Loading
Breast cancer in the UK and the NHS
Breast cancer is the most commonly diagnosed cancer in the UK, and the NHS sees more of it than of any other: 183,420 urgent suspected breast cancer referrals and another 35,571 urgent breast symptomatic referrals in the four months from April to July 2026 alone, one in six of every urgent cancer referral made in England. This page is the part of the story that is the same whichever receptor result comes back. It covers the NHS Breast Screening Programme, which is the oldest and largest cancer screening programme in the country, with its ages, its interval, its uptake, what a recall means and how often it turns out to be nothing, and the benefit and overdiagnosis estimate the programme itself publishes; the family history and very high risk services, who qualifies for them and what they offer; the diagnostic pathway from the referral rules to the one-stop clinic; the waiting-time standards and how breast cancer actually does against them, by route; what the NHS funds whatever the receptor status, including the refusals; and where Scotland, Wales and Northern Ireland differ. What depends on the receptor result is on the subtype pages: triple-negative disease has its own NHS page, and so do the hormone-receptor-positive and HER2-positive pathways.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
A lump or a change, and an urgent suspected cancer referral
183,420 urgent referrals in four months (England, April to July 2026)The commonest door. NICE NG12 recommendation 1.4.1 tells a GP to refer on the suspected cancer pathway anyone aged 30 and over with an unexplained breast lump with or without pain, and anyone aged 50 and over with discharge, retraction or other changes of concern in one nipple only. Recommendation 1.4.2 says to consider the same referral for skin changes that suggest breast cancer, or for an unexplained lump in the armpit at 30 and over. Recommendation 1.4.3 says to consider a non-urgent referral under 30 with an unexplained breast lump. England received 183,420 urgent suspected breast cancer referrals in the four months April to July 2026, against 1,124,238 urgent suspected cancer referrals for all cancers: 16 percent of the total, the largest single tumour group.
Sources: NICE NG12: suspected cancer, recognition and referral, breast cancer recommendations 1.4.1 to 1.4.3. Refer on a suspected cancer pathway at 30 and over with an unexplained breast lump, or at 50 and over with discharge, retraction or other changes of concern in one nipple; consider referral for skin changes that suggest breast cancer or an unexplained axillary lump at 30 and over; consider a non-urgent referral under 30 (2026-04-15); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10); GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10)
The breast symptomatic route: cancer not initially suspected
35,571 breast symptomatic referrals in four months (England, April to July 2026)Breast is the only cancer with a second urgent referral pathway of its own. A GP who thinks a breast symptom is very unlikely to be cancer can still refer urgently on the breast symptomatic pathway, and the person is seen in the same one-stop clinic. England received 35,571 of these referrals between April and July 2026. They are not a lesser pathway: in July 2026, 96 people whose cancer was found this way started treatment, and the route's 62-day performance was 64.6 percent, worse than the urgent suspected cancer route. The 28-day standard applies to this pathway too, and it is met more often here than on the suspected cancer route, at 91.7 percent against 89.9 percent in July 2026.
Sources: NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10); GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10); NHS England: changes to cancer waiting times standards from 1 October 2023. The two-week wait standard was removed in favour of the 28-day Faster Diagnosis Standard, and the ten standards were rationalised to three; the letter says performance against breast and skin specifically would need to be above 90 percent for the Faster Diagnosis Standard to rise to 80 percent (2023-08-17)
Screening
19,291 cancers found by screening (England, 2024/25)The NHS Breast Screening Programme invites women in England for a first mammogram between the ages of 50 and 53 and then every three years until they turn 71. In 2024/25 it issued 2.75 million invitations, 1.94 million women aged 50 to 70 attended within six months, and 19,291 cancers were found: 9.0 per 1,000 women screened. A cancer found this way is usually smaller and earlier than one found because of a symptom, and it enters the 62-day pathway by a different door, the national screening programme route, with its own clock.
Sources: NHS England: women attending first NHS mammogram hits 10-year high as thousands more cancers found. The 2024/25 NHS Breast Screening Programme annual statistics: 2.75 million invitations, 1.94 million women aged 50 to 70 screened within six months, 71.8 percent three-year coverage, 70.6 percent uptake, 63.6 percent first-invite uptake, 19,291 cancers detected at 9.0 per 1,000 (2026-02-19); GOV.UK (NHS England): your guide to NHS breast screening. First invitation between 50 and 53, then every 3 years until 71; results within 2 weeks; 96 in 100 need no further tests, 4 in 100 do and 1 of those 4 has cancer (2026-02-23); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10)
A family history
A minority of breast cancers run in families, and the NHS has a separate route for the people who carry the risk before any cancer appears. NICE CG164 recommendation 1.3.3 sets out which family histories a GP should refer to secondary care, and 1.4.4 which should go to a specialist genetic clinic; above a 10 percent probability of carrying a BRCA1 or BRCA2 variant, recommendations 1.5.11 to 1.5.13 say genetic testing should be offered. People with a proven high-risk variant leave the routine programme altogether for the very high risk surveillance programme, which starts MRI at 25 or, for a TP53 variant, at 20.
Sources: NICE CG164 recommendations: referral from primary care (1.3.1 to 1.3.6), referral to a specialist genetic clinic (1.4.4), carrier probability at which genetic testing is offered (1.5.11 to 1.5.13), mammographic and MRI surveillance (1.6.3 to 1.6.9), CanRisk (1.6.25) and chemoprevention (1.7.21 to 1.7.28) (2023-11-14); GOV.UK (NHS England): tests and frequency of testing for women at very high risk. The gene-by-gene and age-by-age surveillance protocol for the very high risk programme, including the CanRisk 10-year risk thresholds (2025-11-18)
A cancer that comes back, or that was metastatic from the start
Secondary breast cancer can appear years after the first treatment, and there is no screening for it and no national referral rule. In December 2025 NICE's prioritisation board decided not to develop a guideline on identifying secondary breast cancer in primary care, because the evidence would not support the 3 percent positive predictive value threshold that NG12's referral rules are built on and any recommendations would be consensus only; the decision was published on 21 September 2026. NICE CG81, the advanced breast cancer guideline, was substantially updated on 30 June 2026 with new recommendations on information and supportive care, diagnosis and assessment, and systemic anticancer therapy. The National Audit of Metastatic Breast Cancer now runs alongside the primary one.
Sources: NICE GID-NG10592: identification of secondary breast cancer in primary care. The prioritisation board decided on 15 December 2025 not to prioritise the topic, because there is unlikely to be evidence to give the positive predictive values that NG12's 3 percent threshold needs, and any recommendations would be consensus only (decision published 21 September 2026) (2026-09-21); NICE CG81: advanced breast cancer, diagnosis and treatment (published 23 February 2009, last updated 30 June 2026 with new and updated recommendations on information and supportive care, diagnosis and assessment, and systemic anticancer therapy) (2026-06-30); National Audit of Metastatic Breast Cancer (NAoMe), the companion audit for people diagnosed with or progressing to metastatic disease in England and Wales (2026-09-25)
- 1Screening invitationFirst invitation between 50 and 53, then every three years until the 71st birthdayTarget Coverage and uptake: 70% acceptable, 80% achievable
GP practices are called in turn, so a first invitation can arrive at any point between 50 and 53. Women over 71 are not invited automatically but can ask their local service for an appointment every three years. The programme's own standards set coverage, the share of eligible women screened within the last 36 months, at 70 percent acceptable and 80 percent achievable (BSP-S02), and uptake at the same thresholds (BSP-S03). In 2024/25 England reached 71.8 percent coverage and 70.6 percent uptake; first-invite uptake was 63.6 percent, the highest in a decade, which means more than a third of women still do not attend their first appointment.
Sources: GOV.UK (NHS England): your guide to NHS breast screening. First invitation between 50 and 53, then every 3 years until 71; results within 2 weeks; 96 in 100 need no further tests, 4 in 100 do and 1 of those 4 has cancer (2026-02-23); GOV.UK (NHS England): NHS breast screening programme screening standards valid for data collected from 1 April 2021 (BSP-S02 coverage, S03 uptake, S06 results in 2 weeks, S07 referral to assessment, S09 assessment appointment in 3 weeks, S13 positive predictive value) (2026-01-29); NHS England: women attending first NHS mammogram hits 10-year high as thousands more cancers found. The 2024/25 NHS Breast Screening Programme annual statistics: 2.75 million invitations, 1.94 million women aged 50 to 70 screened within six months, 71.8 percent three-year coverage, 70.6 percent uptake, 63.6 percent first-invite uptake, 19,291 cancers detected at 9.0 per 1,000 (2026-02-19)
- 2Two weeks: the screening resultA result letter within two weeks of the mammogramTarget 95% within 14 days (99% achievable)
The programme standard BSP-S06 requires 95 percent of women who need no further tests to have a result letter produced within 14 calendar days of a technically adequate screen, with 99 percent achievable. Of every 100 women screened, about 96 are told no further tests are needed and 4 are called back. The programme also caps the recall rate: BSP-S07 sets the referral-to-assessment rate at under 4 percent on a repeat screen (3 percent achievable) and under 9 percent on a first screen (7 percent achievable).
Sources: GOV.UK (NHS England): your guide to NHS breast screening. First invitation between 50 and 53, then every 3 years until 71; results within 2 weeks; 96 in 100 need no further tests, 4 in 100 do and 1 of those 4 has cancer (2026-02-23); GOV.UK (NHS England): NHS breast screening programme screening standards valid for data collected from 1 April 2021 (BSP-S02 coverage, S03 uptake, S06 results in 2 weeks, S07 referral to assessment, S09 assessment appointment in 3 weeks, S13 positive predictive value) (2026-01-29)
- 3Recall for assessmentAn assessment appointment offered within three weeksTarget 95% offered an appointment within 21 days
Being called back is not a diagnosis. Of the four women in every 100 who need further tests, one turns out to have cancer and three do not. Assessment means some combination of examination, more mammograms, ultrasound and a needle biopsy at a single visit, and standard BSP-S09 requires 95 percent of women to be offered that appointment within 21 calendar days of the screening mammogram. BSP-S10 requires 95 percent of women who do have cancer to have the diagnosis made in three assessment visits or fewer, and BSP-S13 sets the positive predictive value of a recall at 24 percent or more on a repeat screen and 8 percent or more on a first one: in other words the programme expects most recalls to be false alarms and monitors the rate at which they are.
