Your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.

After your breasts have been X-rayed, the mammogram will be checked for any abnormalities. The results of the mammogram will be sent to you and your GP no later than 2 weeks after your appointment.

Following screening, about 1 in 25 women will be called back for further assessment.

Being called back doesn’t mean you definitely have cancer. The 1st mammogram may have been unclear. About 1 in 4 women who are called back for further assessment are diagnosed with breast cancer.

If you have any breast symptoms (such as a lump or nipple discharge) it is important that you see your GP without delay, even if you are due to have a screening mammogram shortly.

Please note that for 50-71 year olds screening is strictly by invitation only.

Women over 70 can self-refer for breast screening every three years by contacting us on 01204 390454.

If you want to be screened, you need to register with a GP practice. It is easy to register, and you should be able to register with a GP practice of your choice.

A GP practice cannot refuse to register you if you have no form of identification or because you do not have a fixed address.

The Bolton, Bury and Rochdale Breast Screening Service is run from the Breast Unit at the Royal Bolton Hospital, however to enable women to be screened closer to home, screening is carried out at four sites across the area:

• Breast Unit, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR
• Bolton One, Moor Lane, Bolton, BL3 5BN
• Radcliffe Primary Care Centre, 69 Church Street West, Radcliffe, Bury, M26 2SP
• Nye Bevan House, Maclure Rd, Rochdale, OL11 1HR

At present, we send a letter to women asking them to contact us to book an appointment, however, we are shortly going to be reverting back to sending timed appointments where women will receive a letter with a date and time for their mammogram and they will only need to contact us if this is inconvenient.

If women do not attend this appointment, they will be sent a second timed appointment.

Women with a learning or physical disability have always received timed appointments.

We are hoping that by moving back to this way of working it will make things easier for all involved and our phone lines will not be as busy which means if women do need to contact us, they shouldn’t have to wait too long to get through.

Every woman’s breasts are different in terms of size, shape and consistency. It’s also possible for one breast to be larger than the other.

Get used to how your breasts feel at different times of the month. This can change during your menstrual cycle. For example, some women have tender and lumpy breasts, especially near the armpit, around the time of their period.

After the menopause, normal breasts feel softer, less firm and not as lumpy.

The NHS Breast Screening Programme has produced a 5-point plan for being breast aware:

• know what’s normal for you
• look at your breasts and feel them
• know what changes to look for
• report any changes to a GP without delay
• attend routine screening if you’re aged 50 to 70.

If women have a physical or learning disability, a double appointment slot is given and easy read information booklets and letters will be sent out to anyone with a learning disability.

Women who are deaf will automatically have a British Sign Language (BSL) signer booked to accompany them to their screening appointment and any follow up appointments that may be necessary.

During the appointment we’ll discuss your medical history and you may have a:

• breast examination
• breast X-ray (mammogram) or ultrasound
• biopsy – where a needle is inserted into the lump to remove cells for testing

You may be told your results on the same day, although biopsy results take longer. As soon as we get your results, you will be invited for another appointment.

We will discuss your results in detail and, if appropriate, the treatment options that are available to you. If you have cancer, you will be managed within a multidisciplinary team (MDT), which is a team of specialists who work together to provide the best treatment and care.

The main treatments for breast cancer are:

• surgery
• radiotherapy
• chemotherapy
• hormone therapy
• biological therapy

You may have one of these treatments, or a combination. Together we will decide on the best option for you and create a treatment plan tailored to your needs. You will then either be referred for surgery or to Oncology (cancer) depending on your needs.

During this time, you’ll be supported by a breast care nurse. This nurse will be your first point of contact and will be by your side at every single appointment.

The Breast Unit offers a wide range of services to patients with breast problems.

Breast cancer diagnosis

We understand that receiving a breast cancer diagnosis can be frightening and overwhelming. At our Bolton Breast Unit, you will be fully-supported through all steps of your diagnosis, treatment and aftercare.

Your individual case will be discussed with you and treatments will be tailored specifically to you. We work with you to ensure that you are central to all decision-making about your care.

If you are diagnosed with breast cancer, you will be introduced to your Breast Care Nurse at that appointment. Your Breast Care Nurse will support you throughout your treatment and aftercare. You will also meet with one of our surgeons who will discuss any further tests and treatment options with you.

If you are recommended to have chemotherapy or radiotherapy, you will have an appointment in the Churchill Unit at Royal Bolton Hospital to discuss this with an Oncologist from the Christie Hospital.

Further information about being diagnosed with breast cancer can be found here: Breast cancer diagnosis

Moving Forward Programme

This programme aims to improve quality of life and the patient experience throughout their cancer journey. It provides tailored support, patient education including health promotion and early recognition of disease progression, enabling patients to self-manage their care, and places a greater focus on their recovery, health and wellbeing.

The course is delivered one morning each week for four weeks and is repeated four times a year and is facilitated by Breast Services in collaboration with Breast Cancer Now.

Breast surgery

Breast surgery is delivered at Royal Bolton Hospital by a team of six surgeons who offer the full range of surgical techniques for investigating and treating breast cancer. We also work closely with the plastic surgeons at Wythenshawe hospital.

The suitable surgical options will be fully discussed with you and you will be supported by your surgeon and breast care nurse, in making a decision that is best suited to you. Every patient with a diagnosis of breast cancer will receive an individualised treatment plan.

The operations that might be discussed with you include:

• Duct excision
• Wide local excision
• Excision biopsy
• Therapeutic mammoplasty
• Mastectomy
• Sentinel lymph node biopsy
• Axillary node clearance

Breast reconstruction

Breast reconstruction is surgery to build a breast shape when a mastectomy has been performed. This can be made using tissue taken from another part of your body, using a breast implant or a combination of both. Women may choose to use a false breast (prosthesis) instead.

Breast reconstruction may be performed at the same time as the initial operation, or a few months, or even years afterwards.

There is no time limit on when this surgery can be done.

Surgery on the normal (other) breast can be performed to try and match your natural breast to the breast reconstruction.

Here is an overview of just some of the techniques which can be used in breast reconstruction:

• Skin sparing mastectomy: the breast tissue and nipple are removed but the skin is preserved. This allows for a more natural result with less scarring.
• Reconstruction using implants: an implant is placed under the skin and muscle that covers your chest to create a breast shape.
• Reconstruction using your own tissue: skin, fat and muscle are taken from another part of your body to create a breast shape.
• Combination of both implant and your own tissue: a breast shape is created using both an implant, and skin, fat and muscle from another part of your body.

Adjuvant breast cancer treatments

Adjuvant breast cancer treatments are treatments for breast cancer in addition to surgery. Before any treatment is started, your overall treatment plan will be outlined to you. Sometimes, the full recommendations for additional treatments cannot be made until the results of surgery are available.

Adjuvant treatments that may be discussed with you include:

• Endocrine treatment
• Radiotherapy
• Chemotherapy
• Trastuzumab

The treatment programme involves:

• A family tree/pedigree is drawn up and other factors associated with risk are discussed. These include age, gender, hormonal and lifestyle choices.
• Ongoing checks in the form of MRI and mammograms are arranged on an individual basis.
• Identification of high risk patients or those with a complex family history may necessitate further referral to the Regional Genetic Centre in Manchester for further counselling and discussion.
• If breast cancer is diagnosed, the patient is referred to a consultant breast surgeon in the department.

Referral letters should be directed to:

Angela Duckworth
Breast Services, Evergreen Suite
Royal Bolton Hospital
Minerva Road
Bolton, BL4 0JR