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1. What is cancer?
2. What is breast tissue?
3. What is breast cancer?
4. How common is breast cancer?
5. What causes breast cancer?
6. Is it only women with a family history of breast cancer who develop the disease?
7. What are the main risk factors for breast cancer?
8. What are some of the unproven risk factors associated with breast cancer?
9. Are women at higher levels of risk for breast cancer eligible for screening through the BreastScreen NSW Program?
10. What are some of the myths associated with the development of breast cancer?
11. What does BreastScreen NSW do?
12. What is screening?
13. What is a mammogram?
14. How effective is mammographic screening?
15. Does having a mammogram hurt?
16. What are the differences between a screening mammogram and a diagnostic mammogram?
17. At what age should women start having a screening mammogram?
18. Are women aged 70 years and over eligible to attend for screening?
19. Are women aged 40 to 49 years eligible to attend for screening?
20. What are the downsides for women aged 40 - 49 attending for breast screening?
21. Why are women under 40 years not eligible to attend for a screening mammogram at BreastScreen NSW?
22. Why do women need to keep coming back for a regular screening mammogram
    every two years?
23. How do I make an appointment for a free screening mammogram with BreastScreen NSW?
24. What happens when you have a screening mammogram at BreastScreen NSW?
25. Will a screening mammogram prevent breast cancer from developing?
26. What should I do if I notice a breast symptom or a change in my breast?
27. Why is a screening mammogram provided free at BreastScreen NSW?
28. How do I know I am receiving the best possible service when I attend BreastScreen NSW for a screening mammogram?
29. Is there any difference in the quality of mammograms taken at a mobile screening unit as compared to mammograms taken at a fixed unit?
30. Is there any risk for my unborn child if I have a routine screening mammogram
    when pregnant?

1. What is cancer?

A cancer is a collection of cells that are growing in an uncontrolled manner. This abnormal growth allows the cancer to invade normal tissue and potentially to spread throughout the body.

2. What is breast tissue?

Breast tissue covers a large area of a woman's chest extending from the collarbone, to under the arm, to just under the breasts and includes the breast mounds.

Breasts consist of fibrous (connective tissue that supports the other tissue), glandular (containing cells that can produce milk and respond to hormones) and fatty tissue. During a woman's lifetime her breasts will change. They change under the influence of female hormones during puberty, menstruation, pregnancy and menopause (change of life).

As a woman grows older the fibrous and glandular tissue (that appears white on a breast x-ray) will be replaced by fatty tissue (that appears translucent or clear on a breast x-ray). This is why the texture and shape of breasts will change over time.

3. What is breast cancer?

Breast cancer occurs when cells in a woman's breast tissue start to grow abnormally. Breast cancer can be benign (stays within the breast) or malignant (able to spread outside of the breast).

There are several different types of breast cancer. The term 'breast cancer' usually refers to the most common type, which is called adenocarcinoma. Other types of breast cancer include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Treatment of the disease depends upon the type of breast cancer diagnosed in a woman (National Breast Cancer Centre 2003).

Breast cancer is usually a slow growing cancer. If the disease spreads it can invade the lymph nodes under the armpit, and can then invade other tissues such as the bones and the lungs. This is called metastatic disease (National Breast Cancer
Centre 2003).

4. How common is breast cancer?

In 2002, breast cancer was the most common cancer in NSW women, comprising 29% of all cancers and there were 3981 new cases of breast cancer diagnosed. (Tracey, Chen & Sitas 2004).