Sources: GOV.UK (NHS England): your guide to NHS breast screening. First invitation between 50 and 53, then every 3 years until 71; results within 2 weeks; 96 in 100 need no further tests, 4 in 100 do and 1 of those 4 has cancer (2026-02-23); GOV.UK (NHS England): NHS breast screening programme screening standards valid for data collected from 1 April 2021 (BSP-S02 coverage, S03 uptake, S06 results in 2 weeks, S07 referral to assessment, S09 assessment appointment in 3 weeks, S13 positive predictive value) (2026-01-29)
- 4Day 0: the referralAn urgent suspected cancer referral, an urgent breast symptomatic referral, or a screening recall
The 62-day clock starts at the referral, whichever of the three doors it comes through, and a fourth door, the consultant upgrade, starts it when a clinician escalates someone already in the system. Breast is the only cancer with a symptomatic pathway of its own, kept when the two-week wait standards were abolished on 1 October 2023 because the referral itself, not the target attached to it, is what routes people to a one-stop clinic.
Sources: NICE NG12: suspected cancer, recognition and referral, breast cancer recommendations 1.4.1 to 1.4.3. Refer on a suspected cancer pathway at 30 and over with an unexplained breast lump, or at 50 and over with discharge, retraction or other changes of concern in one nipple; consider referral for skin changes that suggest breast cancer or an unexplained axillary lump at 30 and over; consider a non-urgent referral under 30 (2026-04-15); NHS England: changes to cancer waiting times standards from 1 October 2023. The two-week wait standard was removed in favour of the 28-day Faster Diagnosis Standard, and the ten standards were rationalised to three; the letter says performance against breast and skin specifically would need to be above 90 percent for the Faster Diagnosis Standard to rise to 80 percent (2023-08-17); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10)
- 5The one-stop clinic: triple assessmentClinical examination, imaging and biopsy at a single hospital visitTarget NICE QS12 statement 1
NICE quality standard QS12, statement 1, says people with suspected breast cancer referred to specialist services are offered the triple diagnostic assessment in a single hospital visit. The National Audit of Primary Breast Cancer found in its 2026 report that 68.1 percent of people on a non-screening pathway in England were diagnosed through such a clinic, and that the rate ranged from 5.3 percent to 89.3 percent depending on the organisation. Some of that spread is real and some is recording: the audit had to estimate the English figure with an algorithm because trusts were not completing the specific data item, and where the item was completed the rate was 79.2 percent. The lowest figure in England, 5.3 percent, is The Royal Marsden, a tertiary centre most of whose patients arrive already diagnosed elsewhere, which is why an audit indicator is not a league table.
Sources: NICE QS12: breast cancer, quality statement 1 on timely diagnosis. People with suspected breast cancer referred to specialist services are offered the triple diagnostic assessment in a single hospital visit (published 28 September 2011, last updated 30 June 2026) (2026-06-30); National Audit of Primary Breast Cancer, State of the Nation report 2026 (NATCAN, Royal College of Surgeons of England, published September 2026): 146,795 people diagnosed with primary breast cancer in England and Wales in 2021 to 2023, of whom 1,060 were men; 68.1 percent of people on a non-screening pathway in England were diagnosed through a triple diagnostic assessment clinic, with rates from 5.3 to 89.3 percent by organisation (2026-09); National Audit of Primary Breast Cancer, State of the Nation report 2026 (PDF). Stage at diagnosis, triple diagnostic assessment, breast-conserving surgery, immediate reconstruction, re-operation, adjuvant radiotherapy and three-year survival for England and Wales (2026-09); National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery) (2026-09)
- 628 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of referralTarget 75%, rising to 80%; above 90% expected for breast
Breast cancer is one of the two tumour groups NHS England expects to beat this standard comfortably: the 2023 letter that abolished the two-week wait said performance against breast and skin specifically would need to be above 90 percent for the national threshold to rise to 80 percent. In July 2026, 47,198 of 53,020 suspected breast cancer pathways met it, 89.0 percent, against 79.3 percent for all cancers; the breast symptomatic pathway did better at 91.7 percent. The route that lags is screening: 4,475 of 5,471, or 81.8 percent, because a screening recall goes to assessment before it goes to diagnosis.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023. The two-week wait standard was removed in favour of the 28-day Faster Diagnosis Standard, and the ten standards were rationalised to three; the letter says performance against breast and skin specifically would need to be above 90 percent for the Faster Diagnosis Standard to rise to 80 percent (2023-08-17); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10); GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10)
- 7The breast multidisciplinary teamReceptor status available before treatment is discussed
NICE NG101 recommendation 1.3.1 says the oestrogen receptor, progesterone receptor and HER2 status of every invasive breast cancer are assessed simultaneously at the time of the initial histopathological diagnosis, and 1.3.5 says all three must be available and recorded at the preoperative and postoperative multidisciplinary team meetings. That is the moment the family page stops and the subtype page starts: the three results decide which of the three pathways a person is on. Recommendation 1.3.6 adds germline BRCA1 and BRCA2 testing for women under 50 with triple-negative disease whatever the family history. Recommendations 1.2.1 to 1.2.3 govern the staging: ultrasound of the axilla for everyone, with needle sampling of any abnormal node, and MRI only where the extent of disease is unclear, the breast is too dense to assess or the cancer is lobular and breast-conserving surgery is being considered.
- 831 days: decision to treat to first treatmentTreatment starts within 31 days of the decision to treatTarget 96%
Breast cancer does slightly better than the average here. In July 2026, 12,554 of 13,640 breast treatments started within 31 days, 92.0 percent, against 92.5 percent for all cancers; first treatments were 92.7 percent and subsequent treatments 91.7 percent. Across April to July 2026 the breast figure was 92.0 percent on 50,797 treatments, the largest volume of any tumour group.
Sources: NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10); GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10)
- 962 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85%
This is where breast cancer is worse than its reputation. In July 2026, 3,435 of 4,931 people started treatment within 62 days: 69.7 percent, below the 71.2 percent for all cancers and a long way below the 85 percent standard. The route matters: 66.5 percent on the urgent suspected cancer route, 70.6 percent through screening, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade. Across April to July 2026 it was 68.5 percent on 17,872 treatments. The gap between a 28-day standard almost met at 89 percent and a 62-day standard missed by fifteen points says where the delay is: not in getting the diagnosis, but in the month between the diagnosis and the first operation or infusion.
Sources: NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The breast rows for July 2026: 47,198 of 53,020 suspected breast cancer pathways met the 28-day standard (89.0 percent), 8,225 of 8,971 breast symptomatic pathways (91.7 percent), 12,554 of 13,640 breast treatments met the 31-day standard (92.0 percent) and 3,435 of 4,931 met the 62-day standard (69.7 percent), split 66.5 percent on the urgent suspected cancer route, 70.6 percent on the screening route, 64.6 percent on the breast symptomatic route and 82.8 percent on the consultant upgrade route (2026-09-10); GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10)
- 10Surgery, the axilla and reconstructionBreast-conserving surgery where it is possible; reconstruction offered to everyone who has a mastectomy
NICE NG101 recommendation 1.5.1 says to offer breast reconstruction to people after they have had a mastectomy for breast cancer, and 1.5.3 says to offer both immediate and delayed reconstruction whether or not they are available locally. The audit shows how unevenly that is delivered: 27 percent of women in England and 15 percent in Wales who had a mastectomy had an immediate reconstruction, ranging from 5.4 percent at the Isle of Wight NHS Trust to 59.9 percent at Mersey and West Lancashire. On the axilla, recommendation 1.4.9 says to stage with sentinel lymph node biopsy rather than clearance where ultrasound and any needle biopsy are negative, 1.4.14 and 1.4.15 say not to treat the axilla further for micrometastases or isolated tumour cells, and 1.4.3 to 1.4.5 set the margins that trigger a second operation: further surgery is offered where the tumour is at the inked margin, and considered within 1mm for invasive cancer or 2mm for ductal carcinoma in situ, thresholds lowered in 2024 to reduce the number of second operations. Across England and Wales 16 and 19 percent of people needed at least one re-operation within twelve months of breast-conserving surgery, from 7.9 to 32.0 percent by organisation.
Sources: NICE NG101 recommendations: pretreatment assessment (1.2), receptor and genetic testing (1.3.1 to 1.3.6), surgery to the breast and axilla (1.4), breast reconstruction (1.5.1 to 1.5.3), chemotherapy for all receptor subtypes (1.7.1 to 1.7.3), adjuvant bisphosphonates (1.12.1 to 1.12.3), radiotherapy and dose fractionation (1.13.1 to 1.13.29) and lymphoedema (1.14) (2025-04-14); National Audit of Primary Breast Cancer, State of the Nation report 2026 (PDF). Stage at diagnosis, triple diagnostic assessment, breast-conserving surgery, immediate reconstruction, re-operation, adjuvant radiotherapy and three-year survival for England and Wales (2026-09); National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery) (2026-09)
- 11Radiotherapy: one week, not three26 Gy in 5 fractions over 1 week for most peopleTarget NG101 1.13.13
NICE NG101 recommendation 1.13.13 offers 26 Gy in five fractions over one week to people having partial-breast, whole-breast or chest-wall radiotherapy without regional lymph node irradiation, after either breast-conserving surgery or mastectomy. Recommendation 1.13.14 keeps 40 Gy in 15 fractions over three weeks for people with a condition that increases radiosensitivity, an implant-based reconstruction or another reason the longer course is more acceptable, and 1.13.16 keeps it for everyone having their lymph nodes irradiated. Recommendation 1.13.2 requires a deep inspiratory breath-hold technique for left-sided cancers to keep the dose off the heart. The five-fraction schedule is a UK trial result adopted as UK practice: the audit reports 86 percent of women in England and 47 percent in Wales having adjuvant radiotherapy after breast-conserving surgery.
