) to facilitate call and recall. The transition away from NHAIS has resulted in the removal of area code as a method to select screening batches and GP out code has taken its place (this is available on the spine). This could cause screening slippage at some services as the cohort definition has now been changed. This effect could be felt for the 36 months following implementation.

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: screening service

This standard is also the key performance indicator BS2

Reporting period

Monthly and quarterly (produced 4 weeks in arrears).

Review dates

Date standard introduced: May 2000

Date standard last updated: May 2000

BSP-S04: test: repeat examination rate

Description

The proportion of repeat examinations (due to technical recalls or technical repeats) by service (also recommended by mammographer).

Rationale

Sometimes images need to be repeated if the quality of the first image is not adequate for diagnostic reporting. This involves repeating the mammogram and there is a balance between radiation dose and image quality. Services should aim to deliver the optimum image quality with as low a radiation dose as possible to minimise anxiety and exposure to radiation. The number of repeat examinations is monitored to make sure good quality practice.

Definition

Numerator: number of women requiring repeat examinations

Denominator: number of women attending screening

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The measure is calculated with the trainee mammographers. Repeat mammography rates may be higher for trainee mammographers (radiographers and assistant practitioners) than trained staff. Services should calculate the rates both including and excluding trainees for internal monitoring.

Performance thresholds

Acceptable level: less than 3.0%

Achievable level: less than 2.0%

Caveats

None

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Monthly and quarterly (produced 4 weeks in arrears).

Review dates

Date standard introduced: May 2000

Date standard last updated: May 2000

BSP-S05: test: recording appropriate radiation dose

Description

Mean glandular dose (MGD) per view for a standard breast in clinical settings.

Rationale

To make sure that the radiation dose from the mammograms used for screening and assessment is as low as possible. To make sure the minimum harm to women from the radiation used whilst providing sufficient image quality for cancer detection.

Definition

The method of estimating the mean glandular dose to a standard breast using a 45mm thick Perspex (PMMA) phantom is described in ‘Commissioning and routine testing of full field digital mammography systems’ (NHSBSP Equipment Report 0604).

Performance thresholds

Acceptable level: ≤ 2.5mGy

Caveats

None

Data collection and reporting

Data source: screening service physics survey report

Responsible for data quality and completeness: screening services’ physics service(s)

Responsible for submission: screening services’ physics service(s)

Reported by: screening service digital mammography (2-D) equipment

Published by: not currently published

Reporting period

The MGD to the standard breast for each mammography system used in the BSP is measured by a medical physics service routinely every 6 months and after major changes to the equipment, and reported through the Quality Control system.

Review dates

Date standard introduced: May 2000

Date standard last updated: May 2000

BSP-S06: test: image quality

Description

Threshold gold thickness measured using the CDMAM test object.

Rationale

To make sure the technical image quality of mammograms used for screening and assessment is sufficient to achieve the objectives of cancer detection.

Definition

The method of measuring threshold gold thickness is described in ‘Commissioning and routine testing of full field digital mammography systems’ (NHSBSP Equipment Report 0604).

Software is provided by the BSP to automate the analysis of CDMAM images for 0.1 to 1.0mm detail sizes.

Performance thresholds

Diameter of detail (mm)	Threshold gold thickness (μm) acceptable value*	Threshold gold thickness (μm) achievable value*
1	≤ 0.091	≤ 0.056
0.5	≤ 0.150	≤ 0.103
0.25	≤ 0.352	≤ 0.244
0.1	≤ 1.68	≤ 1.10

*Lower values of threshold gold thickness indicate better image quality

Caveats

If a measurement appears to be above the standard, the CDMAM test object should be considered as there is some variability in measurement between test objects.

Data collection and reporting

Data source: screening service physics survey report

Responsible for data quality and completeness: screening services’ physics service(s)

Responsible for submission: screening services’ physics service(s)

Reported by: screening service digital mammography (2-D) equipment

Published by: not currently published

Reporting period

The image quality for each mammography system used in the BSP is measured by a medical physics service every 6 months and reported through the Quality Control system.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2009

BSP-S07: test: receipt of screening results

Description

The proportion of women who are sent their result within 2 weeks of an adequate screen.