Breast cancer can occur at any age, however, it is more common in women as they grow older. If women in NSW live to be 74 years of age they will have a 1 in 11 risk of developing breast cancer. The average age at which breast cancer is diagnosed is 60 years (Tracey, Chen & Sitas 2004). Breast cancer can also occur in men, although it is rare. Male breast cancer accounts for about 1% of all breast cancer cases (National Breast Cancer Centre 2003; Tracey, Chen and Sitas 2004)

Women who were born in some Eastern European and Asian countries have a lower incidence of breast cancer. Women originally from these countries who live in Australia for a few generations will take on the same risk of developing the disease as other Australians. (NHMRC National Breast Cancer Centre 1998)

In 2002, breast cancer was the most common cause of cancer death in women living in New South Wales and 885 women died from the disease (Tracey, Chen & Sitas 2004). Survival with breast cancer depends upon the features of the cancer at time of diagnosis (i.e. how large the cancer is, the type of cancer and whether it has spread). The five-year relative survival for females diagnosed with breast cancer increased from 79% between 1980 and 1995 to 85% between 1994 to 2000. (Coates & Armstrong, 1999; (Tracey, Chen & Sitas 2004).

5. What causes breast cancer?

Although there have been many scientific studies conducted to determine the cause of breast cancer, no single cause has been identified. Scientists have determined that there are many factors that may be associated with an increased risk of developing breast cancer. The two most important risk factors for developing breast cancer are being a woman and growing older.

6. Is it only women with a family history of breast cancer who develop the disease?

No. Nine out of ten women who get breast cancer do not have a family history of the disease.

7. What are the main risk factors for breast cancer?

• Being a woman
  
  All women are at risk of developing breast cancer at some stage in their lifetime. If women in New South Wales live to be 74 years of age they will have a 1 in 11 risk of developing breast cancer. Breast cancer can also occur in men, although it is rare. Male breast cancer accounts for about 1% of all breast cancer cases.
  
  
• Growing older
  
  Breast cancer can occur at any age but it is more common in women as they grow older. More than 70% of breast cancer cases and 90% of deaths associated with breast cancer occur in women over 50. The average age at which breast cancer is diagnosed is 59 years (Tracey & Supramaniam 2004).
  
  
• Family history
  
  Doctors have known for a number of years that breast cancer can run in families. However, less than 10% of women who develop breast cancer carry genes that make them and their families at a greater risk of developing the disease than other women (NHMRC National Breast Cancer Centre 2003).
  
  Women who have a mother, sister or daughter who has been diagnosed with breast cancer will have a slightly higher risk of developing the disease. However, the majority of women diagnosed with breast cancer will not have a family history. Only 1 out of 10 women diagnosed with breast cancer will have a family history of the disease.
  
  BreastScreen NSW recommends that women with a strong family history of breast cancer discuss their circumstances with their general practitioner. The National Breast Cancer Centre (NBCC) provides the following information about the risk of getting breast cancer for women with a family history of the disease.
  
  A woman is said to be at or slightly above average risk of getting breast cancer (this covers more than 95% of the female population) if she has:
• No confirmed family history of breast cancer
• One first degree relative (mother, sister, daughter, father, brother, son) diagnosed with breast cancer at age 50 or over
• One second degree relative (aunt, uncle, cousin, grandmother, grandfather) diagnosed with breast cancer at any age
• Two first or second-degree relatives diagnosed with breast cancer, at age 50 or over, but on different sides of the family.


The lifetime risk of breast cancer for this group: 1 in 12 (for most women in this group) and up to 1 in 8.

A woman is said to be at moderately increased risk of getting breast cancer (this covers less than 4% of the female population) if she has:
• One or two first degree relatives diagnosed with breast cancer before the age of 50 (without the additional features of the potentially high risk group, below)
• Two first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer (without the additional features of the potentially high risk group, below)


The lifetime risk of breast cancer for this group: 1 in 8 (for most women in this group) and up to 1 in 4.

