A CONSULTANT breast surgeon has suggested the health service may need to “get smarter” about encouraging people to attend mammogram appointments.
Mike McKirdy, president of the Royal College of Physicians and Surgeons of Glasgow, has been working in breast cancer since Scotland’s screening programme started at the end of the 1980s.
And on the back of a major review of the programme – which made 17 recommendations for improvement – he is keen to see communications modernised to ensure people in disadvantaged communities are getting checked out.
The review found there has been a steady decline in overall uptake of breast screening which, if it continues, would threaten the effectiveness of the programme.
Average performance on overall uptake over the last 10 years stands at 72%, just above the minimum standard established, and women from deprived areas are less likely to attend than those in more affluent districts.
McKirdy (above) has said more research needs to be done around why women from disadvantaged areas often don’t turn up for screening but he said there are ways in which the system – which is more than 30 years old – can be overhauled to ensure it is in keeping with today’s society.
SNP MSP and Equalities Minister Christina McKelvie has spoken to The National on several occasions about her experience of being diagnosed with breast cancer via a mammogram last year.
McKirdy said using strong narratives such as this on social media could help bring harder-to-reach women into the programme.
“We know there is a social class gradient and that is captured in the report,” he said.
“So we need to do some work about improving access to the health service for people from disadvantaged backgrounds and that’s work we really need to do well. The Scottish Government is very attuned to that.
“One of the aspects of the review is looking at ways of encouraging people to come [to appointments].
“Christina [McKelvie] sharing her story will make many people in her area and age group more aware of the benefit. These narratives are helpful in bringing people forward and maybe the health service needs to get a little smarter and do some of that through things that people now use.
“We traditionally think of advertising on the TV, maybe we also need to do it on social media. We perhaps need to go beyond Elaine C Smith on the side of a bus shelter to reach people with stronger narratives of the benefits of breast screening and make them feel as if that’s something they want to be part of.”
Smith helped to boost breast screening uptake almost a decade ago when she was part of a series of adverts which showed images of breasts with visible evidence of cancer.
In the three months after the campaign started in September 2012, the number of women seeking medical advice about breast cancer increased by 50%. McKirdy added that the health service could make use of text message appointment reminders to ensure women who may move regularly are being contacted successfully.
He said: “When I became a doctor we used to ask people if they were ‘on the telephone’ because not everyone had a phone in their house. Now everyone has one in their pocket.
"We need to use modern means of communications better and I think the review is very clear on that. We could be working a bit more smartly in telling people about their appointments and maybe we could also send them a little message about what will be involved to take away the fear.”
The review also made recommendations about introducing more static centres – of which there are only six in Scotland along with a fleet of 20 mobile units – and centralising the way women are called for screening to ensure they are contacted when they turn 50.
As things stand, women between 50 and 70 are invited for a mammogram based on their GP service. But because practices only take part in the programme every three years, it means some women are not getting a call for their first scan until they are 53. The review recommends individual women are called around their 50th birthday by the NHS directly, rather than through their GP, bringing breast screening more into line with the way bowel screening calls work.
McKirdy said in the 1980s there wasn’t the capacity to centralise breast screening calls. The Forrest report produced at the end of the decade – which led to the implementation of screening in the UK – recommended mammograms should take place close to people’s homes.
He said we now have better technology to ensure women are not left waiting for crucial screening appointments and welcomed the recommendation to overhaul the system.
He also suggested having more static centres could be another way to encourage more people to attend as he feels there may have been a “psychological shift” in what is deemed a comfortable setting for a scan.
“The thing about calling people by practice is it does lead to situations where, if you were 49 and ¾ when it was last in your area, then you’ll be 52 and three-quarters when it comes back again,” McKirdy said.
“The way of addressing that now is to use the computing power we have 35 years after this was all put in place.
“We also don’t feel as though we need to take a van to every supermarket car park to get people to come and be screened. It’s possible now to say to people we’d like you to travel a bit further to be screened and indeed one of the recommendations is to build more static centres.
“It may be that the mobile units are not actually the most comfortable places to go for your mammogram. Maybe that would be better done in an environment where it was a little more clinical.
“The idea of the mobile units was to increase uptake but perhaps society has changed a bit and people would be happier to get their mammogram at a more obviously medical space. I think there’s been a psychological shift.”
A new Breast Screening Modernisation Programme Board, chaired by Dr Marzi Davies, will take forward the recommendations from the report.