Rationale

It is essential that women receive the results of screening in a timely manner to minimise anxiety.

Definition

Numerator: number of adequately screened women sent results within 2 weeks

Denominator: number of adequately screened women sent results

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 95.0%

Achievable level: 100.0%

Caveats

None

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Monthly and quarterly (produced 4 weeks in arrears).

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S08: referral: referral to assessment rate

Description

The proportion of eligible women with a technically adequate screen who are referred for assessment. This standard is reported in 2 parts: S08a (prevalent screen) and S08b (incident screen).

Rationale

High specificity assessment rates should be examined together with cancer detection rates to make sure that both screening specificity and sensitivity are maximised. Those responsible for interpreting the images from breast screening need to make sure that they are recalling the right women with abnormalities which require further investigation, whilst not recalling too many women where no abnormalities are subsequently found.

Definition

S08a – prevalent screen

Numerator: number of adequately screened women referred for assessment

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Prevalent screen includes women aged 45 to 52 (from KC62 Table A).

S08b – incident screen

Numerator: number of adequately screened women referred for assessment

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Incident screen includes women aged 50 to 70 (from KC62 Table C1).

Performance thresholds

Prevalent screen:

• acceptable level: less than 10.0%

• achievable level: less than 7.0%

Incident screen:

• acceptable level: less than 7.0%

• achievable level: less than 5.0%

Caveats

Screening services may not always seek to reduce recall rates depending on levels of cancer detection.

Where particularly high cancer detection rates are found it may not always be feasible to reduce referral for assessment rates. New image readers are expected to have higher rates of referral on average than experienced readers.

Data collection and reporting

Data source: NBSS (KC62 report)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Quarterly (6 weeks in arrears), and annually (definitive data) 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S09: diagnosis and or intervention: short-term recall rates

Description

The proportion of women screened who are placed on short-term recall.

Rationale

Every effort should be made to obtain a definitive diagnosis at initial assessment. Short-term recall should be used only in exceptional circumstances and with informed consent, as it is associated with significant anxiety. Detailed information is available in the clinical guidance for breast cancer screening assessment.

Definition

Numerator: number of eligible women screened given short-term recall appointment

Denominator: number of eligible women adequately screened

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: less than 0.25%

Achievable level: less than 0.12%

Caveats

There are rare occurrences when a short-term recall may be justified but women should not receive more than one short-term recall outcome within a normal 3-yearly screening episode.

Data collection and reporting

Data source: NBSS (KC62, table T, aged 50 to 70)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Quarterly (6 weeks in arrears), and annually (definitive data) 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S10: referral: time to first offered appointment for assessment

Description

The proportion of women who are offered an appointment at an assessment centre within three weeks of attendance for the screening mammogram.

Rationale

It is important to minimise anxiety in women who need to attend for further screening tests to obtain a definitive malignant, benign or normal diagnosis.

Definition

Numerator: number of eligible women whose first offered appointment for assessment is within 3 weeks of an initial adequate screen

Denominator: number of eligible women referred for assessment following an initial adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Cancellations to attend assessment by the patient do not impact on the first offered appointment date. Cancellations by the service to a later assessment date will extend the waiting time.

It is useful to examine this standard in conjunction with the time from screening mammogram to actual attendance at assessment to make sure that actual waiting times are being minimised.

Performance thresholds

Acceptable level: greater than 98.0%

Achievable level: 100.0%

Caveats

None

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Monthly and quarterly (6 weeks in areas).

Review dates

Date standard introduced: April 2017

Date standard last updated: April 2017

BSP-S11: diagnosis and or intervention: number of assessment visits to obtain a definitive diagnosis

Description

The acceptable level is that 95% of women should require no more than 3 separate visits for diagnostic assessment (including visits to receive results). The number of visits will depend on the structure of the assessment process; however no more than 2 needle biopsy procedures carried out on separate occasions should normally be needed to achieve a non-operative diagnosis.

