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Women covered by this guidance should have both procedures up to and including the age of 50. At the screen when the woman is aged between 50 and before her 51st birthday, breast density should be reviewed by the reporting image reader at the time of her breast screening. If the mammogram shows an entirely fatty breast (BI-RADS A, see the BI-RADS Atlas - Reporting System), MRI is unlikely to add value and her screening protocol should change to mammography only for the remainder of her screening invitations. The review is undertaken by one image reader and the outcome recorded on NBSS. The breast density measurement can also be reported using an automated tool which can measure density giving a BI-RADS score. If there is uncertainty over the category of breast density, a further image reader should be consulted.

Referrals for women aged 30 and above with a proven germline BRCA1/2 or PALB2 pathogenic variant can be automatically accepted into the very high risk programme, with supporting evidence. Jones G, Riley M, Dwyer T. Breastfeeding in early life and bone mass in prepubertal children: a longitudinal study. Osteoporos Int. 2000;11(2):146–52. The bone mass assessment in adolescents also showed diverse findings. While two studies observed higher bone mass values among those who were breastfed [ 6, 8]; one reported a direct relation between breastfeeding duration and bone outcomes [ 9] and one did not find any association [ 11].

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Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba B, Fairweather-Tait S. Calcium requirements of lactating Gambian mothers: Effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr. 1995;62:58–67. if the complete VHR protocol includes MRI and mammography, her NTDD moves to 12 months from the date of the original screen (for MRI) and mammography should be requested 6 months after this date. Her next VHR screening invitation should be for both MRI and mammography (as per protocol), 6 months after the date of her previous screening mammography appointment. Transgender (trans) men and non-binary people who have breast tissue and fulfil the criteria to be eligible for very high risk screening will be invited for screening if they are registered with a GP with a gender marker of female or indeterminate. If they are registered with a gender marker of male, they will not be automatically invited. They will need to speak to their GP who can arrange for a referral to a local hospital for the appropriate screening on an annual basis.

Cooper C, Cawley M, Bhalla A, Egger P, Ring F, Morton L, et al. Childhood growth, physical activity and peak bone mass in women. J Bone Miner Res. 1995;10:940–7.Once a referral has been accepted, the woman needs to be appropriately identified as very high risk on Breast Screening Select ( BSS) and NBSS. Documentation should be scanned and uploaded to the woman’s BSS record. See more detailed information regarding these processes. Referrals by BARD Women in this group who were treated with radiotherapy between the ages of 10 and 35 years are referred into the NHS BSP very high risk programme. The NICE familial breast cancer guidelines categorise women at increased risk of breast cancer into moderate or high risk categories. Pirila S, Taskinen M, Viljakainen H, Kajosaari M, Turanlahti M, Saarinen-Pihkala UM, et al. Infant milk feeding influences adult bone health: a prospective study from birth to 32 years. PLoS One. 2011;6(4):e19068. Andres A, Casey PH, Cleves MA, Badger TM. Body fat and bone mineral content of infants fed breast milk, cow’s milk formula, or soy formula during the first year of life. J Pediatr. 2013;163(1):49–54.

Shedding: This occurs when the growth pattern is interrupted, forcing too many hairs prematurely into the resting phase resulting in increased hair fall out. Hair shedding is usually a temporary problem and is most often seen by visible hair loss in the shower or hair brush. Bates CJ, Prentice A. Breast milk as a source of vitamins, essential minerals and trace elements. Pharmacol Ther. 1994;62:193–220. Increased Breakage: This is not technically hair loss but can look very similar. Fragile hair can snap along the hair shaft resulting in less growth. Although it’s not a type of hair loss, it can be seen alongside other types and requires strengthening treatments.a proven germline pathogenic variant in BRCA1, BRCA2, TP53, A-T homozygotes, PALB2, PTEN, STK11 or CDH1 or any other high risk gene based on testing in a clinically accredited laboratory Before we reveal the results of our four-week test, I’m here to help you identify the type of hair loss you’re experiencing, so you can find an effective solution to treat your concern at home. that the referred woman has been registered onto BSS (on the pending list if referred before her protocol screening age) or both BSS and NBSS if she is due screening now