8 9 Meet the team that knows breast If there’s one team in the trust facing a particularly exciting challenge in 2026, it has to be the breast screening service. On April 1 the RFL added West of London and Outer North East London breast screening services to the areas it already covers, making us the largest provider in the country, responsible for screening everywhere north of the Thames right out to the M25. That’s an additional 310,000 women, bringing the total number served by RFL to 750,000. In practice it will mean that women will have a greater choice over the location of their screening, and more flexibility to book appointments at a time convenient to them. The trust now covers four of London’s six breast screening services. In addition, the hub which is run by RFL is already responsible for the administration work for all of London, equating to 1.3 million women. Service with a strong track record The service wasn’t always the enormous operation it is today. It has grown over the years, and with that has come the knowledge, expertise and track record to enable the expansion. The team now numbers more than 220 staff, including mammographers, radiographers, clinical nurse specialists and administrative staff. Kenneth Blake is assistant operations manager for the London administrative hub. Outside of London each individual service provides an end-to-end provision, but since 2016 the RFL has been responsible for the call centre, scheduling (both staff and patients) and data collation across London. “We handle over 20,000 calls a month,” said Kenneth. “Our call centre is open seven days a week and I’m proud to say the average waiting time for the call to be answered is less than 30 seconds. “Patients can book their screening online and we are now investigating the possibility of introducing a web chat function, but it doesn’t end there. The hub ensures that all eligible women are communicated with effectively, whether that be an invitation, attendance outcome or GP notification. All patients referred for cancer treatment have their data logged and recorded on national breast screening systems.” We have already identified a number of cancers in women who might otherwise have not attended “ “ We have built resilience into our workforce “ “ Take-up of screening in London is historically lower than other areas of the country due to a number of factors, including a diverse population and greater movement. Letters and reminder texts often go unanswered. “We do everything in our power to get the women to attend their appointments, but we know more can be done,” said Claire Mabena. Claire is the lead clinical nurse specialist (CNS) for the breast screening service, and as well as leading a team of nurses she is also in charge of a health promotion team. She said: “It’s about contacting women, engaging with them and reassuring them. Sometimes it means breaking down common myths, such as concerns about the amount of radiation being used. It’s also about making reasonable adjustments for patients with learning difficulties, special needs, physical disabilities or mental health issues. This is work that makes a difference. We have already identified a number of cancers in women who may not otherwise have attended without our intervention.” There is a lot of primary care community engagement, especially with underrepresented groups such as the Somali, Bangladeshi, Romanian and Greek communities. The health promotion team regularly trains champions within those communities to build trust. Claire added: “Now our geographical area has grown we will need to look at other ethnicities concentrated in the new areas.” The team also feeds into the primary care network meetings to encourage GPs to run health and wellbeing events in their surgeries, which the health promotion team can be a part of. Early diagnosis is key More than 10,000 women are screened each month, with 400 of those brought back for further tests such as ultrasound and biopsies, and about 1,000 people are diagnosed every year – 75% at stage 1 or 2 which means less aggressive treatments and better long-term prognosis. As the screening programme continues year on year, the size of cancers found is smaller and image quality has improved greatly. Of course, with the growth in the service these numbers will all rise. Kim Stoddard, senior operations manager and Kenneth Blake, assistant operations manager for the London administrative hub Breast screening senior team colleagues William Teh, director of screening and Stephanie Scott, superintendent radiographer Staff from the London administrative hub Kim Stoddard, senior operations manager, said: “We’ve spent a lot of time and hard work developing our teams. We know the expansion will bring challenges, but we embrace that. We have built resilience into our workforce and we make sure there is senior oversight and support, so our staff have that reassurance.” North London has its own particular needs. People of Jewish heritage have a significantly higher risk of carrying a mutated BRCA gene compared to the general population. As part of an extension to routine screening, a high-risk programme is in place with an extended age range. Within this programme approximately 75 women a month require MRI scans to assess their breasts and approximately 500 women aged from 25 to 71 will have a mammogram each year. Research is also an important element of the screening service, with three large trials concluding and others commencing. One which recently closed compared 2D with 3D imaging, and another compared surgery with active monitoring for women with low risk ductal carcinoma in situ (DCIS). More than 11,000 women have been involved in breast screening research at the RFL over the last two years. William Teh, director of screening at the RFL, said: “As well as waiting to hear the results of the large trials, we also have a small trial taking place where we are looking at removing a small tumour – less than 15mm in size and classed as grade 1 – by using a vacuum needle, instead of the current standard care, which involves a surgical approach. All these trials could end up changing how women are treated in the future. “We are also looking to introduce a study to assess how we can harness AI to improve cancer detection. A further piece of work supported by AI could potentially be used to help us reach out to non-attendees.” Steven Davies, operations manager, is excited about the opportunities on the horizon. He said: “By being bigger we have more shared staff resources, which will enable us to increase patient choice and flexibility, and offer more research and development opportunities; all with the aim of improving patient care.” Although there is a national shortage of mammographers, the numbers are robust in the trust’s service. The team is proud of its strong recruitment and retention rates and ability to promote staff from the apprentice programme and internal development initiatives.
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