Rationale

It is important to reduce anxiety in women by aiming to minimise the number of assessment visits required in order to obtain a definitive diagnosis. An early non-operative diagnosis of malignancy is highly desirable as it allows informed pre-treatment counselling of the patient and facilitates one-stage treatment thus ensuring that anxiety is minimised.

Definition

Numerator: number of women with ≤ 3 visits for diagnostic assessment and results appointments

Denominator: number of eligible women attending assessment

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 95.0%

Caveats

In some circumstances, repeated visits may be necessary where difficult to diagnose lesions are found to be multi-focal or the multi-disciplinary team (MDT) requires further investigations to be undertaken.

Some services may not have the resources to allow all investigations to be undertaken in 1 visit. This may lead to more than 2 visits for further diagnostic tests on occasion.

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: sub-region

Reporting period

Annually as part of the Association of Breast Surgery (ABS) audit

Review dates

Date standard introduced: April 2005

Date standard last updated: April 2017

BSP-S12: diagnosis and or intervention: benign biopsies rates

Description

The proportion of the eligible women with a technically adequate screen who have an open surgical biopsy with a benign or normal histological outcome. This standard is reported in 2 parts: S12a (prevalent screen) and S12b (incident screen).

Rationale

To minimise unnecessary surgery. The number of open surgical biopsies performed as a result of screening that prove to be benign should be as low as possible given high rates of non-operative diagnosis in the programme.

Definition

S12a – prevalent screen

Numerator: number of surgical biopsies with a benign or normal histological outcome

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 1,000 to give the rate per 1,000 screened.

Prevalent screen includes women aged 45 to 52 (from KC62 Table A).

S12b – incident screen

Numerator: number of surgical biopsies with a benign or normal histological outcome

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 1,000 to give the rate per 1,000 screened.

Incident screen includes women aged 50 to 70 (from KC62 Table C1).

Performance thresholds

Prevalent screen:

• acceptable level: less than 1.5 per 1000
• achievable level: less than 1.0 per 1000

Incident screen:

• acceptable level: less than 1.0 per 1000
• achievable level: less than 0.75 per 1000

Caveats

Lack of availability or access to vacuum assisted biopsy could impact on the number of women referred onwards to open surgical biopsy.

Data collection and reporting

Data source: NBSS (KC62)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

6-monthly (provisional data), annually (definitive data) 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S13: diagnosis and or intervention: rates of non-operative diagnosis

Description

The number of women who have a non-operative diagnosis of cancer by needle histology or cytology after a maximum of 2 visits expressed as a proportion of all women screened diagnosed with breast cancer.

Rationale

It is important to minimise the number of operative procedures and to enable treatment planning in advance of surgery. This can be achieved when the majority of cancers receive a non-operative pathological diagnosis of cancer.

Definition

Numerator: number of women with non-operative diagnosis (within 2 visits to assessment)

Denominator: number of women diagnosed with breast cancer

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Services should report non-invasive diagnosis rates both with and without lobular carcinoma in situ (LCIS) as this will impact on non-operative diagnosis rates achievable.

Performance thresholds

Invasive disease:

• acceptable level: greater than or equal to 90.0%
• achievable level: greater than or equal to 95.0%

Non-invasive disease:

• acceptable level: greater than or equal to 85.0%
• achievable level: greater than or equal to 90.0%

Caveats

None

Data collection and reporting

Data source: NBSS (KC62, table T, 50 to 70)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

6-monthly (provisional data), annually (definitive data) 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S14: diagnosis and or intervention: age standardised detection ratios (SDRs) for invasive cancers

Description

The SDR is the ratio of the observed number of invasive cancers to the expected number in the eligible population invited and screened, given the age distribution of the population screened. This standard is reported in 2 parts: S14a (prevalent screen) and S14b (incident screen).