Sources: NICE NG101 recommendations: pretreatment assessment (1.2), receptor and genetic testing (1.3.1 to 1.3.6), surgery to the breast and axilla (1.4), breast reconstruction (1.5.1 to 1.5.3), chemotherapy for all receptor subtypes (1.7.1 to 1.7.3), adjuvant bisphosphonates (1.12.1 to 1.12.3), radiotherapy and dose fractionation (1.13.1 to 1.13.29) and lymphoedema (1.14) (2025-04-14); National Audit of Primary Breast Cancer, State of the Nation report 2026 (PDF). Stage at diagnosis, triple diagnostic assessment, breast-conserving surgery, immediate reconstruction, re-operation, adjuvant radiotherapy and three-year survival for England and Wales (2026-09); Murray Brunt et al, Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial, Lancet 2020 (2020)
- 12Genetic testing and the familyR208 germline testing where the criteria are met, then predictive testing for relatives
Germline testing is requested by the breast team, not only by a genetics clinic. The rare and inherited disease test directory's R208 criteria include breast cancer under 40, bilateral breast cancer under 60, triple-negative breast cancer under 60, breast cancer in anyone assigned male at birth at any age, Ashkenazi Jewish ancestry at any age, a grandparent from Westray in Orkney or Whalsay in Shetland at any age, and a pathology-adjusted Manchester score of 15 or more or a CanRisk score of 10 percent or more. Once a variant is found in the family, relatives are tested for that one variant under R242, predictive testing for known familial variants, which can only be offered by clinical genetics. R444.1 is the separate code for BRCA1 and BRCA2 testing to decide whether someone is eligible for a PARP inhibitor.
Sources: NHS England: rare and inherited disease eligibility criteria version 9.1, R208 inherited breast cancer and ovarian cancer. Testing criteria include breast cancer under 40, bilateral breast cancer under 60, triple-negative breast cancer under 60, breast cancer in anyone assigned male at birth at any age, a pathology-adjusted Manchester score of 15 or more or a CanRisk score of 10 percent or more, Ashkenazi Jewish ancestry at any age, and a grandparent from Westray or Whalsay at any age (2026-05-20); NHS England: rare and inherited disease national genomic test directory, version 9 (R208.1 inherited breast cancer and ovarian cancer, R216.1 Li-Fraumeni syndrome, R242.1 predictive testing for a known familial variant, R444.1 NICE approved PARP inhibitor treatment) (2026-05-20); NHS England: the NHS Genomic Medicine Service (seven Genomic Laboratory Hubs deliver the test directory in England) (2026-09-25)
Where you would be treated
16 centre entries across 4 nations, with what each offers for this cancer. The service model note below says what happens only at a specialist centre and what can be given closer to home under its MDT.
England
Manchester University NHS Foundation Trust
Manchester University NHS Foundation Trust
Manchester
- The largest breast cancer caseload in the audit: 2,168 people having breast-conserving surgery in 2021 to 2023
- Triple diagnostic assessment in a single visit for 35.6 percent of 1,557 people diagnosed outside screening
- Immediate reconstruction after 36.9 percent of 902 mastectomies
- Re-operation after 16.1 percent of breast-conserving operations, at the national average
Service pageListed by National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery), National Audit of Primary Breast Cancer, State of the Nation report 2026 (NATCAN, Royal College of Surgeons of England, published September 2026)
University Hospitals Sussex NHS Foundation Trust
Brighton
- 1,983 people diagnosed outside screening in 2021 to 2023, the largest diagnostic volume in the audit
- Triple diagnostic assessment in a single visit for 71.2 percent
- Immediate reconstruction after 30.7 percent of 707 mastectomies
University Hospitals Birmingham NHS Foundation Trust
Birmingham
- 1,795 people diagnosed outside screening in 2021 to 2023
- Triple diagnostic assessment in a single visit for 66.2 percent
- Immediate reconstruction after 26.8 percent of 727 mastectomies
Liverpool University Hospitals NHS Foundation Trust
Liverpool
- 1,421 people diagnosed outside screening in 2021 to 2023
- Triple diagnostic assessment in a single visit for 77.7 percent, above the English average
University Hospitals Plymouth NHS Trust
Plymouth
- The highest one-stop clinic rate in England: triple diagnostic assessment in a single visit for 89.3 percent of 798 people
- Re-operation after 10.3 percent of 861 breast-conserving operations, among the lowest in the audit
Service pageListed by National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery), National Audit of Primary Breast Cancer, State of the Nation report 2026 (NATCAN, Royal College of Surgeons of England, published September 2026)
Norfolk and Norwich University Hospitals NHS Foundation Trust
Norwich
- The lowest re-operation rate of any high-volume centre: 10.0 percent after 1,117 breast-conserving operations against a national average of 16 percent
- The highest immediate reconstruction rate of any large centre: 59.5 percent of 477 mastectomies
- Triple diagnostic assessment in a single visit for 34.4 percent, one of the lowest in England
The Royal Marsden NHS Foundation Trust
London and Sutton
- Immediate reconstruction after 51.8 percent of 523 mastectomies
- The lowest recorded one-stop clinic rate in England at 5.3 percent, which reflects a tertiary referral model in which most people arrive already diagnosed rather than the quality of the service
Service pageSecond opinionListed by National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery), National Audit of Primary Breast Cancer, State of the Nation report 2026 (NATCAN, Royal College of Surgeons of England, published September 2026)
Scotland
South East Scotland Breast Screening Centre
Edinburgh
- Screening for NHS Lothian, NHS Borders, part of NHS Forth Valley and the Fife practices not covered by Tayside
- Ardmillan House, 42 Ardmillan Terrace
Service pageListed by NHS inform
West Scotland Breast Screening Centre
Glasgow
- Screening for NHS Greater Glasgow and Clyde, NHS Lanarkshire, part of NHS Forth Valley and part of NHS Highland
- Stock Exchange Court, 77 Nelson Mandela Place
- Evening clinics on Tuesday to Thursday
Service pageListed by NHS inform
North of Scotland Breast Centre
Inverness
- Screening for NHS Highland excluding Argyll and Bute, NHS Western Isles and the Forres area of Grampian
- Raigmore Hospital
Service pageListed by NHS inform
North East Scotland, East Scotland and South West Scotland Breast Screening Centres
Aberdeen, Dundee and Irvine
- Aberdeen Royal Infirmary covers NHS Grampian, Orkney and Shetland
- Ninewells Hospital in Dundee covers NHS Tayside and part of NHS Fife
- Ayrshire Central Hospital in Irvine covers NHS Ayrshire and Arran and NHS Dumfries and Galloway
Service pageListed by NHS inform
Wales
Breast Test Wales
Cardiff, Swansea, Llandudno and Wrexham
- The national screening service, with four static centres and eleven mobile units visiting over 100 sites in each three-year round
- 174,364 women aged 50 to 70 invited in 2023/24, 68.5 percent uptake and 1,303 cancers detected
Aneurin Bevan University Health Board
Newport
- The highest recorded one-stop clinic rate in the audit: triple diagnostic assessment in a single visit for 93.2 percent of 251 people diagnosed in the second half of 2023
Cardiff and Vale University Health Board
Cardiff
- 221 people diagnosed outside screening in the second half of 2023, with a recorded one-stop clinic rate of 9.5 percent, the lowest in Wales and the outlier the audit flags
Northern Ireland
Northern Ireland Breast Screening Programme
Belfast, Antrim, Craigavon and Londonderry
- Four area screening centres covering Belfast and South Eastern, Northern, Southern and Western areas, plus mobile units
- Women aged 50 to 70 invited every three years and all invited before their 53rd birthday
- About four in 100 called back after a first mammogram, of whom three in four have normal results
Service pageListed by nidirect, HSC Public Health Agency
The service model
Breast cancer is treated in more hospitals than any other common cancer, because most of the surgery is day-case and most of the radiotherapy is five visits. There is no small national list of centres and no volume standard of the kind that governs pancreatic or oesophageal surgery. What there is, since 2024, is an audit: the National Audit of Primary Breast Cancer covers every NHS trust in England and every health board in Wales, and its 2026 report is the first source that names organisations with numbers attached. The cards above are drawn from its data tables rather than from any commissioning list. Read them as a map of variation, not a league table. Three of the audit's indicators vary far more than clinical need can explain: the one-stop clinic rate runs from 5.3 to 89.3 percent, immediate reconstruction after mastectomy from 5.4 to 59.9 percent, and re-operation after breast-conserving surgery from 7.9 to 32.0 percent. But the lowest one-stop rate belongs to a tertiary centre whose patients mostly arrive already diagnosed, the audit itself had to estimate the English one-stop figure with an algorithm because trusts were not completing the data item, and Wales's numbers cover only the second half of 2023 because a new dataset was being implemented. The screening side is different again: screening is organised nationally, not by trust, and in Scotland, Wales and Northern Ireland the screening service is the national service, which is why those cards name screening centres rather than surgical units. Where a person is treated for a particular receptor subtype, and which centres run trials in it, is on the subtype pages rather than here.
