The Breast Cancer after Radiotherapy Dataset (BARD): An initiative to improve screening for breast cancer in a cohort of high risk female lymphoma survivors in England


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John Radford1, Sacha Howell1, Catherine O'Hara2, Valerie Goode1, Kate Vaughan1, Simon Davies3, Richard Cowan1, Anthony Swerdlow4
1The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK, 2North West Public Health England, 3Teenage Cancer Trust, London, UK, 4Institute of Cancer Research, London, UK

Background

Female survivors of lymphoma who received radiotherapy involving breast tissue under age 36 are at increased risk of breast cancer. Since 2003, national guidelines have recommended these women undergo annual breast screening starting 8 years after treatment. In 2009 we showed that penetration of screening into this at-risk population was poor (Howell et al, BJC, 2009). In addition, anecdotal evidence suggested that appointments for screening were not always issued in a timely way and/or required repeat referrals from the treating oncologist or GP. These factors limit the effectiveness of screening and generate anxiety for at-risk women.

Method

To address these issues we have established a national breast cancer after radiotherapy dataset (BARD), hosted at Public Health England (Northwest) in Manchester and funded by Teenage Cancer Trust.

Results

BARD comprises contact details for women irradiated pre-2003 and identified as part of a recall exercise undertaken in 2003, those irradiated 2003-2009 identified from cancer registries/radiotherapy centre records and finally women irradiated 2009-2013 and beyond identified from the nationally mandated radiotherapy dataset. The names of women irradiated under age 30 and requiring screening will be forwarded annually to the NHS Breast Screening Programme (NHSBSP) that will then issue a screening appointment. For women irradiated 30-35 whom NHSBSP is not currently commissioned to screen, BARD will send a letter to the GP reminding them to refer for screening.

Conclusion

For the first time BARD brings together a cohort of women in England at high risk of breast cancer following radiotherapy. In collaboration with NHSBSP, BARD will facilitate the timely issue of screening appointments and improve the efficiency/reliability of screening and the user experience. Evaluation of the screening protocol and trends in breast cancer incidence as radiotherapy practice evolves will also be possible. Discussions around extending the scope of BARD to other countries in the UK are underway.