How should I counsel patients about the benefits and risks of mammography screening?

When counselling patients about mammography screening, it is essential to provide clear, balanced information on both the benefits and risks to support informed decision-making. Explain that mammography can help detect breast cancer early, potentially improving treatment outcomes and survival rates, especially in women at moderate to high risk. However, also discuss that mammography may miss cancers, particularly in women with dense breast tissue, which can reduce sensitivity and lead to false reassurance. Patients should be informed about the possibility of false positives, which can result in additional investigations and psychological distress due to recall visits. Additionally, the risk of radiation exposure, although low, should be acknowledged as part of the risk-benefit discussion.

It is important to tailor the discussion based on the patient's individual risk category: for example, women at moderate or high risk may be offered annual mammographic surveillance starting from age 40, while those at near population risk typically participate in the national screening programme from age 50 onwards. Women with known genetic mutations such as BRCA1, BRCA2, or TP53 may have different surveillance strategies, including MRI in addition to mammography, which should be explained.

Provide written information covering these points and offer support such as risk counselling or psychological support if concerns persist. Emphasise that surveillance plans may change over time depending on family history or genetic findings, and patients should understand the reasons for any changes. Encourage breast awareness alongside formal screening to empower patients in early detection.

This approach aligns with NICE guidelines which recommend discussing benefits and risks including overdiagnosis, radiation exposure, and psychological impact before surveillance decisions, and ensuring surveillance is conducted to national breast screening programme standards with audit and written information provided ¹. Recent literature also supports individualized risk assessment and shared decision-making to optimize screening benefits while minimising harms (Vegunta et al., 2022; Unknown, 2017).