Sources: National Audit of Primary Breast Cancer, State of the Nation report 2026 (NATCAN, Royal College of Surgeons of England, published September 2026): 146,795 people diagnosed with primary breast cancer in England and Wales in 2021 to 2023, of whom 1,060 were men; 68.1 percent of people on a non-screening pathway in England were diagnosed through a triple diagnostic assessment clinic, with rates from 5.3 to 89.3 percent by organisation (2026-09); National Audit of Primary Breast Cancer, State of the Nation report 2026 (PDF). Stage at diagnosis, triple diagnostic assessment, breast-conserving surgery, immediate reconstruction, re-operation, adjuvant radiotherapy and three-year survival for England and Wales (2026-09); National Audit of Primary Breast Cancer, State of the Nation 2026 data tables (organisation-level results for triple diagnostic assessment, immediate breast reconstruction and re-operation after breast-conserving surgery) (2026-09); NHS inform: breast screening centres in Scotland. Six centres, at Raigmore Hospital in Inverness, Aberdeen Royal Infirmary, Nelson Mandela Place in Glasgow, Ayrshire Central Hospital in Irvine, Ninewells Hospital in Dundee and Ardmillan House in Edinburgh, with mobile units; women aged 50 to 70 are invited every 3 years and may not get a first invitation until 53 (2026-05-27); Public Health Wales: Breast Test Wales annual statistical report 2023 to 2024 (published 19 March 2026). Women aged 50 to 70 are invited every three years; the programme has centres in Cardiff, Swansea, Llandudno and Wrexham and eleven mobile units visiting over 100 sites in each three-year round (2026-03-19); nidirect: breast screening, an overview (Northern Ireland). Women aged 50 to 70 registered with a GP are invited every three years and all eligible women should be invited before their 53rd birthday; results within two weeks; about four in 100 are called back after a first mammogram and three out of four of those have normal results; the four screening centres are in the Belfast and South Eastern, Northern, Southern and Western areas (2026-09-25)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| Before any cancer: risk reduction at high or moderate familial risk | Tamoxifen for five years if premenopausal; anastrozole for five years if postmenopausal; raloxifene as an alternative for postmenopausal women with a uterus The evidence is two UK trials: IBIS-I for tamoxifen and IBIS-II for anastrozole. Anastrozole was licensed for prevention in 2023 under the MHRA repurposing programme, so a generic tablet costing a few pence a day is now a licensed prevention drug. | NHS England CG164 1.7.21 to 1.7.282023-11-14 Funded through the NHS on NICE CG164. Recommendation 1.7.21 says to offer tamoxifen for five years to premenopausal women at high risk unless they have or are at risk of thromboembolic disease or endometrial cancer; 1.7.22, amended in 2023, says to offer anastrozole for five years to postmenopausal women at high risk unless they have severe osteoporosis; 1.7.23 keeps tamoxifen and raloxifene as alternatives; 1.7.25 to 1.7.27 make the same three options a 'consider' at moderate risk. Recommendation 1.7.28 says not to continue beyond five years, and 1.7.24 says not to offer chemoprevention after a bilateral risk-reducing mastectomy. Raloxifene use for this indication was off-label in March 2017. | NHS England CG164 is an England and Wales guideline; Scotland delivers familial risk assessment and risk-reducing medication through its regional genetics services and the very high risk screening pathway, and no separate Scottish appraisal of tamoxifen or anastrozole for prevention was found. | Wales: CG164 applies in Wales. NI: CG164 is adopted in Northern Ireland; the very high risk surveillance programme runs there under the same name. |
| Before any cancer: surveillance at very high risk | Annual MRI, annual mammography, or both, through the very high risk arm of the NHS Breast Screening Programme NICE CG164 recommendations 1.6.3 to 1.6.9 cover the level below this, for moderate and high risk that is not gene-proven: annual mammography from 40 to 49 at moderate risk, annual MRI from 30 to 49 where the probability of carrying BRCA is over 30 percent, and no MRI at all at moderate risk. | NHS England NHSBSP very high risk protocol2025-11-18 Commissioned as part of the NHS Breast Screening Programme. The published protocol sets the tests and ages by gene: BRCA1, BRCA2 and PALB2 carriers have annual MRI from 25 to under 40, MRI plus mammography from 40 to under 51, and mammography with or without MRI from 51 to under 71; carriers of a pathogenic TP53 variant have annual MRI from 20 to under 71 and mammography is contraindicated; the same applies to people with biallelic ATM variants from 25. Carriers of variants in ATM c.7271T>G, biallelic CHEK2, PTEN, STK11 or CDH1 start MRI at 30. People who have not been tested, or who carry a variant in another gene, qualify on a CanRisk 10-year risk of 8 percent or more from age 30 or 12 percent or more from age 40, and are not screened through the very high risk programme after 50. Women irradiated to breast tissue between 10 and under 20 years old start at 25, or eight years after the first irradiation, whichever is later. | NHS England Scotland runs an equivalent high-risk surveillance pathway through its breast screening centres; the published protocol above is the England programme's. | Wales: Breast Test Wales operates the equivalent surveillance pathway. NI: The programme was renamed the Very High Risk Breast Surveillance Screening Programme in Northern Ireland in September 2020 to match national guidance. |
| Before any cancer: risk-reducing surgery | Bilateral risk-reducing mastectomy with reconstruction; bilateral risk-reducing oophorectomy Recommendation 1.6.26 says not to offer surveillance to women who have had a bilateral mastectomy. | NHS England CG164 1.7.30 to 1.7.512023-11-14 Funded through the NHS on NICE CG164. Recommendation 1.7.30 says bilateral risk-reducing mastectomy is appropriate only for a small proportion of women from high-risk families and must be managed by a multidisciplinary team; 1.7.31 says it should be raised as an option with all women at high risk; 1.7.32 requires genetic counselling in a specialist cancer genetic clinic before a decision; 1.7.38 says everyone considering it must be able to discuss immediate and delayed reconstruction with a surgeon with oncoplastic or reconstructive skills, and 1.7.39 says the operation must be done by such a team. Recommendations 1.7.41 to 1.7.51 set the equivalent conditions for risk-reducing oophorectomy, including a discussion of early menopause and of hormone replacement. | Not checked | Wales: CG164 applies in Wales. NI: CG164 is adopted in Northern Ireland. |
| Early breast cancer: surgery and reconstruction | Breast-conserving surgery or mastectomy, sentinel lymph node biopsy, and reconstruction offered to everyone who has a mastectomy The margin thresholds that decide a second operation were changed in 2024: NG101 1.4.3 offers further surgery where tumour is at the inked margin, and 1.4.4 and 1.4.5 consider it within 2mm for ductal carcinoma in situ and within 1mm for invasive cancer, narrowed from 2mm to reduce re-operations. | NHS England NG101 1.4 and 1.5; HTG6422025-04-14 Funded through the NHS on NICE NG101. Recommendation 1.5.1 says to offer breast reconstruction after mastectomy and 1.5.3 to offer both immediate and delayed reconstruction whether or not they are available locally. Recommendation 1.4.9 says to stage the axilla with sentinel lymph node biopsy rather than clearance where ultrasound and any needle biopsy are negative, and 1.4.10 says to use the dual isotope and blue dye technique. NICE HTG642 additionally recommends the Magtrace and Sentimag magnetic tracer as an option in hospitals with limited or no access to radiopharmacy. | Not checked | Wales: NG101 applies in Wales; the audit shows immediate reconstruction after 15 percent of mastectomies against 27 percent in England. NI: NG101 is adopted in Northern Ireland; the audit does not cover Northern Ireland. |
| Early breast cancer: radiotherapy | 26 Gy in 5 fractions over one week; 40 Gy in 15 fractions where nodes are irradiated or the shorter course is unsuitable Intraoperative radiotherapy is the exception: NICE TA501 does not recommend the Intrabeam system for routine commissioning and allows its use only on machines already installed, under NHS England governance and data collection arrangements. | NHS England NG101 1.132025-04-14 Funded through the NHS on NICE NG101 recommendations 1.13.13 to 1.13.16. One week is the default and three weeks the exception, reversing the position of a decade ago. Deep inspiratory breath-hold is required for left-sided cancers (1.13.2). Partial-breast radiotherapy is an option for women 50 and over with tumours 3cm or less, node-negative, ER-positive, HER2-negative and grade 1 to 2 who will take five years of endocrine therapy (1.13.4), and radiotherapy can be omitted altogether for women 65 and over with T1N0 grade 1 to 2 ER-positive HER2-negative disease who will take endocrine therapy (1.13.7), a decision NICE quantifies as local recurrence in about 50 women per 1,000 at five years without radiotherapy against about 10 with it, and no difference in overall survival at ten years. | Not checked | Wales: NG101 applies in Wales; the audit records adjuvant radiotherapy after 47 percent of breast-conserving operations in Wales against 86 percent in England, a gap the audit flags rather than explains. NI: NG101 is adopted in Northern Ireland. |
| Early breast cancer: chemotherapy backbone, whatever the receptor status | A regimen containing both a taxane and an anthracycline; weekly or fortnightly paclitaxel available locally | NHS England NG101 1.72025-04-14 Funded through the NHS on NICE NG101 recommendations 1.7.1 to 1.7.3. Where adjuvant chemotherapy is indicated, the regimen should contain both a taxane and an anthracycline; recommendation 1.7.3 tells services to make weekly and fortnightly paclitaxel available locally because it is better tolerated than three-weekly docetaxel, particularly for people with other conditions. Which drugs are added on top of that backbone depends entirely on the receptor result and is on the subtype pages. | Not checked | Wales: NG101 applies in Wales. NI: NG101 is adopted in Northern Ireland. |
