Breast screening After Radiotherapy Dataset

Designed to optimise screening. BARD is a confidential database of women in England who have received radiotherapy involving breast tissue when aged between 10 to 35 years. It has been set up to make sure all those at risk can be informed of screening options at the right time.

• Current national guidelines recommend that screening should start 8 years after radiotherapy to breast tissue or at age 25 or 30 (depending on circumstances), whichever occurs later.

In addition to making sure that screening appointments arrive at the right time, BARD will allow monitoring of the effectiveness of screening.

Following a pilot in Q4 2020, BARD commenced referrals in January 2021.

Women identified as having had radiotherapy to the chest area involving breast tissue when aged between 10 to 35 years. 

• Radiotherapy to this area is most commonly given for Hodgkin or non-Hodgkin lymphomas but it can sometimes be used to treat other cancers too.

Oncologists and GPs speak to patients explaining that breast screening is offered at an earlier age to women who have had this type of treatment.

Every woman is at risk of developing breast cancer at some stage in her life. Having radiotherapy involving breast tissue at a younger age means there is a higher risk of developing breast cancer later in life. Under current guidelines, patients who received radiotherapy to breast tissue between ages 10 and 35 are eligible for enhanced breast screening.

The increase in risk for women who have had radiotherapy will vary based on a number of factors:

• The age when radiotherapy received
• The size (area) of the radiation field
• The dose of radiation received

The increased risk of breast cancer doesn’t occur straight after the radiotherapy. It takes some years to develop. For women who were treated as young adults, there is thought to be no additional risk until approximately 10 years after treatment.

MRI stands for magnetic resonance imaging. An MRI scanner is a large tube surrounded by a strong magnetic field, with a platform bed that slides into it.

For breast screening, patients will be asked to lie face down on this bed. MRI involves taking many different images of the breast, which may take a while. The scanner makes a loud tapping nose as it scans the breasts.

MRI for breast screening is only carried out at certain centres, as both the equipment and screening staff are specialised and must meet specific screening standards.

• More information on MRI scans can be found on the NHS website

Mammograms are carried out by women called mammographers. The mammographer will first explain what will happen. She will then place your breast onto the mammogram machine and lower a plastic plate onto it to flatten it. This helps to keep your breast still and get clear X-rays.

The mammographer will usually take two X-rays of each breast – one from above and one from the side. She will go behind a screen while the X-rays are taken. You will have to keep still for several seconds each time.

The whole appointment takes less than half an hour and the mammogram itself only takes a few minutes.

Breast screening will be offered once a year (annual screening) according to national imaging protocols.

Breast screening should not be carried out whilst a women is pregnant or breastfeeding.

No screening method can detect every cancer; and cancer can sometimes develop in between screening appointments. If you notice any unusual changes in your breasts, please speak to your GP as soon as possible. Do not wait for your next screening appointment.

Remember to be Breast Aware 

All women should be breast aware. This means knowing how your breasts normally look and feel, and reporting any unusual changes to your doctor as soon as possible. We advise following the ‘touch look check’ (TLC) 3 simple steps: 

• TOUCH your breasts. Can you feel anything unusual? 
• LOOK for changes. Is there any change in shape or texture? 
• CHECK anything unusual with your doctor. 

(TLC information reproduced by permission of Breast Cancer Now.)

Having breast screening from an earlier age is entirely your choice. Choosing not to have screening doesn’t affect any other aspect of your healthcare.

If you do not wish your name to be included on BARD please let us know you would like to opt out by sending an email to chn-tr.bard@nhs.net – please include your name and NHS number. This is a secure email account to which personal details can be sent safely. The BARD team will then ensure that your details are removed from the dataset. 

If you have your name removed from BARD, you will still receive an invitation for routine breast screening between the ages of 50 and before your 53rd birthday. Routine breast screening is offered every 3 years to all women aged between 50 and before your 71st birthday. 

If you decide not to have screening from an earlier age now, but later change your mind, then you can still be screened from that date. All you need to do is contact BARD (email address: chn-tr.bard@nhs.net) who will add your name to the list.

There will be a small number of women who have received radiotherapy to breast tissue as part of a treatment plan for diagnoses other than lymphoma.

In these instances, the BARD non-lymphoma patient referral form should be completed by a consultant clinical oncologist to refer the patient to BARD. The BARD team will then organise breast screening in line with national guidelines.

Due to the nature of cancer registration processes, it is recognised that NDRS (National Disease Registration Service) cannot guarantee to hold data on all patients that would be eligible for inclusion in the BARD project screening. NDRS would not be held liable for any patient omitted from screening due to missing data and the BARD project is responsible for identification of the screening cohort.

Areas where NDRS may be missing data on patients may include (but is not limited to): 

1. Incomplete or inaccurate data received from health care providers
2. Patients who have opted-out from disease registration
3. Transgender patients who may be recorded as male on the NDRS database and therefore not identified as being eligible for inclusion

For more information about BARD, please contact:

BARD
c/o Joanna Williams / John Radford,
Department 26,
The Christie Hospital NHS Foundation Trust,
Wilmslow Road,
Manchester,
M20 4BX

Email: chn-tr.bard@nhs.net