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Covid-19: Breast screening

Version 3. Updated 25 March 2020.

Should we still be screening?

I work for the NHS National Breast Screening Programme and the team are concerned we are still screening amid the escalating Covid-19 infections. The close proximity we have to be in when performing mammograms goes against the advice of keeping your distance from each other; we are directly in the path of the women's breath.

We would recommend:

  1. Making your employer aware of the staff concerns because they are responsible for the health and safety of their employees.
  2. Performing a local risk assessment taking advice from your infection control team which may include removing vulnerable staff from the service, or preventing women from attending.
  3. Reviewing the risk assessment daily taking account of latest government guidance, employer restrictions, and staff concerns.

NHS England and NHS Improvement say they are reviewing screening and will issue definitive guidance soon. Some trusts have taken a local decision to cease routine screening ahead of the guidance.

The Northern Ireland government responded:

With respect to breast screening, the minister (for health) has advised that the routine screening programme is paused. Higher risk screening will continue, given the higher risk of breast cancer associated with individuals in the programme, but out of area higher risk screening will cease and all women should be screened within the Northern Trust Higher Risk unit. These actions are for three months in the first instance.

It will be imperative that no one misses a screen as a result of these changes to the programme. The PHA will be in contact with the relevant professional groups to ensure that failsafes are in place in each unit and across the programme.

It is important that anyone who is already in a screening pathway is able to complete that pathway as clinically appropriate. This includes anyone who has been referred for further investigation following their initial screen and anyone who has been diagnosed as a result of screening and requires treatment.

Dr Sinéad McGuinness
Consultant in Public Health Medicine
QA Lead, Northern Ireland Breast Screening Programme

Wales and Scotland national services have also been contacted.

Anecdotal feedback from services

Some services have ceased routine screening, redeploying staff to support acute services. This is a local level decision and may form part of business continuity or major incident plans. Service managers are advised to discuss this with senior management teams and make decisions based on local service needs.

Staff redeployment

I've been asked by our departmental management for SoR guidance on emergency movement of HCPC registered staff to areas which they do not normally work, in anticipation of staff shortages relating to the Covid-19 epidemic.

The example I was asked to enquire about was that breast-screening mammographers could hypothetically be asked to move in the short term to general x-ray to assist there, with the breast-screening service being paused for asymptomatic patients.

They would not be asked to make diagnostic exposures, but would assist in patient care, manual handling, administrative elements and so on.

We would recommend:

  • The director of AHPs and HR within the provider organisation should be made aware of the changes to working practises/roles and you are aware of any employer guidance on redeployment.
  • You should be provided with adequate education and training to support working practices in the newly deployed area and this should be recorded.
  • If you are to be an Operator under IR(ME)R 2017, or if there is any requirement for decision making relating to the exposure, that you are suitably trained and entitled under IR(ME)R.  It’s important to ensure that you receive adequate training relevant to the area of practice and that the training is recorded within your training record.
  • Recent regulator guidance from the HCPC 

Screening women over 70 years of age

Should we be screening women over 70, as their attendance at screening sessions is against government advice?

Our advice is to follow the national/local authority guidance that is updated daily. A routine screening appointment can be postponed until the situation is calmer. If a women presents as symptomatic, we would encourage they contact a GP in the normal way for guidance.

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