Answers to some commonly asked questions about the Breast Screening Programme.

1. Who should have screening mammograms?
2. What happens when you have a mammogram?
3. Do mammograms hurt?
4. Are mammograms safe?
5. How long does it take to have a mammogram?
6. Do I have to take my clothes off?
7. Do I need to have mammograms if I am well and can't feel any lumps in my breasts?
8. Do I need to have mammograms when there is no history of breast cancer in my family?
9. What if I have a breast lump?
10. What if I have a family history of breast cancer?
11. Isn't breast cancer mainly a disease of young women?
12. Why are women over 70 not in the programme?
13. What about mammograms for women under 45?
14. Why is it that screening in younger women may not be effective?
15. What about women who go through the menopause early?
16. What about women who have had a hysterectomy at an early age?
17. What about women on Hormone Replacement Therapy (HRT) - how does that affect the density of the breast tissue?
18. How long does it take to receive the results of the screening mammograms?
19. How will I receive the results?
20. Is the information obtained during screening confidential?
21. What if I have an abnormal result?
22. What if I have breast cancer?
23. The programme is free, but how free is free?
24. How often should I have mammograms?
25. How do I join the breast screening programme?
26. Can someone come with me when I have a mammogram?
27. What if I have breast implants?
28. What if English is not my first language - how can I get the information explained?
29. Will a BreastScreen Aotearoa mammogram cost me anything?
30. What are the signs of breast cancer?
31. What if I already have a breast problem?
32. What if I have had breast cancer before?
33. After a diagnosis of breast cancer, when can I re-join BreastScreen Aotearoa?
34. How do you make a complaint about any part of the programme?

1. Who should have screening mammograms?

It is recommended women aged 45 and over have screening mammograms every two years.  BreastScreen Aotearoa offers free mammograms for women in the 45 to 69 eligible age range.

2. What happens when you have a mammogram?

Each breast in turn is held between plates on the mammography machine while the pictures are taken.  This takes a few seconds.

3. Do mammograms hurt?

The plates on the mammography machine hold the breasts firmly.  Most women find this uncomfortable and a few find it painful.

4. Are mammograms safe?

Only a very small amount of radiation is used in mammography so the radiation risk is extremely low.

5. How long does it take to have a mammogram?

The whole visit, including waiting time and breast screening time, is usually about 30 minutes.

6. Do I have to take my clothes off?

You will need to undress from the waist up, so it is a good idea to wear a skirt or trousers.  You will be offered a gown to wear on top.

7. Do I need to have mammograms if I am well and can't feel any lumps in my breasts?

A mammogram can show changes and abnormalities (something unusual) in your breasts before anything can be seen or felt.  It is the best available test to detect small cancers at an early stage when there is a very good chance of successful treatment.

8. Do I need to have mammograms when there is no history of breast cancer in my family?

Yes, you do.  Most women who develop breast cancer have no close relatives with the disease.

9. What if I have a breast lump?

If you have a lump you should see your GP to get it checked. Do not wait to have a screening  mammogram. Screening is for women who do not have a breast problem
All breasts have areas of lumpiness that fluctuate with the menstrual cycle. 
In younger women: most lumps have a hormonal basis, so if any lump persists after one menstrual cycle if should be examined by your doctor.
In older women new lumps should be investigated straightaway by your GP.

10. What if I have a family history of breast cancer?

Women with a strong family history , particularly in several members of the whanau or their mother or sister had cancer in both breasts or were treated for it before their menopause,  have an increased risk of developing the disease. You can discuss this with your doctor.  However, most people with breast cancer in the family will never develop the disease.

11. Isn't breast cancer mainly a disease of young women?

No. Breast cancer can occur at any age but it usually occurs after the age of 40 and your chances of getting it increase as you get older.  Three quarters of breast cancers occur in women over the age of 50.

12. Why are women over 70 not in the programme?

For women aged 70 years and over you cannot have free mammograms with BreastScreen Aotearoa.  There is very little evidence of the benefit of screening women over 70.