| Early breast cancer: adjuvant bone treatment | Zoledronic acid or sodium clodronate for postmenopausal women An adjuvant treatment that reduces recurrence and is off-label and generic sits in a blind spot: there is no technology appraisal, no company to promote it and no national uptake figure, and NICE itself noted the evidence was not strong enough to recommend it for premenopausal women. | NHS England NG101 1.122025-04-14 Funded through the NHS on NICE NG101 recommendation 1.12.1, which says to offer bisphosphonates as adjuvant therapy to postmenopausal women with node-positive invasive breast cancer, and 1.12.2, which says to consider them for postmenopausal women with node-negative disease at high risk of recurrence. Recommendation 1.12.3 requires a discussion of osteonecrosis of the jaw, atypical femoral fractures and osteonecrosis of the external auditory canal. In March 2025 this use of zoledronic acid and sodium clodronate was off-label. | Not checked | Wales: NG101 applies in Wales. NI: NG101 is adopted in Northern Ireland. |
| Germline BRCA1 or BRCA2, whatever the receptor status | Olaparib for one year after chemotherapy in high-risk early disease; olaparib in advanced disease after an anthracycline and a taxane This is the one drug decision on this page that is driven by the germline result rather than the receptor result, which is why it is here rather than on a subtype page. The test that opens it is R444.1 in the genomic test directory. | NICE TA8862023-05-10 Recommended. TA886 recommends adjuvant olaparib, alone or with endocrine therapy, within its marketing authorisation for HER2-negative high-risk early breast cancer treated with neoadjuvant or adjuvant chemotherapy in people with germline BRCA1 or BRCA2 variants. TA1040 recommends olaparib for germline BRCA-mutated HER2-negative locally advanced or metastatic disease after an anthracycline and a taxane, and after endocrine therapy if the cancer is hormone receptor-positive; recommendation 1.2 says that where olaparib is one of several suitable options the lowest cost one should be used. | SMC SMC2518 Accepted for use in NHS Scotland: SMC2518 for the adjuvant indication and SMC2737 for the advanced one. | Wales: As England: NICE guidance applies in Wales and the New Treatment Fund requires availability within 60 days. NI: As England: NICE technology appraisals are adopted in Northern Ireland. |
| Metastatic disease: bone metastases | Denosumab, or a bisphosphonate, to prevent skeletal-related events Bone is the commonest site of breast cancer metastasis and this appraisal applies whatever the receptor status, which is why it is here. What is given alongside it depends on the subtype. | NICE TA2652012-10-24 Recommended. TA265 recommends denosumab for preventing skeletal-related events (pathological fracture, radiation to bone, spinal cord compression or surgery to bone) in adults with bone metastases from breast cancer and from solid tumours other than prostate, where bisphosphonates would otherwise be prescribed and the manufacturer provides the patient access scheme discount. Recommendation 1.2 excludes prostate cancer. | Not checked | Wales: As England. NI: As England. |
| Metastatic disease: the refusals that apply to everyone | Bevacizumab with a taxane; bevacizumab with capecitabine; the Intrabeam system TA501 similarly does not recommend the Intrabeam intraoperative radiotherapy system for routine commissioning. | NICE TA2142011-02-23 Not recommended. TA214 does not recommend bevacizumab with a taxane for first-line metastatic breast cancer; the European Medicines Agency narrowed the licence to paclitaxel during the appraisal. TA263 does not recommend bevacizumab with capecitabine within its marketing authorisation for first-line metastatic breast cancer. Both still stand: when NICE reversed almost twenty years of refusals for bevacizumab in bowel cancer in February 2026 (TA1136), it did not revisit breast. | Not checked | Wales: Not funded, as England. NI: Not funded, as England. |
| Metastatic disease: appraisals abandoned before a decision | Sacituzumab govitecan in hormone receptor-positive disease; trastuzumab deruxtecan in HER2-low hormone receptor-positive disease A separate refusal, TA992 on trastuzumab deruxtecan for HER2-low disease after chemotherapy, is under rapid review as GID-TA12551, with no publication date set. The detail of that decision belongs to the subtype pages; what belongs here is the pattern, which is that four of the recent gaps in NHS funding for breast cancer were created by companies declining to submit rather than by committees saying no. | NICE TA10892025-08-13 No recommendation, because the company did not submit evidence. TA1089, terminated on 13 August 2025, records that NICE is unable to make a recommendation on sacituzumab govitecan for hormone receptor-positive HER2-negative metastatic breast cancer after two or more treatments because the company did not provide an evidence submission. TA1112, terminated on 19 November 2025, says the same of trastuzumab deruxtecan for hormone receptor-positive HER2-low metastatic breast cancer after two or more endocrine treatments. A terminated appraisal is not a refusal on the evidence: it means the NHS has no funding route and no committee ever looked. | SMC SMC2916 The same pattern in Scotland: SMC2916 is a non-submission for sacituzumab govitecan and SMC2888 a non-submission for trastuzumab deruxtecan. | Wales: Nothing to adopt: with no NICE recommendation there is nothing for the New Treatment Fund to fund. NI: Nothing to adopt. |
This table is deliberately short and deliberately not about receptor-directed drugs. CDK4/6 inhibitors, endocrine therapy, anti-HER2 antibodies and antibody-drug conjugates, and immunotherapy for triple-negative disease, are each on the page for the subtype they treat, with their own appraisal numbers and Scottish positions. What is here is what applies whichever result comes back: prevention, surveillance, surgery, radiotherapy, the chemotherapy backbone, bone treatment, the germline BRCA drug, and the decisions that went the other way. NICE has published 125 products on breast cancer and the list is still growing: camizestrant, giredestrant, inavolisib, vepdegestrant, imlunestrant and datopotamab deruxtecan all have appraisals in development or awaiting development. The Cancer Drugs Fund can fund a drug from the point of positive draft guidance while the evidence matures, and its list is published monthly by NHS England. In Wales the AWMSG does not appraise a medicine NICE is appraising, so NICE guidance is the Welsh position and the New Treatment Fund requires health boards to make a recommended medicine available within 60 days. Northern Ireland adopts NICE technology appraisals. Scotland decides separately through the Scottish Medicines Consortium, whose breast advice list runs to 21 medicines.
Sources: NICE: all products on breast cancer (125 products, including the appraisals in development and awaiting development) (2026-09-25); NHS England: the Cancer Drugs Fund and the national Cancer Drugs Fund list (the page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026); All Wales Therapeutics and Toxicology Centre: AWMSG in relation to NICE. The AWMSG does not appraise a medicine that NICE is appraising; NICE guidance applies in Wales (2026-09-25); Welsh Government: the New Treatment Fund, which makes medicines recommended by NICE and the AWMSG available within 60 days (2026-09-25); Scottish Medicines Consortium: medicines advice for breast cancer (the keywords parameter, which the search form does not offer, returns the 21 breast advices with their SMC numbers in the slug) (2026-09-25)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| Oestrogen receptor, progesterone receptor and HER2 | pathology | Immunohistochemistry on the diagnostic biopsy, with in situ hybridisation where HER2 is equivocal, reported quantitatively | The three results decide which pathway you are on: hormone receptor-positive, HER2-positive or triple-negative. Everything drug-related on this site below the family page follows from them. | NICE NG101 recommendation 1.3.1 says to assess all three simultaneously at the time of the initial histopathological diagnosis, and 1.3.5 says all three must be available and recorded at both the preoperative and the postoperative multidisciplinary team meeting. Ask for the report; the three results and the grade are on it. |
| BRCA1, BRCA2, PALB2 and the rest of the inherited breast and ovarian cancer panel | R208.1 | Germline small panel, 635 genes' worth of capture reported against the inherited breast and ovarian cancer gene list, from blood or saliva | Adjuvant olaparib (TA886) and olaparib in advanced disease (TA1040); entry to the very high risk surveillance programme; risk-reducing surgery; and predictive testing for relatives. | Eligibility criteria version 9.1 lists the routes in: breast cancer under 40, bilateral breast cancer under 60, triple-negative breast cancer under 60, breast cancer in anyone assigned male at birth at any age, breast cancer under 45 with a first-degree relative under 45, Ashkenazi Jewish ancestry at any age, at least one grandparent from Westray or Whalsay at any age, or a pathology-adjusted Manchester score of 15 or more or a CanRisk score of 10 percent or more. The breast team can request it; testing of unaffected and deceased relatives can only be offered by clinical genetics. Sources: NHS England: rare and inherited disease eligibility criteria version 9.1, R208 inherited breast cancer and ovarian cancer. Testing criteria include breast cancer under 40, bilateral breast cancer under 60, triple-negative breast cancer under 60, breast cancer in anyone assigned male at birth at any age, a pathology-adjusted Manchester score of 15 or more or a CanRisk score of 10 percent or more, Ashkenazi Jewish ancestry at any age, and a grandparent from Westray or Whalsay at any age (2026-05-20); NHS England: rare and inherited disease national genomic test directory, version 9 (R208.1 inherited breast cancer and ovarian cancer, R216.1 Li-Fraumeni syndrome, R242.1 predictive testing for a known familial variant, R444.1 NICE approved PARP inhibitor treatment) (2026-05-20) |
