International Journal of Public Health

, Volume 60, Issue 8, pp 881–890 | Cite as

Breast cancer screening in England and the United States: a comparison of provision and utilisation

  • Joseph WilliamsEmail author
  • Linda Garvican
  • Anna N. A. Tosteson
  • David C. Goodman
  • Tracy Onega



Comparing breast cancer screening across countries within the context of some of the benefits and harms offers the opportunity to improve effectiveness through mutual learning.


This paper describes the provision of breast cancer screening in England and the United States. The various recommendations for accessing breast cancer screening in the two countries are set out and the organisation of services including quality assurance, incentives and performance mechanisms considered.


In the United States, younger women are routinely screened; they are less likely to benefit and more likely to be harmed. The utilisation of breast cancer screening amongst eligible women is broadly comparable in the two countries. However, there are differences in technical performance; the reasons for these including radiological reading procedures and cultural factors are explored.


Despite a well-functioning screening programme, breast cancer mortality and survival in England are poor relative to other countries. Emphasis for American improvement should be on reducing false-positive recall rates, while the English NHS could supplement existing efforts to understand and improve comparatively poor survival and mortality.


Breast cancer Screening Mammography England United States 


Compliance with ethical standards

Conflict of interest

None of the authors declared any conflicts of interest.


  1. American Cancer Society (2014a) Medicare coverage for cancer prevention and early detection. Accessed 10 Aug 2014
  2. American Cancer Society (2014b) Breast cancer: early detection. Accessed 30 Oct 2014
  3. American College of Obstetricians and Gynecologists (2011) Breast cancer screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); Aug 11 p (ACOG practice bulletin; no. 122)Google Scholar
  4. American College of Radiology (2014) Mammography Accreditation Program requirements. Accessed 10 Aug 2014
  5. Armstrong K, Moye E, Williams S, Berlin JA, Reynolds EE (2007) Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians. Ann Intern Med 146(7):516–526CrossRefPubMedGoogle Scholar
  6. Autier P, Boniol M, Gavin A, Vatten LJ (2011) Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ 343:d4411PubMedCentralCrossRefPubMedGoogle Scholar
  7. Bewley S (2011) The NHS breast screening programme needs independent review. BMJ 343:d6894CrossRefPubMedGoogle Scholar
  8. Blanks RG, Day NE, Moss SM (1996) Monitoring the performance of breast screening programmes: use of indirect standardisation in evaluating the invasive cancer detection rate. J Med Screen 3(2):79–81PubMedGoogle Scholar
  9. Bond M, Pavey T, Welch K, Cooper C, Garside R, Hyde C (2013) Systematic review of the psychological consequences of false-positive screening mammograms. Evid Based Med 18:54–61CrossRefPubMedGoogle Scholar
  10. Buist DS, Anderson ML, Haneuse SJ, Sickles EA, Smith RA, Carney PA, Taplin SH, Rosenberg RD, Geller BM, Onega TL, Monsees BS, Bassett LW, Yankaskas BC, Elmore JG, Kerlikowske K, Miglioretti DL (2011) Influence of annual interpretive volume on screening mammography performance in the United States. Radiology 259(Issue 1):72–84PubMedCentralCrossRefPubMedGoogle Scholar
  11. Burnside ES, Sickles EA, Sohlich RE, Dee KE (2002) Differential value of comparison with previous examinations in diagnostic versus screening mammography. AJR 179:1173–1177CrossRefPubMedGoogle Scholar
  12. Cassels A (2012) Seeking Sickness. Greystone Books, VancouverGoogle Scholar
  13. Centers for Disease Control and Prevention (2012) National Centre for Health Statistics, National Health Interview Survey. Accessed 10 Aug 2014
  14. Centers for Disease Control and Prevention (2014b) What screening tests are there? Accessed 10 Aug 2014
  15. Centers for Disease Control and Prevention (2014) National Breast and Cervical Cancer Early Detection Program. Accessed 10 Aug 2014