A woman is said to be at potentially high risk of getting breast cancer (covers much less than 1% of the female population) if she has:
• Two first or second degree relatives on one side of the family diagnosed with breast cancer plus one or more of the following features on the same side of the family:
  • Additional relative with breast or ovarian cancer
  • Breast cancer diagnosed before the age of 40
  • Ovarian cancer diagnosed before the age of 50
  • Bilateral breast cancer
  • Breast and ovarian cancer in the same woman
  • Jewish ancestry
  • Breast cancer in a male relative
• One first or second degree relative diagnosed with breast cancer at age 45 or younger plus another first or second degree relative on the same side of the family with sarcoma (bone/soft tissue) at age 45 or younger
• Member of a family in which the presence of a high-risk breast cancer gene mutation has been established


The lifetime risk of breast cancer for this group: 1 in 4 to 1 in 2, or possibly higher if shown to have a high-risk mutation

For further information about the familial risks associated with breast cancer, please go to the NBCC website at: www.nbcc.org.au.

• Breast problems including a previous history of breast cancer
  
  If a woman has been diagnosed with breast cancer previously, there is a greater risk of the disease reoccurring or developing in the other breast (Meister & Morgan 2000). Women who have had benign (non-cancerous) breast problems are also at an increased risk but to a lesser extent (Meister & Morgan 2000). It is very important for these women to have regular check ups with their doctor or specialist.
  
  
• Early menstruation and late menopause
  
  Studies have indicated that women who started menstruating at an early age (before the age of 12 years) and/or go through a late menopause (after the age of 55 years) have a slightly higher risk of developing breast cancer (Meister & Morgan 2000). This is thought to be due to the presence of the female hormone, oestrogen throughout a woman's reproductive lifetime (from start of menstruation to menopause).
  
  NB: Menopause refers to the change in life a woman experiences when her menstrual cycle (periods) stops and she can no longer have children.
  
  
• Having a child late in age or not having any children
  
  Women who have their first child at an early age have a lower risk of breast cancer. Women who never have any children or who have a child later in life have a slightly higher risk of developing the disease (Meister & Morgan 2000).
  
  
• Being overweight
  
  What women eat and how much exercise they do after menopause has been linked with breast cancer (Meister & Morgan 2000). To look after your body women should eat healthy foods and be active.
  
  
• Alcohol
  
  Latest research suggests that about 4% of breast cancers in developed countries like Australia are linked to drinking alcohol (Collaborative Group on Hormonal factors in Breast Cancer 2002).
  
  
• Hormone Replacement Therapy (HRT)
  
  Taking HRT will increase a woman's risk of developing breast cancer by a small but significant amount, particularly when it is taken for 5 years or longer. The risk of developing breast cancer will reduce within 5 years of stopping HRT American Cancer Society 2002. However, for an individual woman, the benefits of taking HRT may outweigh the small increase in risk of developing breast cancer. This should be discussed between a woman and her doctor. Women taking HRT should continue to have regular screening mammograms.

8. What are some of the unproven risk factors associated with breast cancer?

• Smoking
  
  Whilst smoking is a major risk factor for cancers such as lung cancer, there is no evidence to link smoking with breast cancer at this time (Collaborative Group on Hormonal Factors in Breast Cancer 2002).
  
  
• Contraceptive Pill
  
  There have been no conclusive studies that have linked the development of breast cancer with the contraceptive pill. Some research has indicated that the pill may slightly increase the risk of developing breast cancer. However, this risk will be reduced within 10 years of stopping taking the pill (Meister & Morgan 2000).
  
  
• Environmental Pollution
  
  Studies show no link between exposure to pollutants such as pesticides and an increased risk of breast cancer American Cancer Society 2002.

9. Are women at higher levels of risk for breast cancer eligible for screening through the BreastScreen NSW Program?

BreastScreen NSW is a population-based screening program that aims to screen women who are not aware of breast problems and who do not have symptoms of breast cancer. The operations of BreastScreen NSW are geared to this, in that women are screened every two years by two view mammography alone and on the basis of the results from reading these films are returned to routine screening or recalled to assessment. It has been found that this is the most effective way of reducing the impact of breast cancer in the population.