Rationale

Services should aim to maximise the numbers of invasive cancers detected. It is important to compare cancer detection between screening services with differing mean ages of screening populations, as the age of women screened is a major determinant of cancer detection rates. This is corrected for by using a SDR.

Definition

S14a – prevalent screen

Numerator: number of invasive cancers diagnosed in eligible women screened

Denominator: the expected number of invasive cancers in eligible women screened.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The expected number of cancers is based on applying criteria from the Swedish Two Counties randomised control trial which is used as a comparator of performance.

Prevalent screen includes women aged 45 to 70 (from KC62 Table A + B).

S14b – incident screen

Numerator: number of invasive cancers diagnosed in eligible women screened

Denominator: the expected number of invasive cancers in eligible women screened.

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

The expected number of cancers is based on applying criteria from the Swedish Two Counties randomised control trial which is used as a comparator of performance. Incident screen includes women aged 50 to 70 (from KC62 Table C1).

Performance thresholds

Acceptable level: greater than or equal to 1.00

Achievable level: greater than or equal to 1.40

Caveats

The reporting breast screening services may refer women for treatment to alternative providers. Sometimes it can be difficult to obtain the pathology and treatment details accurately for entry onto NBSS which may mean that cancers may be under-reported by the reporting service where the woman was initially screened.

The ability of a screening service to maintain screening round length standards over the period should be analysed. Screening intervals shorter than 36 months or longer than 36 months may have an impact on rates of cancer detection.

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: screening service for incident screen (NHS Digital statistical bulletin)

Reporting period

6-monthly (provisional data), annually (6 months in arrears: definitive data).

Review dates

Date standard introduced: May 2000

Date standard last updated: March 2011

BSP-S15: diagnosis and or intervention: small cancer age standardised detection ratios for invasive cancers

Description

The SDR is the ratio of the observed number of invasive cancers to the expected number in the eligible population invited and screened, given the age distribution of the population screened. Small cancers (less than 15mm in diameter) are expected to be 55% of the expected overall number of invasive cancers.

Rationale

To achieve a significant reduction in breast cancer mortality it is of significant importance that small invasive breast cancers (less than 15 mm diameter) are detected. It is important to compare cancer detection between screening services with differing mean ages of screening populations, as the age of women screened is a major determinant of cancer detection rates. This is corrected for by using a SDR.

Definition

Numerator: number of invasive cancers diagnosed less than 15mm in diameter in eligible women screened

Denominator: the expected number of invasive cancers diagnosed less than 15mm in diameter in eligible women screened

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than or equal to 1.00

Achievable level: greater than or equal to 1.40

Caveats

The size distribution of all invasive cancers should be examined to establish whether there is any ‘rounding up’ of cancers measuring between 14mm and 15mm by pathologists. If this is shown, it may reduce the numbers of small cancers detected.

The reporting breast screening services may refer women for treatment to alternative providers. Sometimes it can be difficult to obtain the pathology and treatment details accurately for entry onto NBSS which may mean that cancers may be under-reported by the reporting service where the woman was initially screened.

Ability of a screening service to maintain screening round length standards over the period should be analysed. Round lengths shorter than 36 months or longer than 36 months may have an impact on rates of cancer detection.

Data collection and reporting

Data source: NBSS (KC62 report, Tables A, B and C1, ages 45 to 70)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

6-monthly (provisional data), annually (6 months in arrears: definitive data).

Review dates

Date standard introduced: April 2017

Date standard last updated: April 2017

BSP-S16: diagnosis and or intervention: non-invasive cancer detection rates

Description

The rate of non-invasive carcinoma (in situ) cancers that are detected per 1000 women screened. This standard is reported in 2 parts: S16a (prevalent screen) and S16b (incident screen).

Rationale

Detection of non-invasive cancer at screening (predominantly ductal carcinoma in situ (DCIS)), particularly high-grade types, is assumed to be a factor contributing to long-term reduction in mortality. No firm scientific evidence currently exists to confirm this. The majority of DCIS detected at screening is of the high-risk type. It is believed to be good practice to detect and treat DCIS.