  16. Centers for Medicare and Medicaid Services (2014a). Accessed 10 Aug 2014
  17. Centers for Medicare and Medicaid Services (2014b) Accountable Care Organization 2014 program analysis quality performance standards narrative measure specifications. Accessed 30 Oct 2014
  18. Cohen RA, Martinez ME (2013) Health insurance coverage: early release of estimates from the National Health Interview Survey, 2012. National Center for Health Statistics. Accessed 10 Aug 2014
  19. Department of Health (2013) Public health functions to be exercised by NHS England, service specification No.24: Breast Screening Programme. Accessed 30 Oct 2014
  20. Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW (1998) Ten-year risk of false positive screening mammograms and clinical breast examination. New Eng J Med 338:1089–1096CrossRefPubMedGoogle Scholar
  21. Elmore JG, Nakano CY, Koepsell TD, Desnick LM, D’Orsi CJ, Ransohoff DF (2003) International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst 95(18):1384–1393PubMedCentralCrossRefPubMedGoogle Scholar
  22. Elmore JG, Armstrong K, Lehman CD, Fletcher SW (2005a) Screening for breast cancer. JAMA 293:1245–1256PubMedCentralCrossRefPubMedGoogle Scholar
  23. Elmore JG, Taplin SH, Barlow WE, Cutter GR, D’Orsi CJ, Hendrick RE, Abraham LA, Fosse JS, Carney PA (2005b) Does litigation influence medical practice? The influence of community radiologists’ medical malpractice perceptions and experience on screening mammography. Radiology 236(1):37–46PubMedCentralCrossRefPubMedGoogle Scholar
  24. Elmore JG, Jackson SL, Abraham L, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Onega T, Rosenberg RD, Sickles EA, Buist DS (2009) Variability in interpretive performance at screening mammography and radiologists’ characteristics associated with accuracy. Radiology 253(3):641–651PubMedCentralCrossRefPubMedGoogle Scholar
  25. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917CrossRefPubMedGoogle Scholar
  26. Foot C, Harrison T (2011) How to improve cancer survival: explaining England’s relatively poor rates. The King’s Fund, LondonGoogle Scholar
  27. Garvican L, Field S (2001) A pilot evaluation of the R2 image checker system and users’ response in the detection of interval breast cancers on previous screening films. Clin Radiol 56(10):833–837CrossRefPubMedGoogle Scholar
  28. Gerber AS, Patashnik EM, Doherty D, Dowling C (2010) A national survey reveals public skepticism about research-based treatment. Health Aff 29(10):1882–1884CrossRefGoogle Scholar
  29. Gilliland FD, Joste N, Stauber PM, Hunt WC, Rosenberg R, Redlich G, Key CR (2000) Biologic characteristics of interval and screen-detected breast cancers. J Natl Cancer Inst 92(9):743–749CrossRefPubMedGoogle Scholar
  30. Goossens M, Van Hal G, Van der Burg M, Kellen E, Van Herck K, De Grève J, Martens P, Van Limbergen E (2014) Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium. Prev Med 69:280–286CrossRefPubMedGoogle Scholar
  31. Hofvind S, Geller BM, Skelly J, Vacek PM (2012) Sensitivity and specificity of mammographic screening as practiced in Vermont and Norway. Br J Radiol 85(1020):e1226–e1232PubMedCentralCrossRefPubMedGoogle Scholar
  32. Howard DH, Adams EK (2012) Mammography rates after the 2009 US Preventive Services Task Force breast cancer screening recommendation. Prev Med 55(5):485CrossRefPubMedGoogle Scholar
  33. Information Centre for Health and Social Care (2014) Breast Screening Programme, England, 2012–2013. Accessed 10 Aug 2014
  34. Kalager M, Zelen M, Langmark F, Adami HO (2010) Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 363:1203–1210CrossRefPubMedGoogle Scholar
  35. Lambert PC, Holmberg L, Sandin F, Bray F, Linklater KM, Purushotham A, Robinson D, Møller H (2011) Quantifying differences in breast cancer survival between England and Norway. Cancer Epidemiol 35(6):526–533CrossRefPubMedGoogle Scholar
  36. Levy AR, Bruen BK, Ku L (2012) Health care reform and women’s insurance coverage for breast and cervical cancer screening. Prev Chronic Dis 9:1545–1551 (E159) CrossRefGoogle Scholar