A woman may have a higher level of risk of breast cancer due to a significant family history of the disease, a personal history of breast cancer, current symptoms of breast cancer or other medical reasons. Women who are at higher levels of risk often require surveillance that is more than just two yearly mammography. Our strong recommendation to these women is that they seek advice from their GP or specialist about an appropriate surveillance plan and do not necessarily rely on routine mammographic screening alone. The Program was not designed to specifically meet the needs of these women and it is essential that women make an informed decision about attendance at BreastScreen NSW if they choose to come in these circumstances.

Women who are at higher risk for breast cancer remain eligible and welcome to attend BreastScreen NSW and can ring for an appointment if they wish .

10. What are some of the myths associated with the development of breast cancer?

• Knock or bump to the breast
  
  A knock, bump or bruising to the breast (breast trauma) will not cause breast cancer (Meister & Morgan 2000).
  
  
• Wearing a bra
  
  There is no evidence that wearing a bra will cause breast cancer (American Cancer Society 2002).
  
  
• Wearing deodorant
  
  There is no evidence to support the view that wearing deodorant will increase the risk of breast cancer (Meister & Morgan 2000).
  
  
• Breast Size
  
  There is no evidence to suggest a link between the size of women's breasts and breast cancer (Meister & Morgan 2000).

11. What does BreastScreen NSW do?

BreastScreen NSW is a State and Federal Government funded Program that provides free screening mammograms to women aged 50 to 69 years who are invited to attend for a screening mammogram every two years. Studies have shown that women aged 50 to 69 years get the greatest benefit from having a screening mammogram every two years. Women aged 40 to 49 and those over 70 may also be screened on request.

Women who attend the Program should not have any symptoms of breast cancer (asymptomatic or well women). If you have a symptom such as a lump, persistent pain, nipple discharge or any other change in your breast that you are concerned about, you should see your doctor without delay.

The Program takes a population health approach to breast screening. This means that decisions about the Program and interventions will be based on what has proven to work, or evidence of effectiveness. The evidence to support breast screening to detect breast cancer at an early stage in women aged 50 to 69 years was the basis on which the Program was established.

The aim of the Program is to reduce the amount of illness and death associated with breast cancer through the early detection of the disease.

12. What is screening?

Screening is the process of looking for disease in a population of healthy people who have no symptoms of disease.

Breast screening (otherwise known as mammographic screening) is therefore the process of looking for breast cancer in a population of women who have no symptoms of breast cancer, such as a lump or nipple discharge.

13. What is a mammogram?

A mammogram is an x-ray picture that enables doctors to see inside the breast. Just as a photograph captures a moment in time, a mammogram will only show doctors what the inside of a breast looks like at the time it is taken. For this reason, it is very important to have a regular screening mammogram so that any unusual change to your breast can be found at an early stage. Generally, this means having a screening mammogram every two years.

A mammogram can detect changes to the breast that are as small as a grain of rice. This will be long before the change may be noticeable to you or your doctor. A previous screening mammogram taken at BreastScreen NSW will be compared with the current mammogram so that changes to the breast can be detected and further investigated if necessary. Mammograms are able to detect at least 90% of breast cancers before they can be picked up by physical examination. However, up to 10% of breast cancers may not be detected.

Therefore, women are encouraged by BreastScreen NSW to do the following:

• Have a screening mammogram with BreastScreen NSW every two years if you are aged 50 to 69 years.
• Have a clinical breast examination by your doctor or women's health nurse once every year.
• See your doctor immediately if you notice any unusual changes in your breasts, such as lumps, pain or nipple discharge, even if your screening mammogram has been normal.

14. How effective is mammographic screening?

International trials of mammographic screening suggest that screening may reduce the risk of dying from breast cancer by up to 30%.

In NSW this would mean a reduction in the cumulative risk of a woman dying from breast cancer between the ages of 50 and 79 from 2.4% to 1.7% (or from 1 in 43 to 1 in 58.)

(Please note: This calculation is based upon the breast cancer death rate in 1996, before screening was widely taken up, as the current breast cancer death rate may already have been reduced by screening.)