| A variant already known in the family | R242.1 | Targeted testing for the one variant found in a relative | A definite yes or no for a person who has no cancer, and with it either entry to very high risk surveillance and risk-reducing options or discharge to the ordinary programme. | Only clinical genetics can offer predictive testing, and NICE CG164 recommendation 1.4.11 says it should not be offered without adequate genetic counselling. Recommendations 1.5.5 and 1.5.6 say the search for a variant should start with an affected family member wherever one is available. R444.1 is the separate code used when the question is not inherited risk but whether someone is eligible for a PARP inhibitor. Sources: NHS England: rare and inherited disease national genomic test directory, version 9 (R208.1 inherited breast cancer and ovarian cancer, R216.1 Li-Fraumeni syndrome, R242.1 predictive testing for a known familial variant, R444.1 NICE approved PARP inhibitor treatment) (2026-05-20); NICE CG164 recommendations: referral from primary care (1.3.1 to 1.3.6), referral to a specialist genetic clinic (1.4.4), carrier probability at which genetic testing is offered (1.5.11 to 1.5.13), mammographic and MRI surveillance (1.6.3 to 1.6.9), CanRisk (1.6.25) and chemoprevention (1.7.21 to 1.7.28) (2023-11-14) |
| TP53 (Li-Fraumeni syndrome) | R216.1 | Germline small panel | A different surveillance protocol entirely: annual MRI from 20 to under 71, with mammography contraindicated because of the radiosensitivity that comes with the syndrome. | A specialised-service test, requested through clinical genetics. NICE CG164 recommendation 1.6.6 says not to offer mammographic surveillance at any age to a woman with a known TP53 variant, and 1.6.7 offers annual MRI from 20 to 49; the screening programme's own protocol extends MRI to 71. Sources: NHS England: rare and inherited disease national genomic test directory, version 9 (R208.1 inherited breast cancer and ovarian cancer, R216.1 Li-Fraumeni syndrome, R242.1 predictive testing for a known familial variant, R444.1 NICE approved PARP inhibitor treatment) (2026-05-20); NICE CG164 recommendations: referral from primary care (1.3.1 to 1.3.6), referral to a specialist genetic clinic (1.4.4), carrier probability at which genetic testing is offered (1.5.11 to 1.5.13), mammographic and MRI surveillance (1.6.3 to 1.6.9), CanRisk (1.6.25) and chemoprevention (1.7.21 to 1.7.28) (2023-11-14); GOV.UK (NHS England): tests and frequency of testing for women at very high risk. The gene-by-gene and age-by-age surveillance protocol for the very high risk programme, including the CanRisk 10-year risk thresholds (2025-11-18) |
| Ten-year and lifetime risk in a family with no variant found | CanRisk (BOADICEA) | A risk calculation from the family history, and where available breast density, hormonal and genetic factors | The thresholds that decide everything else: 10 percent carrier probability for genetic testing, a 30 percent lifetime risk for referral to a specialist genetic clinic, and 8 percent ten-year risk from 30 or 12 percent from 40 for the very high risk surveillance programme. | NICE CG164 recommendation 1.6.25 says that when a woman not known to carry a variant is referred to a specialist genetic clinic she should be offered assessment of her carrier probability with a calculation method of acceptable performance, and names CanRisk (BOADICEA) as an example. The screening programme's very high risk protocol quotes CanRisk thresholds directly. Sources: NICE CG164 recommendations: referral from primary care (1.3.1 to 1.3.6), referral to a specialist genetic clinic (1.4.4), carrier probability at which genetic testing is offered (1.5.11 to 1.5.13), mammographic and MRI surveillance (1.6.3 to 1.6.9), CanRisk (1.6.25) and chemoprevention (1.7.21 to 1.7.28) (2023-11-14); GOV.UK (NHS England): tests and frequency of testing for women at very high risk. The gene-by-gene and age-by-age surveillance protocol for the very high risk programme, including the CanRisk 10-year risk thresholds (2025-11-18) |
| Tumour profile, to decide whether chemotherapy is worth it | M3.12 | EndoPredict, IHC4+C, MammaPrint, Oncotype DX or Prosigna on the surgical specimen | Avoiding adjuvant chemotherapy where the gene expression score says the benefit is small. The eligible population is oestrogen or progesterone receptor-positive, HER2-negative early breast cancer with nought to three positive nodes, so the detail belongs on the hormone receptor-positive page; the test itself is commissioned nationally. | NICE HTG719, published 9 May 2024, replaced diagnostics guidance DG34 and absorbed DG58; the test directory lists it as M3.12 and cites that guidance as the eligibility rule. Sources: NICE HTG719: tumour profiling tests (EndoPredict, IHC4+C, MammaPrint, Oncotype DX and Prosigna) to guide adjuvant chemotherapy decisions in early breast cancer. Published 9 May 2024; replaces diagnostics guidance DG34, and diagnostics guidance DG58 has been migrated to this reference unchanged (2024-05-09); NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M3 breast cancer: M3.5 NTRK fusion panel, M3.6 PIK3CA, AKT1 and PTEN panel, M3.7 DPYD, M3.9 ETV6-NTRK3, M3.12 tumour profiling, M3.13 circulating tumour DNA panel; M234.1 whole genome sequencing in triple-negative disease (2026-09-25) |
| DPYD | M3.7 | Hotspot genotyping before a fluoropyrimidine | A dose reduction, or a different drug, for the small minority who cannot metabolise capecitabine or fluorouracil safely. Delivered as a germline test. | Required before fluoropyrimidine treatment. The test directory lists it under breast cancer as M3.7 with the eligibility criterion 'patient planned to receive fluoropyrimidine treatment'. |
| NTRK1, NTRK2, NTRK3 and ETV6-NTRK3 | M3.5 and M3.9 | RNA fusion panel; FISH or RT-PCR for the ETV6-NTRK3 fusion | A tumour-agnostic TRK inhibitor where a fusion is found, and confirmation of secretory carcinoma of the breast, a rare type defined by the ETV6-NTRK3 fusion. | M3.5 is offered where the person's clinical status means they would be eligible for an NTRK inhibitor if a rearrangement were found. M3.9 is offered to support a suspected diagnosis of secretory carcinoma after specialist pathology review. |
Two directories govern breast cancer testing in England and they are easy to confuse. The cancer (non-central nervous system) test directory, version 16, holds the tumour tests under clinical indication M3, and everything in it is done on the cancer. The rare and inherited disease directory, version 9 with eligibility criteria version 9.1 dated 20 May 2026, holds the germline tests under the R codes, and everything in it is done on the person and has consequences for the family. The germline side has widened twice in recent years in ways worth knowing about. The R208 criteria now include founder-variant ancestries: Ashkenazi Jewish ancestry with breast cancer at any age, and at least one grandparent from Westray in Orkney or Whalsay in Shetland with breast cancer at any age, the last reflecting founder variants in two small island populations. And since January 2023 the NHS Jewish BRCA Testing Programme has offered free BRCA testing by post to anyone in England aged 18 or over with at least one Jewish grandparent, regardless of family history: over 25,000 kits had been requested by January 2025, around 11,000 processed and 235 people, 2.1 percent, found to carry a variant. Around one in 40 Ashkenazi Jews and one in 140 Sephardi Jews carry a BRCA variant, against around one in 250 of the general population. The molecular tests that guide drug choice in advanced disease, M3.6 for PIK3CA, AKT1 and PTEN and M3.13 for the same panel plus ESR1 in circulating tumour DNA, are tied to specific appraisals in hormone receptor-positive disease and are covered on that subtype's page rather than here.
Sources: NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M3 breast cancer: M3.5 NTRK fusion panel, M3.6 PIK3CA, AKT1 and PTEN panel, M3.7 DPYD, M3.9 ETV6-NTRK3, M3.12 tumour profiling, M3.13 circulating tumour DNA panel; M234.1 whole genome sequencing in triple-negative disease (2026-09-25); NHS England: rare and inherited disease national genomic test directory, version 9 (R208.1 inherited breast cancer and ovarian cancer, R216.1 Li-Fraumeni syndrome, R242.1 predictive testing for a known familial variant, R444.1 NICE approved PARP inhibitor treatment) (2026-05-20); NHS England: rare and inherited disease eligibility criteria version 9.1, R208 inherited breast cancer and ovarian cancer. Testing criteria include breast cancer under 40, bilateral breast cancer under 60, triple-negative breast cancer under 60, breast cancer in anyone assigned male at birth at any age, a pathology-adjusted Manchester score of 15 or more or a CanRisk score of 10 percent or more, Ashkenazi Jewish ancestry at any age, and a grandparent from Westray or Whalsay at any age (2026-05-20); NHS England: hundreds of people at increased cancer risk identified by new NHS BRCA testing programme. Over 25,000 saliva kits requested in two years, around 11,000 processed and 235 people (2.1 percent) positive; around 1 in 40 Ashkenazi Jews and 1 in 140 Sephardi Jews carry a BRCA variant against around 1 in 250 of the UK general population (2025-01-16); NHS England: the National Genomic Test Directory (the page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; the workbooks it links to under wp-content/uploads do resolve)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
ISRCTN81384017Recruiting from 1 May 2026
EDITH (Early Detection using Information Technology in Health)
Artificial intelligence as a reader in the NHS Breast Screening Programme
Up to 30 NHS breast screening services in England
A randomised trial with a target of 660,000 participants, sponsored by the University of Warwick and running to November 2028. It is the trial that will decide whether an AI system can replace one of the two human readers who look at every NHS mammogram, which is the only realistic answer to a radiologist shortage that limits how fast the programme can grow.
Registry or sponsor page →ISRCTN15109512Closed to recruitment; follow-up to 2025 and beyond
PROSPECTS
Digital breast tomosynthesis added to, or replacing, standard 2D digital mammography in screening
NHS breast screening services in England, coordinated from King's College London
A target of 100,000 women randomised between 2019 and 2020. Three-dimensional mammography finds more cancers per thousand than two-dimensional; whether the extra cancers are ones that would have killed anyone is the question the follow-up is designed to answer.
Registry or sponsor page →ISRCTN33292440Recruitment closed March 2020; end date December 2031
AgeX
One extra screening round at 47 to 49, and one at 71 to 73, offered by cluster randomisation inside the national programme
The NHS Breast Screening Programme in England
A target of four million participants, run from the University of Oxford: the largest randomised trial ever conducted inside a screening programme, and the reason the age range has not been extended in either direction.