  37. Mainiero MB, Lourenco A, Mahoney MC, Newell MS, Bailey L, Barke LD, D’Orsi C, Harvey JA, Hayes MK, Huynh PT, Jokich PM, Lee SJ, Lehman CD, Mankoff DA, Nepute JA, Patel SB, Reynolds HE, Sutherland ML, Haffty BG (2013) ACR appropriateness criteria breast cancer screening. J Am Coll Radiol 10(1):11–14. doi: 10.1016/j.jacr.2012.09.036 CrossRefPubMedGoogle Scholar
  38. Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, White E (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 92(13):1081–1087CrossRefPubMedGoogle Scholar
  39. Mavroforou A, Mavrophorosb D, Michalodimitrakisa E (2006) Screening mammography, public perceptions, and medical liability. Eur J Radiol 57(3):428–435CrossRefPubMedGoogle Scholar
  40. Miller JW, King JB, Joseph DA, Richardson LC, Centers for Disease Control and Prevention (2012) Breast cancer screening among adult women—Behavioral Risk Factor Surveillance System, United States 2010. MMWR Morb Mortal Wkly Rep 61(Suppl):46–50PubMedGoogle Scholar
  41. Møller H, Sandin F, Bray F, Klint A, Linklater KM, Purushotham A, Robinson D, Holmberg L (2010) Breast cancer survival in England, Norway and Sweden: a population-based comparison. Int J Cancer 127(11):2630–2638CrossRefPubMedGoogle Scholar
  42. National Cancer Institute (2014) Mammograms factsheet. Accessed 10 Aug 2014
  43. National Institute for Health and Care Excellence (2013) Familial breast cancer: classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancerGoogle Scholar
  44. National Institute for Health and Care Excellence (2014) The Quality and Outcomes Framework. Accessed 30 Oct 2014
  45. National Research Council (2005) Improving breast imaging quality standards. The National Academies Press, WashingtonGoogle Scholar
  46. NHS Breast Cancer Screening Programme (2005) Consolidated guidance on standards for the NHS Breast Screening Programme. Accessed 30 Oct 2014
  47. NHS Breast Cancer Screening Programme (2010) Age extension full randomised control trial. Accessed 10 Aug 2014
  48. NHS Breast Screening Programme (2002) New ways of working: second report on implementation. Accessed 10 Aug 2014
  49. NHS Breast Screening Programme (2013) Guidelines on organising the surveillance of women at higher risk of developing breast cancer in an NHS Breast Screening ProgrammeGoogle Scholar
  50. NHS Cancer Screening Programmes (2011) Quality assurance guidelines for breast cancer screening radiology, second editionGoogle Scholar
  51. NHS Cancer Screening Programmes (2012) NHS Breast Screening Programme 2012 annual review. Accessed 10 Aug 2014
  52. Onega T, Aiello Bowles EJ, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Sickles EA, Elmore JG (2010) Radiologists’ perceptions of computer aided detection versus double reading for mammography interpretation. Acad Radiol 17(10):1217–1226PubMedCentralCrossRefPubMedGoogle Scholar
  53. Pace LE, He Y, Keating NL (2013) Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer 119(14):2518–2523CrossRefPubMedGoogle Scholar
  54. Raffle AE, Gray JAM (2007) Screening: evidence and practice. Oxford University Press, OxfordCrossRefGoogle Scholar
  55. Rauscher GH, Johnson TP, Cho YI, Walk JA (2008) Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 17(4):748–757CrossRefPubMedGoogle Scholar
  56. Richards M (2011) An independent review is under way. BMJ 343:d6843CrossRefPubMedGoogle Scholar
  57. Roelofs AA, Karssemeijer N, Wedekind N, Beck C, van Woudenberg S, Snoeren PR, Hendriks JH, Rosselli del Turco M, Bjurstam N, Junkermann H, Beijerinck D, Séradour B, Evertsz CJ (2007) Importance of comparison of current and prior mammograms in breast cancer screening. Radiology 242(1):70–77CrossRefPubMedGoogle Scholar
  58. Schwartz LM, Woloshin S, Fowler FJ, Welch HG (2004) Enthusiasm for cancer screening in the United States. JAMA 291(1):71–78CrossRefPubMedGoogle Scholar
  59. Sharpe RE, Levin DC, Parker L, Rao VM (2013) The effect of the controversial US Preventive Services Task Force recommendations on the use of screening mammography. J Am Coll Radiol 10(1):21–24CrossRefPubMedGoogle Scholar
