How can I effectively communicate the risks and benefits of breast cancer screening to my patients?

Effectively communicating the risks and benefits of breast cancer screening to patients involves providing comprehensive, tailored information to enable informed decision-making ²,³ ((Lobb et al., 2002)).

• Tailor Information and Explore Beliefs: It is crucial to tailor the information provided, considering its format, content, and the patient's individual needs and beliefs ²,³ ((Lobb et al., 2002)). Explore the woman's expectations about breast screening ².
• Explain the Screening Process: Clearly explain what to expect, including that an invitation will arrive by post and can be rearranged if inconvenient ². Describe that the appointment typically lasts about 30 minutes and may be at a mobile, hospital-based, or permanent unit ². Inform patients that they will need to remove clothes from the top part of their body, including their bra, and should avoid talcum powder or spray-on deodorant on the day of screening as it may affect the mammogram ². Explain that each breast is compressed, which some women find uncomfortable or painful, but is necessary for a good-quality image ². Patients should be advised to await contact from the breast screening service regarding results and any follow-up ².
• Discuss Benefits: Emphasise that mammography is the most accurate method for the early detection of breast cancer ². Early detection can lead to improved outcomes ².
• Discuss Harms and Risks: Inform patients about potential discomfort or pain during the mammogram due to breast compression ². Explain that approximately 1 in 23 women are recalled for further tests because their mammogram shows that more tests are needed, but most of these women will not have breast cancer ². Other risks include the possibility that mammography might miss a cancer, especially in women with dense breasts, the increased likelihood of further investigations, possible overdiagnosis, the risk associated with exposure to radiation, and the potential psychological impact of a recall visit ³.
• Provide Written Information and Resources: Always provide written information, such as the Public Health England (PHE) Breast screening information leaflets, the NHS leaflet on Breast cancer screening, and the NHS England leaflet "Breast screening: helping women decide" ¹,². Signpost to further information from organisations like Cancer Research UK and provide details for local and national support groups ¹,³.
• Address Lifestyle and Risk Factors: Discuss modifiable risk factors for breast cancer, including advising on reduction of alcohol intake, maintenance of a healthy weight, increasing physical exercise, and smoking cessation ¹,³. Inform women that having a first child at a younger age, having a large family, and breastfeeding may reduce the risk of breast cancer ¹,³. Provide appropriate information on oral contraceptives and hormone replacement therapy (HRT), noting that for women over 35 with a family history, there is an increased risk of breast cancer associated with combined hormonal contraception ¹,³.
• Consider Specific Patient Needs:
  • For women with breast implants, explain that some breast tissue may be obscured by the implant during routine mammography, making early detection more difficult, and additional images may be taken ². The NHS leaflet on Breast implants and breast screening can be helpful ².
  • For women with a physical disability that may make screening difficult, advise them to contact the local breast screening service for advice on technical feasibility and the best place to attend ².
  • For women with a learning disability or lacking mental capacity, assess for fluctuating capacity and, if ongoing, make a 'best interests' decision in consultation with family, friends, or carers, considering the woman's past views and risk factors ². The NHS leaflet "An Easy Guide to Breast Screening" may be useful ².
• Offer Support and Review: Offer support, such as risk counselling, psychological counselling, and risk management advice, to women with ongoing concerns ³. Advise patients that they can bring a family member or friend to appointments ¹,³. Emphasise that eligibility for surveillance should be reviewed if family history changes ³.