13. What about mammograms for women under 45?

Screening mammography has been shown to work best in women between 50 and 69.The benefits of screening are less and the disadvantages greater for screening women between 40 and 50. There is no evidence that screening women younger than 40 saves lives, but there is evidence that it does cause harm.
It is recommended that women of any age who are at high risk of getting breast cancer get their breasts checked regularly, and this may include a yearly mammogram. Mammograms for these women are not done through BreastScreen Aotearoa, but by DHBs on referral from the GP. Women at high risk are those with:

• a mother or sister who developed breast cancer before menopause or developed cancer in both breasts
• previous breast cancer
• a previous biopsy of breast tissue showing an at-risk lesion
• a breast lump or change which needs checking.

14. Why is it that screening in younger women may not be effective?

Mammograms are less reliable in younger women for a range of reasons. Most younger women have dense breast tissue that make mammograms more difficult to read.  As a result, cancers may not be seen (false negative result). 
Younger women are also more likely to have something show up on their mammogram that needs checking but turns out not to be cancer (false positive result).

15. What about women who go through the menopause early?

It has been suggested that the difference in effectiveness in screening women before and after age 50 is based on menopausal status (ie, when periods end and menopause begins). It is difficult to establish if this is a key factor, however, as few studies have collected data on the menopausal status of the women screened. It is also difficult to determine when periods end and menopause begins. Research is continuing in this area. Age, rather than whether a woman has been through menopause, is the basis for entry into the screening programme. The programme is for women over 45. Overseas studies show that when women over 50 are offered screening at about two-yearly intervals as part of an organised programme, their chances of dying from breast cancer are reduced by a third.

16. What about women who have had a hysterectomy at an early age?

Hysterectomy by itself does not affect the risk of breast cancer.  For the reasons given under "Why is it that screening in younger women may not be effective?" women under 45 years old are not included in the programme.

17. What about women on Hormone Replacement Therapy (HRT) - how does that affect the density of the breast tissue?

Taking HRT can increase breast density and may reduce the chance of detecting a breast cancer on a mammogram.  HRT can also slightly increase your risk of getting a breast cancer and increases the chance of having to have extra tests when in fact nothing is wrong. BreastScreen Aotearoa will ask you to state if you are taking HRT on the form you have to fill in.  This is to inform the radiologist who is reading the mammogram.

18. How long does it take to receive the results of the screening mammograms?

BreastScreen Aotearoa will send your results to you within two weeks.

19. How will I receive the results?

The results will be sent directly to you.  They will also be sent to your GP if you have agreed to this.

20. Is the information obtained during screening confidential?

Yes. The Health Information Privacy Code ensures your privacy.  You will receive more information about confidentiality when you are invited to, or attend, a BreastScreen Aotearoa centre.

21. What if I have an abnormal result?

Some women will be contacted for a second appointment for further checking.  This may involve:
• another mammogram
• an ultrasound
• the taking of a small sample of tissue for examination under a microscope.
Most women recalled for further checks will not have cancer.

22. What if I have breast cancer?

You will be referred to a specialist for treatment.

23. The programme is free, but how free is free?

Mammograms, and any follow-up testing needed are free to women in the eligible age range who have joined the programme.  However, if treatment such as surgery is necessary this is free in the public health system only.  Also, if you feel the need to see your GP about any issues to do with breast health while you are in the programme, this visit is not free as it is not part of the programme.

24. How often should I have mammograms?

You should have a mammogram every two years.  BreastScreen Aotearoa will recall you if you are part of the programme. Please inform your provider if your address changes so they are able to invite you for your next mammogram.

25. How do I join the breast screening programme?

If you have not previously had a mammogram with BSA, you need to enrol by ringing 0800 270 200. You can also register for the programme on-line at www.nsu.govt.nz/current-nsu-programmes/1528.asp and a member of BreastScreen Aotearoa will contact you directly.  Your GP can also refer you to the programme if you have consented.

26. Can someone come with me when I have a mammogram?

Yes. Friends, family or whanau are very welcome to come with you.