  60. Smith RA, Saslow D, Sawyer KA, Burke W, Costanza ME, Evans WP 3rd, Foster RS Jr, Hendrick E, Eyre HJ, Sener S, American Cancer Society High-Risk Work Group, American Cancer Society Screening Older Women Work Group; American Cancer Society Mammography Work Group; American Cancer Society Physical Examination Work Group; American Cancer Society New Technologies Work Group; American Cancer Society Breast Cancer Advisory Group (2003) American Cancer Society guidelines for breast cancer screening: update 2003. Women’s Health Research Faculty PublicationsGoogle Scholar
  61. Smith-Bindman R, Ballard-Barbash R, Miglioretti DL, Patnick J, Kerlikowske K (2005) Comparing the performance of mammography screening in the USA and the UK. J Med Screen 12:1CrossRefGoogle Scholar
  62. Squires DA (2012) Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. Commonwealth FundGoogle Scholar
  63. Stubbs JW (2009) Statement on the politicization of evidence-based clinical research, in American College of Physicians (database online). Accessed 10 Aug 2014
  64. Tabár L, Vitak B, Chen TH, Yen AM, Cohen A, Tot T, Chiu SY, Chen SL, Fann JC, Rosell J, Fohlin H, Smith RA, Duffy SW (2011) Swedish two-county Trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology 260(3):658–663. doi: 10.1148/radiol.11110469 (Epub 2011 Jun 28) CrossRefPubMedGoogle Scholar
  65. Taylor P, Potts HWW (2008) Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer 44(6):798–807CrossRefPubMedGoogle Scholar
  66. The Independent UK Panel on Breast Cancer Screening (2012) The benefits and harms of breast cancer screening: an independent review. Cancer Research UK and the Department of Health, LondonGoogle Scholar
  67. United States Preventive Services Task Force (2002) Screening for breast cancer. Accessed 10 Aug 2014
  68. United States Preventive Services Task Force (2009) Screening for breast cancer. Accessed 10 Aug 2014
  69. U.S. Food and Drug Administration (2002) Mammography Quality Standards Act Regulations, Sec. 900.12 quality standards. Accessed10 Aug 2014
  70. U.S. Food and Drug Administration (2005) Mammography facility surveys, mammography equipment evaluations, and medical physicist qualification requirements under MQSA.…/ucm094411.pdf. Accessed 30 Oct 2014
  71. Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, Bergh J, Boyages J, Christiansen P, Lee M, Wärnberg F, Allemani C, Engholm G, Fornander T, Gjerstorff ML, Johannesen TB, Lawrence G, McGahan CE, Middleton R, Steward J, Tracey E, Turner D, Richards MA, Coleman MP, ICBP Module 1 Working Group (2013) Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000–2007: a population-based study. Br J Cancer 108(5):1195–1208PubMedCentralCrossRefPubMedGoogle Scholar
  72. Welch GH, Schwartz L, Woloshin S (2011) Overdiagnosed: making people sick in the pursuit of health. Beacon Press, BostonGoogle Scholar
  73. Wilson RM (2000) Screening for breast and cervical cancer as a common cause for litigation. BMJ Int Edit 320(7246):1352–1353CrossRefGoogle Scholar
  74. Wilson MG, Lavis JN (2013) Evidence brief: supporting optimal screening approaches in Canada. McMaster Health Forum, HamiltonGoogle Scholar
  75. Woolf SH (2010) The 2009 breast cancer screening recommendations of the US Preventive Services Task Force. JAMA 303(2):162–163CrossRefPubMedGoogle Scholar
  76. Yankaskas BC, May RC, Matuszewski J, Bowling JM, Jarman MP, Schroeder BF (2011) Effect of observing change from comparison mammograms on performance of screening mammography in a large community-based population. Radiology 261:762–770PubMedCentralCrossRefPubMedGoogle Scholar
  77. Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD (2012) The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 36:237–248CrossRefPubMedGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2015

Authors and Affiliations

  • Joseph Williams
    • 1
    Email author
  • Linda Garvican
    • 2
  • Anna N. A. Tosteson
    • 3
    • 4
  • David C. Goodman
    • 3
  • Tracy Onega
    • 3
    • 4
  1. 1.Care Quality CommissionLondonEngland
  2. 2.South East Coast Cancer Screening QA Reference Centre, Public Health EnglandBattleEngland
  3. 3.The Dartmouth Institute for Health Policy and Clinical Practice at the Dartmouth School of Medicine at DartmouthLebanonUSA
  4. 4.Norris Cotton Cancer Center, Geisel School of Medicine at DartmouthLebanonUSA

Personalised recommendations