Background: Women receiving RT to breast tissue at a young age usually for Hodgkin lymphoma (HL) are at VHR of developing BC. English national guidelines published in 2003, advised clinician referral for annual screening starting at age 25 or 8 yrs after RT, whichever is later. Subsequent research showed screening was effective but reach into the high-risk population was poor (Howell et al, 2009). We concluded that creating a national dataset of women at VHR of BC, removing the requirement for clinician involvement, and implementing direct referral to the national VHR NHS Breast Screening Programme (NHSBSP) would improve outcomes by ensuring all at-risk women are identified and offered screening in a timely way.
Methods: BARD was created by linking data from the National Cancer Registration Dataset, the RT dataset, RT provider treatment records, and a 2003 research database resulting from a national BC risk recall exercise. BARD, included in national VHR screening guidelines since 2020, has been operational since 2021 with women referred to NHSBSP as they become eligible. We studied screening allocation in the pre-BARD era to determine adherence to guidelines by linking BARD data with the NHSBSP dataset.
Results: 3976 women in England who received RT involving breast tissue during treatment for HL (95%) or non-HL (5%) aged 10-35 yrs between 1962 and 2013 were identified and entered on BARD. Pre-BARD, 1173/3976 (29%) had been correctly allocated to annual VHR screening, 2023 (51%) had been incorrectly allocated to three yearly screening and 780 (20%) had not been offered any screening. Using BARD, 442 women due/overdue VHR screening have been referred directly to the NHSBSP since 2021. Remedial screening has also been arranged for a sub-cohort of ~1500 diagnosed pre-2003 allocated incorrect or no screening. The remainder will be referred as they become eligible for a VHR screening appointment.
Conclusion: Although guidelines set the standard for BC screening after RT, they were not implemented reliably in England. Using pioneering linkage of national data for direct patient care, BARD was created and populated with 3976 women in England at VHR of BC after RT involving breast tissue. These are being offered annual VHR BC screening through NHSBSP in line with national guidelines and without the need for clinician referral. BARD is a model for the accurate identification and optimal screening of other cohorts at high risk of late consequences of cancer treatment.
John Radford, Joanna Williams, Elsita Payne, Kirstin Roberts, Jacquie Jenkins, Anne Mackie, Aislinn Macklin-Doherty, Anthony Swerdlow, Martin McCabe, Tanya Massey, Debbie Worthington, Natalie Yates-Bolton, Marianne Aznar, Richard Cowan, Sacha Howell