15. Does having a mammogram hurt?

Pressing (compression) of the breast during a screening mammogram is vital to obtain the best possible picture and to minimise the amount of radiation that is used. If the breast is not compressed, the x-ray picture will appear blurred so that any changes which may have occurred will be harder to find.

Compression of the breast does not hurt for most women, although some women may find it uncomfortable or even painful. Occasionally the compression can result in breast tenderness or bruising but this does not last very long. If your breasts are generally tender, please let the radiographer know before your screening mammogram is taken. The compression will only last a few seconds and you can ask the radiographer to stop if necessary. There is no evidence that having a mammogram harms the breast.

16. What are the differences between a screening mammogram and a diagnostic mammogram?

The key difference, as explained below, is the purpose for which the mammogram was done.

A screening mammogram, as performed in BreastScreen NSW, is a breast x-ray test for women who do not have any breast symptoms (i.e. asymptomatic or well women).
The BreastScreen NSW Program provides free screening mammograms. Screening mammograms do not require a doctor's referral. On occasions, it is necessary for women to be called back for additional x-rays, usually for technical reasons. Some women need to have additional tests at one of our assessment clinics because their x-rays show changes in their breasts. Such tests may include additional breast x-rays (diagnostic mammograms), an ultrasound and breast examination. Most women (9 out of 10) who are asked to return for further tests do not have breast cancer.

A diagnostic mammogram is used as one of the tests for investigating breast changes in women with symptoms (symptomatic women). These symptoms may include a lump, persistent pain, discharge from the nipple, changes in the shape or size of a breast or any other unusual changes.

A diagnostic mammogram may incur a cost and requires a doctor's referral to a private or public radiology practice. Diagnostic mammograms are not offered within the BreastScreen NSW program, except as part of further assessment following a screening mammogram that shows an abnormal area.

17. At what age should women start having a screening mammogram?

BreastScreen NSW actively encourages women to start regular two yearly screening mammograms at the age of 50. If you are aged 50 years and over and have not had a screening mammogram at BreastScreen NSW you may receive a letter in the mail inviting you to attend. If you have not received an invitation letter and you would like to attend simply call 13 20 50 to arrange an appointment.

18.Are women aged 70 years and over eligible to attend for screening?

Women aged from 70 are eligible and welcome to attend BreastScreen NSW and can ring for an appointment if they wish. We advise women in this age group to discuss the requirement for ongoing screening with their GP so they make an informed decision.

Although women from the age of 70 years get breast cancer at increasing rates, it is less likely to affect their mortality. There is a range of clinical reasons for this, one of which is that they may have competing health issues that are of more concern. For this reason, BreastScreen NSW does not routinely send out reminder letters to women as this operates as an incentive to keep screening, when it may not be in their best interest.

19. Are women aged 40 to 49 years eligible to attend for screening?

Yes they are, although they are not actively recruited to the Program. The current BreastScreen Australia policy about screening women aged 40 - 49 states that:

Mammographic screening through BreastScreen Australia is available to women aged 40 to 49 who have decided, based on current knowledge and personal choice, that they wish to attend. However, at this time, it does not appear that the size of benefit in terms of deaths prevented balanced against the possible downsides for women, is sufficient to actively encourage women aged 40 to 49 years into the Program. Recruitment strategies and publicity materials about the Program will continue to be directed to asymptomatic women (women without symptoms) aged 50 - 69, where the evidence is that screening has the greatest potential to prevent mortality from breast cancer).

Further Information

20. What are the downsides for women aged 40 - 49 attending for breast screening?

There are several possible downsides for women who attend for breast screening. All women may experience possible anxiety, inconvenience, cost and discomfort to varying degrees and these are similar for women aged 40 to 49 years and for women over the age of 50. However, these downsides must be balanced against a smaller potential benefit in women aged 40 - 49 years. In addition, some of the other downsides appear to be greater for women aged 40 - 49 years.