Some experts have argued that detection of this stage of breast carcinoma may represent over diagnosis (detecting disease which would never become clinically apparent or threaten life) and causes anxiety and physical harm (unnecessary surgery). Others suggest that detection of DCIS is important because it is a precursor of invasive carcinoma. Until the Sloane Study can give definitive evidence, programme advice is to maximise detection of non-invasive cancer (particularly high-grade disease).

Definition

S16a – prevalent screen

Numerator: number of women with non-invasive or micro-invasive cancer

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 1,000 to give the rate per 1,000 screened.

Prevalent screen includes women aged 45 to 70 (from KC62 Table A).

S16b – incident screen

Numerator: number of women with non-invasive or micro-invasive cancer

Denominator: number of eligible women with a technically adequate screen

We calculate performance by dividing numerator by denominator and multiplying by 1000 to give the rate per 1000 screened.

Incident screen includes women aged 50 to 70 (from KC62 Table C1).

Performance thresholds

Prevalent screen:

• acceptable level: greater than or equal to 0.5 per 1000

Incident screen:

• acceptable level: greater than or equal to 0.6 per 1000

Caveats

Not applicable

Data collection and reporting

Data source: NBSS (KC62)

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

6-monthly (provisional data), annually (definitive data) 6 months in arrears.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017

BSP-S17: diagnosis and or intervention: staging of the axilla

Description

Patients treated surgically for early invasive breast cancer should have an axillary staging procedure carried out if metastatic nodal metastasis is not confirmed non-operatively.

Rationale

It is important to allow planning for appropriate patient management at the earliest opportunity if suspected or diagnosed cancer has spread to the axilla.

Definition

Numerator: number of women with invasive breast cancer with an axillary staging procedure

Denominator: number of women with non-operatively diagnosed invasive breast cancer

We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.

Performance thresholds

Acceptable level: greater than 90.0%

Achievable level: 100.0%

Caveats

None

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Annually all ages as part of the Association of Breast Surgery (ABS) audit.

Review dates

Date standard introduced: April 2009

Date standard last updated: April 2009

BSP-S18: outcome: rates of interval cancers

Description

The number of interval cancers subsequently diagnosed per 1,000 women screened.

Rationale

Cancers that are detected between screens (interval cancers) decrease the likelihood of reducing mortality in the eligible screening population. Services should aim to minimise the number of interval cancers presenting between screening episodes. Further information is available in the reporting, classification and monitoring of interval cancers and cancers following previous assessment guidance.

Definition

Numerator: number of women eligible for screening presenting with an invasive interval cancers within 36 months of a previous screen

Denominator: number of eligible women screened

We calculate performance by dividing numerator by denominator and multiplying by 1000 to give the rate per 1000 screened.

Performance thresholds

Acceptable level:

less than 0.65 per 1,000 diagnosed less than 12 months of the previous screen

less than 1.40 per 1,000 diagnosed between 12 and less than 24 months of the previous screen

less than 1.65 per 1,000 diagnosed between 24 and less than 36 months of the previous screen

Caveats

Analysis of interval cancer data should take place at screening service level aggregating several years’ performance. The number of interval cancers occurring in individual screening services each year is relatively small and analysis of them is likely to be meaningful only when several years’ data are available.

Interval cancers should be examined alongside other screening data (such as SDRs) when considering the performance of a breast screening programme. Failure to achieve interval cancer targets may coincide with high rates of cancer detection and may reflect higher than expected rates of cancer prevalence in the underlying population or failure to meet screening round length targets.

Ability of a screening service to maintain screening round length standards over the period should be analysed as round lengths shorter than the target of 36 months or longer than the target 36 months may have an impact on rates of interval cancer detection.

Data collection and reporting

Data source: NBSS

Responsible for data quality and completeness: screening service

Responsible for submission: screening service

Reported by: screening service

Published by: not currently published

Reporting period

Annual audit for women aged 47 to 73 at screening.

Review dates

Date standard introduced: May 2000

Date standard last updated: April 2017