27. What if I have breast implants?

Screening is more difficult for women with breast implants, and extra views need to be taken. Even so, some parts of the breast may not be seen. Women neeed to inform the service at the time of making an appointment if they have breast implants. The appointment needs to be longer and at a fixed site rather than a mobile unit so the mammograms can be processed immediately to check the quality. Women with breast implants will be asked to sign a special consent form pointing out that cancer is more likely to be missed in women with implants. There is also a very small chance the implant could be damaged during the mammogram.

28. What if English is not my first language - how can I get the information explained?

When you make an appointment at the screening or assessment centre you can ask for BreastScreen Aotearoa to arrange for an interpreter to be present when you visit, or you are welcome to bring a preson with you who can interpret.

29. Will a BreastScreen Aotearoa mammogram cost me anything?

For women 45 to 69 years old, the screening mammogram is free if it done by BSA.
Mammograms for investigation of women with a breast problem or women who are at high risk are also free if your GP refers you to a DHB service. Other mammograms are available through private providers, but you need to pay. You should ask your GP if the mammogram service you are being referred to is a free one.

30. What are the signs of breast cancer?

Possible signs of breast cancer are:

• a new lump or thickening
• a change in breast shape or size
• pain or tenderness in the breast that is unusual
• puckering or dimpling of the skin
• any changes in the nipple such as:
• a turned-in nipple
• a discharge that persists without squeezing
• a rash or reddening appearing only on the breast.

31. What if I already have a breast problem?

If you have a current breast problem, the BreastScreen Aotearoa programme may not be suitable for you. BreastScreen Aotearoa is for women with no apparent breast problems.  When a woman has a screening mammogram through the programme two x-rays of each breast are taken.  Women will only be referred for further investigations in the screening programme if something on the mammogram needs further checking.  A mammogram by itself does not detect all cancers and women with symptoms may need further tests.

If you have breast symptoms we recommend you see your doctor who will examine your breasts and will discuss with you a possible referral for a diagnostic mammogram.  This is different to a screening mammogram.  It is undertaken to diagnose breast changes and may involve other tests as well as a mammogram.   You can always decide to discuss these options with another doctor. 

Some of the breast symptoms that you should see your doctor about are:

• a new lump or thickening
• a change in breast shape or size
• pain or tenderness in the breast that is unusual 
• puckering or dimpling of the skin 
• any changes in the nipple such as: 
• a turned-in nipple 
• a discharge that persists without squeezing 
• a rash or reddening appearing only on the breast.

Most breast lumps and other breast symptoms will not be cancer but this can be a worrying time.  It is important that you see a doctor to have these symptoms checked as soon as possible.  During your visit you can discuss whether BreastScreen Aotearoa is appropriate for you.

 

32. What if I have had breast cancer before?

If you have had breast cancer it is very important that you have regular check-ups with your doctor. These should include a clinical breast examination and an annual mammogram.  This is because you are at an increased risk of developing breast cancer again. BreastScreen Aotearoa recommends that you continue to visit your breast specialist or general practitioner for these ongoing annual check ups. They will organise an annual mammogram for you through the public hospital or at a private radiology practice. The mammogram is free of charge if it is organised through the public hospital.

33. After a diagnosis of breast cancer, when can I re-join BreastScreen Aotearoa?

You can have a screening mammogram every two years through BreastScreen Aotearoa if:

• you are aged between 45 to 69, and 
• you have no breast problems, and
• are not pregnant or breast feeding, and 
• your breast cancer was treated more than five years ago.

If you do rejoin BreastScreen Aotearoa you should still continue to have an annual breast examination by your doctor. A normal consultation fee would usually be charged.

 

34. How do you make a complaint about any part of the programme?

The Code of Health and Disability Services Consumers’ Rights allows you to make a complaint in a way that is appropriate to you. You should not be treated unfairly in any way because you have made a complaint.  You can ring BreastScreen Aotearoa on freephone 0800 270 200 to find out more about the best options for you. You can contact an advocate from the Office of the Health and Disability Commissioner to help you with your complaint, freephone 0800 11 22 33 or website http://www.hdc.org.nz/.