More women aged 40 - 49 will be reported as having an abnormal mammogram at each screening and will require further investigation for possible breast cancer. A high proportion of these women (about 95%) will not have breast cancer (NBCC 1998). That is, they will be given a false positive result in the original mammogram.

A greater number of women in the 40 - 49 age group will also be told incorrectly that they do not have any signs of breast cancer only to discover at a later stage (sometimes when breast cancer symptoms appear) that they do have the disease. That is, they will be given a false negative result.

False positive and false negative results occur because of biological differences in the breasts of younger women, who have more glandular and fibrous tissue in their breasts, which appears white on a breast x-ray. Breast cancer also appears white on a breast x-ray, which makes it harder to detect in younger, pre-menopausal women. This means that mammography may not be as effective in detecting breast cancer in women aged 40 - 49 years.

21. Why are women under 40 years not eligible to attend for a screening mammogram at BreastScreen NSW?

BreastScreen NSW does not provide screening mammograms to women under 40 years of age for two main reasons.

Firstly, although all women are at risk of developing breast cancer at some time during their lives, it is quite uncommon for younger women to develop the disease. The risk of developing breast cancer increases with age and the majority of breast cancer cases occur in women over 50 years of age.

Secondly, the breast tissue of younger women contains more glandular and fibrous tissue rather than fatty tissue, which makes the breast tissue much denser. Glandular and fibrous tissue appears white on a breast x-ray and breast cancer also appears white on a breast x-ray. This means that a screening mammogram is not a very accurate way of detecting breast cancer in young women.

Young women who have a screening mammogram would need to undergo further investigations, such as biopsies, more frequently. This is because the original screening mammogram incorrectly identified a normal area of breast tissue as abnormal (false positive). They may also be told incorrectly that they do not have any signs of breast cancer, as the screening mammogram could not detect these signs (false negatives).

Further Information

22. Why do women need to keep coming back for a regular screening mammogram every two years?

A screening mammogram will only show doctors what the inside of your breast looks like at the time it is taken. To effectively detect a change to your breast over time, a current mammogram should be compared to a previous mammogram. International studies have established that a screening mammogram taken on a regular basis will be effective in detecting breast cancer at an early stage in women aged 50 to 69 years. In Australia, the breast screening interval is every two years.

23. How do I make an appointment for a free screening mammogram with BreastScreen NSW?

You do not need a Doctor's referral to make an appointment at BreastScreen NSW. Simply call 13 20 50 and make an appointment today.

When you make this call, the number will be automatically diverted to your nearest Screening Service. Please ask where the most convenient screening site is located. If you make this call from a mobile phone, you will be diverted to the BreastScreen NSW State Coordination Unit. Your call will then be redirected to your nearest Screening Service.

A booking clerk will ask for your personal details and whether or not you have had a mammogram before. You may also be asked some general questions, such as "Are you currently experiencing any breast problems?" You will then be asked when you would like to attend for a screening mammogram and the booking clerk will book you in and confirm your contact details.

24. What happens when you have a screening mammogram at BreastScreen NSW?

When you arrive for your appointment at a BreastScreen NSW Service a receptionist will check that your paperwork has been completed. You will then be shown to a private waiting room where you will be asked to remove your bra and place your shirt or a robe back on.

A radiographer will call you when it is time to take your mammogram. The screening mammogram will only take a few minutes. Sometimes your mammogram will be processed immediately to check that there are no technical problems with the x-rays. A technical problem may occur when the picture produced is not clear enough. Once your x-rays are checked the radiographer will let you know that you can go.

Once the films are processed and read women will be sent a letter informing them that everything on their mammogram is normal and that they will be invited to come back in 2 years. Occasionally you may be asked to come back for a repeat of your mammogram to improve the picture quality of the x-ray.

Other women will be asked to come back for further tests as there is an area on their breast x-ray that needs further investigation. If you are asked to come back for further tests, you will be asked to go to an assessment centre, which may or may not be the same place that you had your screening mammogram.