Registry or sponsor page →ISRCTN36585784Recruiting to February 2030
ATNEC
Axillary management in T1-3N1M0 breast cancer with biopsy-proven nodal metastases after neoadjuvant chemotherapy: whether the axilla needs treating at all when the nodes have cleared
NHS breast units across the UK, sponsored by University Hospitals of Derby and Burton
Target 1,900. The question is lymphoedema: axillary clearance and axillary radiotherapy both cause it, and if chemotherapy has already sterilised the nodes neither may add anything.
Registry or sponsor page →ISRCTN54765244Closed to recruitment in 2021; end date July 2026
POSNOC
One or two positive sentinel nodes: adjuvant therapy alone against adjuvant therapy plus axillary clearance or axillary radiotherapy
NHS breast units across the UK, sponsored by University Hospitals of Derby and Burton
1,900 women. POSNOC is the trial behind NG101 recommendation 1.4.13, which tells clinicians to discuss not treating the axilla further with women who have one or two sentinel node macrometastases and are having whole-breast radiotherapy with systemic therapy.
Registry or sponsor page →ISRCTN41579286Closed to recruitment in 2022; end date May 2030
PRIMETIME
Omitting radiotherapy after breast-conserving surgery in women selected as very low risk by the IHC4+C biomarker score
NHS radiotherapy centres, sponsored by the Institute of Cancer Research
Target 2,400. A prospective cohort rather than a randomised trial: it tests whether a biomarker score can pick the women for whom NG101 1.13.7 already allows radiotherapy to be left out.
Registry or sponsor page →ISRCTN42400492Recruitment closed December 2025; end date December 2035
OPTIMA
Whether a tumour profiling test can safely direct chemotherapy in node-positive early breast cancer
NHS breast units across the UK, sponsored by University College London
Target 5,000, the largest UK trial of test-directed chemotherapy. NICE HTG719 already commissions profiling for nought to three positive nodes; OPTIMA is the trial that will say whether the same logic holds further out.
Registry or sponsor page →These are the trials that ask questions about breast cancer as a whole rather than about a receptor subtype: how to screen for it, whether to treat the armpit, whether to give radiotherapy, whether to give chemotherapy. Drug trials in triple-negative, hormone receptor-positive and HER2-positive disease are listed on those pages. The pattern here is unusual and worth naming: four of the seven are trials of doing less, and three of the seven ask whether a test can tell you when doing less is safe. That is what a cancer looks like once survival is high enough that the harm of treatment is the thing left to reduce.
Sources: ISRCTN81384017: EDITH, Early Detection using Information Technology in Health. Randomised trial of artificial intelligence to help healthcare professionals detect cancer in the UK breast screening programme, sponsored by the University of Warwick, target 660,000 participants, recruiting from 1 May 2026 to 30 November 2028 (2026-09-25); ISRCTN33292440: the AgeX trial, a nationwide cluster-randomised trial of extending the NHS breast screening age range in England, University of Oxford, target 4,000,000, recruitment June 2009 to March 2020 and end date December 2031 (2026-09-25); ISRCTN36585784: ATNEC, axillary management in T1-3N1M0 breast cancer with needle biopsy-proven nodal metastases at presentation after neoadjuvant chemotherapy, University Hospitals of Derby and Burton, target 1,900, recruiting to February 2030 (2026-09-25); ISRCTN42400492: OPTIMA, optimal personalised treatment of early breast cancer using multiparameter analysis, University College London, target 5,000, recruitment September 2012 to December 2025 (2026-09-25)
The UK trial legacy
START and FAST-Forward: how Britain shortened breast radiotherapy for the world (1998-2020)
For most of the twentieth century breast radiotherapy meant twenty-five visits over five weeks, on the theory that small daily doses spared normal tissue. Two UK trials run from the Institute of Cancer Research disproved it. START-B randomised 2,215 women to 40 Gy in 15 fractions over three weeks or the international standard of 50 Gy in 25, and at ten years local-regional relapse was 4.3 percent with the shorter schedule against 5.5 percent with the longer, with fewer late changes to the breast. FAST-Forward then randomised 4,096 women to 40 Gy in 15 or 26 Gy in five fractions over one week: five-year relapse in the breast was 1.4 percent after one week against 2.1 percent after three, non-inferior, with similar late effects. IMPORT LOW, from the same group, showed that treating only the part of the breast around the tumour bed was as safe as treating the whole breast. NICE NG101 recommendation 1.13.13 now makes one week the NHS default. The result is 20 fewer hospital visits per patient than in 2000, on a cancer the NHS treats more than any other: the largest single reduction in cancer treatment burden any British trial has produced.
Sources: Haviland et al, The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results, Lancet Oncology 2013 (2013); Murray Brunt et al, Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial, Lancet 2020 (2020); Coles et al, Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial), Lancet 2017 (2017); NICE NG101 recommendations: pretreatment assessment (1.2), receptor and genetic testing (1.3.1 to 1.3.6), surgery to the breast and axilla (1.4), breast reconstruction (1.5.1 to 1.5.3), chemotherapy for all receptor subtypes (1.7.1 to 1.7.3), adjuvant bisphosphonates (1.12.1 to 1.12.3), radiotherapy and dose fractionation (1.13.1 to 1.13.29) and lymphoedema (1.14) (2025-04-14)
IBIS-I and IBIS-II: the UK trials that made prevention a prescription (1992-2020)
Jack Cuzick's group at Queen Mary University of London ran two prevention trials over nearly thirty years. IBIS-I randomised 7,154 women at increased risk to five years of tamoxifen or placebo; at a median sixteen years, 251 women on tamoxifen had developed breast cancer against 350 on placebo, a hazard ratio of 0.71, and the protection was as strong in the second decade as the first even though the drug had been stopped. IBIS-II randomised 3,864 postmenopausal women to anastrozole or placebo; after a median of almost eleven years, 85 against 165 had developed breast cancer, a hazard ratio of 0.51. Neither trial showed a mortality difference, which is the honest caveat, and both found the benefit confined to oestrogen-receptor-positive disease. Together they are the evidence behind NICE CG164 recommendations 1.7.21 to 1.7.27, and in 2023 the MHRA licensed anastrozole for prevention through its repurposing programme, making a tablet costing pennies a licensed way for a woman at high familial risk to halve her chance of ever being on this pathway at all.
IBIS-I (International Breast Intervention Study I)IBIS-II (International Breast Intervention Study II)
Sources: Cuzick et al, Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial, Lancet Oncology 2015 (2015); Cuzick et al, Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial, Lancet 2020 (2020); NICE CG164 recommendations: referral from primary care (1.3.1 to 1.3.6), referral to a specialist genetic clinic (1.4.4), carrier probability at which genetic testing is offered (1.5.11 to 1.5.13), mammographic and MRI surveillance (1.6.3 to 1.6.9), CanRisk (1.6.25) and chemoprevention (1.7.21 to 1.7.28) (2023-11-14)
AgeX and the Age trial: forty years of asking where the screening age should start (1988-2031)
The NHS Breast Screening Programme began in 1988 with an age range, 50 to 64, chosen from the evidence then available, and the argument about whether it is the right one has never stopped. The UK Age trial randomised women to annual mammography from 40 and reported its final results in 2020: a reduction in breast cancer mortality confined to the first ten years that did not persist thereafter. AgeX, run from Oxford inside the programme since 2009, cluster-randomised close to four million women to an extra screen at 47 to 49 or at 71 to 73; recruitment closed in March 2020 and the mortality endpoint is not due until 2031. In the meantime the programme's own answer has been to hold the line: NHS England still describes the range as 50 up to the 71st birthday and names AgeX as research. The UK National Screening Committee, which has never formally appraised breast screening because the programme predates the committee, last reviewed the condition in December 2019 and has a review due for 2025 to 2026. That review, and AgeX, are where the age range will next be decided.
Sources: ISRCTN33292440: the AgeX trial, a nationwide cluster-randomised trial of extending the NHS breast screening age range in England, University of Oxford, target 4,000,000, recruitment June 2009 to March 2020 and end date December 2031 (2026-09-25); Duffy et al, Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial, Lancet Oncology 2020 (2020); UK National Screening Committee: breast cancer recommendation. Last reviewed December 2019, next review due 2025 to 2026; the 2012 Marmot review found the programme prevents around 1,300 deaths a year and that for every death prevented around 3 women are treated for a cancer that would not have harmed them (2019-12); GOV.UK (NHS England): breast screening programme overview. Screening is offered to women aged 50 up to their 71st birthday; about 1 in 7 women are diagnosed with breast cancer in their lifetime (2026-05-18)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
Lifetime risk of a breast cancer diagnosis
about 1 in 7 women
UK · 2026
NHS England's programme overview raised this from 1 in 8 to 1 in 7 on 28 June 2023.
Sources: GOV.UK (NHS England): breast screening programme overview. Screening is offered to women aged 50 up to their 71st birthday; about 1 in 7 women are diagnosed with breast cancer in their lifetime (2026-05-18)
Invitations issued by the screening programme
2.75 million
England · 2024/25
Around 10 percent more than the previous year.
Women aged 50 to 70 screened within six months of invitation
1.94 million
England · 2024/25
Up 193,745 on 1.75 million the previous year. Counting all ages, 2.15 million women aged 45 and over were screened, a 10.3 percent increase.
Three-year screening coverage
71.8%
England · 2024/25
Up 1.8 percentage points on 2023/24, against a programme standard of 70 percent acceptable and 80 percent achievable. 4.79 million eligible women are up to date.
Screening uptake, women aged 50 to 70
70.6%
England · 2024/25
Up from 70.0 percent. First-invite uptake was 63.6 percent, the highest in ten years, which still means around three in ten women do not take up the offer.
Cancers detected by screening
19,291 (9.0 per 1,000 screened)
England · 2024/25
Up almost 16 percent on 16,677 the previous year, on a roughly 11 percent rise in women screened.