At assessment, some of the tests include a mammogram, an ultrasound and a clinical breast examination. Most women who are asked to come back for further tests will not have breast cancer. It is very important to come back if you are asked to, just to make sure everything is normal. You are more than welcome to bring a friend or family member with you.

25. Will a screening mammogram prevent breast cancer from developing?

A screening mammogram will not prevent breast cancer from developing. However, a screening mammogram can pick up breast cancer early. The earlier breast cancer is detected the greater the treatment options available and the greater a woman's chance of survival.

Medical tests, such as a screening mammogram, are not 100% accurate. Research indicates that mammograms safely detect about 90% of breast cancers. Breast cancer may also develop during the interval between a previous and current screening mammogram. For these reasons, one mammogram is simply not enough.

A screening mammogram is the most effective way to detect breast cancer early, long before you or your doctor will notice a change. Currently, research shows that women aged 50 to 69 years get the greatest benefit from having a screening mammogram every two years.

To get the most benefit it is also important to maintain good breast health by doing the following:

• Have a clinical breast examination by your doctor or women's health nurse once a year
• If you notice an unusual change in the look and feel of your breasts see your doctor immediately.

26. What should I do if I notice a breast symptom or a change in my breast?

If you notice a breast change or experience a breast symptom you should see your doctor without delay. A doctor will do a clinical breast examination and refer you for further tests such as a diagnostic mammogram or ultrasound if needed. These tests require a doctor's referral and may be performed in a private radiology practice or a public hospital.

It is important to be aware of any changes to your breasts that are not normal for you. These changes may include:

• A breast lump, lumpiness or thickening
• A change to the nipple including shape or colour
• A discharge from the nipple
• A change to the breast, including puckering or dimpling of the skin, unusual redness or other colour change
• Any other noticeable change in the shape or size of the breast
• A persistent pain in the breast

  Most changes to your breasts that you see or feel will not be breast cancer. However, your doctor can examine your breasts and refer you for further tests if needed.

27. Why is a screening mammogram provided free at BreastScreen NSW?

BreastScreen NSW is a Federal and State Government funded breast screening program. The Program provides free screening mammograms to women aged 50 to 69 years, however women aged 40 to 49 years and 70 years and over are also eligible to attend.

The aim of the Program is to reduce illness and death associated with breast cancer through the early detection of the disease.

28. How do I know I am receiving the best possible service when I attend BreastScreen NSW for a screening mammogram?

BreastScreen NSW Screening and Assessment Services undertake a rigorous accreditation process every three years. The Services must meet high quality standards outlined in the BreastScreen Australia National Accreditation Standards.

At BreastScreen NSW the radiographers are all female and they have been specially trained in taking screening mammograms. When you have your screening mammogram, the radiographer will take two views (x-rays) of each breast. This means that both a side view and top view of each breast will be taken. This is to ensure that as much breast tissue as possible will be included in the picture and therefore a thorough investigation undertaken.

Your breast x-rays will then be read by two radiologists (specialist doctors) independently of one another. If the opinion of each radiologist differs then a third read will take place to determine the result.

BreastScreen NSW Screening and Assessment services will send you a reminder letter when you are next due for a breast screen. If you change your address in the meantime just let the Service know and your record will be updated for you.

If you are aged 50 to 69 years call 13 20 50 for an appointment at a BreastScreen NSW Screening and Assessment Service. The service is provided free. You do not need a doctor's referral. Call today and arrange an appointment at your nearest Service.

29. Is there any difference in the quality of mammograms taken at a mobile screening unit as compared to mammograms taken at a fixed unit?

No. BreastScreen NSW provides high standards and quality of services at each of their sites whether mobile or fixed location. Performance is assessed against rigorous national standards.

30. Is there any risk for my unborn child if I have a routine screening mammogram when pregnant?

Using current mammography techniques, there is no evidence that the foetus will receive any significant dose of radiation at any stage of pregnancy. If by chance you have a screening mammogram during pregnancy, this is not considered a cause of concern for the health of your unborn child.