What a screening result means, per 100 women screened
96 need no further tests; 4 are recalled; 1 of those 4 has cancer
England · 2026
From the programme's own decision leaflet. The programme caps the recall rate too: under 4 percent on a repeat screen and under 9 percent on a first screen.
Deaths from breast cancer prevented by screening
around 1,300 a year
UK · 2012 review, still the current position
The 2012 independent review chaired by Sir Michael Marmot. The same review found that for every death prevented, around 3 women are treated for a cancer that would not have harmed them, and concluded that screening has significant benefit and should continue. The UK National Screening Committee has never formally appraised breast screening because the programme predates it.
Screening uptake, women aged 50 to 70
75.9% (539,575 of 711,189 invited)
Scotland · three years 2020/23
Higher than England's, but the publication is under review: Public Health Scotland suspended the series' accredited status on 24 February 2026 after finding data quality errors, and the latest available update covers only to 31 March 2023.
Screening uptake by deprivation
64.2% most deprived fifth against 82.8% least deprived, a gap of 18.6 percentage points
Scotland · three years 2020/23
The only current UK figure found that splits breast screening uptake by deprivation. It narrowed by 0.2 percentage points on the previous three-year period.
Screening coverage, women aged 53 to 70
70.0%
Wales · at 31 March 2024
Up from 56.1 percent a year earlier as the three-year round length recovered from the pandemic pause. Uptake among the 174,364 women aged 50 to 70 invited was 68.5 percent.
Cancers detected by screening
1,303 (9.8 per 1,000 screened)
Wales · 2023/24
133,339 women aged 49 and over screened; 3.6 percent referred for further assessment; 83.0 percent of the cancers invasive, and 40.0 percent of the invasive ones under 15mm.
Urgent referrals for a breast problem
183,420 suspected cancer and 35,571 breast symptomatic
England · April to July 2026
The suspected cancer figure is 16 percent of all 1,124,238 urgent suspected cancer referrals in England over those four months: the largest single tumour group.
28-day Faster Diagnosis Standard, suspected breast cancer
89.0% overall; 89.9% urgent route, 81.8% screening route
England · July 2026
47,198 of 53,020, against 79.3 percent for all cancers. The breast symptomatic pathway did better still at 91.7 percent. NHS England's 2023 letter said breast performance would need to be above 90 percent.
62-day standard, breast cancer, by route
69.7% overall; 66.5% urgent suspected cancer, 70.6% screening, 64.6% breast symptomatic, 82.8% consultant upgrade
England · July 2026
3,435 of 4,931, against 71.2 percent for all cancers and an 85 percent standard. Across April to July 2026 it was 68.5 percent on 17,872 treatments.
31-day standard, breast cancer
92.0%
England · July 2026
12,554 of 13,640 treatments, against 92.5 percent for all cancers and a 96 percent standard; 92.7 percent for first treatments and 91.7 percent for subsequent ones.
Triple diagnostic assessment in a single hospital visit
68.1%, ranging from 5.3% to 89.3% by organisation
England and Wales · diagnosed 2021 to 2023
Where the specific data item had been completed the English rate was 79.2 percent, so part of the spread is recording rather than service design. The Welsh rate for the second half of 2023, when the new data item existed, was 72.9 percent.
Immediate reconstruction after mastectomy
27% in England and 15% in Wales, ranging from 5.4% to 59.9% by organisation
England and Wales · diagnosed 2021 to 2023
National average across both countries 26 percent. NICE NG101 1.5.1 says to offer reconstruction to everyone who has a mastectomy.
Re-operation within 12 months of breast-conserving surgery
16% in England and 19% in Wales, ranging from 7.9% to 32.0% by organisation
England and Wales · diagnosed 2021 to 2023
A fourfold spread between organisations on a measure that is largely about how margins are judged.
Three-year survival after a primary breast cancer diagnosis
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 92% all-cause; 98% breast cancer-specific three-year survival after a primary breast cancer diagnosis (England and Wales, diagnosed 2021 to 2023, stage 1 to 3A).
- A population figure for people diagnosed at stage 1 to 3A, not a prognosis for any individual. The Welsh follow-up was shorter and the estimate extrapolated.
England and Wales · diagnosed 2021 to 2023, stage 1 to 3A
People diagnosed with primary breast cancer
146,795, of whom 1,060 were men
England and Wales · 2021 to 2023
138,524 in England and 8,271 in Wales. Eleven percent were non-invasive (stage 0), 78 percent early invasive (stage 1 to 3A) and 3 percent locally advanced; 396 people, under 0.3 percent, had inflammatory breast cancer.
Free BRCA testing through the NHS Jewish BRCA Testing Programme
25,000 kits requested, 11,000 processed, 235 people (2.1%) carrying a variant
England · January 2023 to January 2025
Open to anyone in England aged 18 or over with at least one Jewish grandparent, regardless of family history. Around 1 in 40 Ashkenazi Jews and 1 in 140 Sephardi Jews carry a BRCA variant, against around 1 in 250 of the general population.
Support in the UK
Charities focused on this cancer, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
Charity
- A free nurse helpline on 0808 800 6000
- Someone Like Me: peer support from someone who has had a similar diagnosis
- Moving Forward courses for people finishing treatment
- An online forum
- Information on family history and inherited risk
Your local breast screening service
NHS- Rearranging or cancelling a screening appointment
- Arranging a mammogram if you are over 71 and want to keep being screened
- Talking to a breast screening nurse by telephone before an assessment appointment
- Opting out of screening invitations
The family history or genetics clinic
NHS- A formal risk assessment using CanRisk where a family history warrants it
- Genetic counselling before and after testing
- Entry to the very high risk surveillance programme where a variant or a risk-equivalent score is found
- Predictive testing for relatives once a variant is identified in the family
The NHS Jewish BRCA Testing Programme
NHS- A free BRCA test by post for anyone in England aged 18 or over with at least one Jewish grandparent
- No family history or referral needed
- Access to surveillance and risk-reducing options for anyone found to carry a variant
Lymphoedema information and services
NHS- Written information about the risk of lymphoedema before treatment starts, and how to self-monitor
- Reassurance that blood tests, injections, blood pressure measurement, air travel and physical activity on the treated side do not increase the risk
- Referral to a specialist lymphoedema service if it develops
Macmillan Cancer Support
Charity- A support line staffed by nurses, welfare rights advisers and work-support specialists
- Information centres in most cancer hospitals
- Macmillan Grants
- Benefits advice
A medical exemption certificate
Cost and benefit- Free NHS prescriptions in England for five years for anyone being treated for cancer, the effects of cancer or the effects of its treatment
- Applied for on an FP92A form signed by your doctor
- Not needed in Scotland, Wales or Northern Ireland, where prescriptions are free
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- Northern Ireland publishes no breast screening statistics that OnCo could find. Searches of health-ni.gov.uk and publichealth.hscni.net returned the programme's descriptive pages and its leaflets, but no statistical bulletin with uptake, coverage or cancer detection; the only quantitative statements located are the general ones on nidirect, that about four in 100 women are recalled after a first mammogram and that three in four of those have normal results. Every other nation publishes an annual report.
- Scotland's breast screening statistics cannot currently be relied on. Public Health Scotland records that data quality issues have been identified, that previously published statistics contain errors, that the Office for Statistics Regulation was informed and the accredited status suspended on 24 February 2026, and that the figures are now official statistics in development. The most recent update covers only to 31 March 2023 and the next note is promised for 24 November 2026. The 2020/23 uptake and deprivation figures on this page are quoted with that warning attached, and should be treated as provisional.
- The NHS England Digital publication behind the English screening figures, Breast Screening Programme, England 2024-25, answered HTTP 403 with a Cloudflare interstitial to every automated request OnCo made on 25 September 2026, including through a browser-header fetch. The figures on this page are taken from NHS England's own release of them, which quotes the annual statistics line by line, rather than from a secondary account; the underlying tables have not been read directly.
- Wales publishes no breast-specific waiting-time figure. The monthly NHS activity and performance summary reports all cancers together, and the StatsWales successor at stats.gov.wales renders its cancer waiting times cube in a browser only, with no comma-separated, JSON or OData route that answers. Northern Ireland publishes no 62-day figure by tumour site either. Only England and Scotland can be compared on breast cancer waiting times, and even they measure the 62-day clock from different starting points.
- There is no national figure for how long a woman waits between a screening recall and her assessment appointment in practice, as opposed to the date first offered. The programme standard BSP-S09 measures the date of the first offered appointment, and the standards document itself notes that this should be examined alongside actual attendance, which is not published.
- The overdiagnosis estimate on this page is fourteen years old. The Marmot review's figure of around three women overtreated for every death prevented remains the official UK position, quoted on the UK National Screening Committee's own page, but it was calculated in 2012 on trials mostly run in the 1980s, before digital mammography, before tomosynthesis and before the current treatment of small screen-detected cancers. The 2025 revision of the patient leaflet dropped the numerical statement of overdiagnosis altogether and now describes the risk in words, which makes the current programme's own estimate of its harm harder to find, not easier. The UK NSC review due for 2025 to 2026 had not reported when this page was written.
- No UK source was found that gives the share of breast cancers that are each receptor subtype from a cancer registry rather than from a charity's patient information. The routes into that question, and the figures that do exist, are on the subtype pages.
- NATCAN's reports carry an all-rights-reserved copyright notice. Figures from the National Audit of Primary Breast Cancer are quoted on this page with attribution and linked to the source, as a citation rather than a reproduction; the data tables themselves are not copied into the corpus.
How to read this page. Every figure and decision links to the page it was read from (69 sources, checked 2026-09-25); the drug and trial pills open OnCo records with their own sources. Standards and funding change: confirm with your team and the linked pages. Machine-readable copy at /api/v1/cancers/breast-cancer/uk.json. OnCo is orientation, not medical advice.