A major review of Scotland’s breast screening service has found serious need for reform, amid falling uptake, especially in the country’s most deprived areas where fewer than three in five attend.

Almost one quarter of appointments are missed under the current system, with women telling the reviewers that the design, location and delivery of breast screening is a barrier to accessing the service.

The review recommends the Scottish government develop a strategy to establish static satellite screening centre provision in the central belt of Scotland, to address particularly stark inequalities in uptake in these areas.

Introducing a direct call-recall system - a more personalised way to directly notify women based on their next testing date - to replace the current GP practice calling model could also improve uptake according to the review.

The recommendation comes after ‘two major adverse events’ in the Scottish Breast Screening Programme in recent years, where eligible women were not invited to screening.

A new approach would also allow women with a family history of cancer be called in for checks more frequently – however the authors say this would need ‘robust data quality’ and further system development.

Also among the 17 recommendations is the need to develop a single programme-wide workforce plan, with a focus on training capacity, role development and redesign in the six NHS boards that host breast screening services.

The review found centres are ‘significantly over-reliant’ on locum staff and the service is vulnerable to understaffing and shortages of experienced radiographers, particularly in the East of Scotland.

The Scottish government has accepted all recommendations made by the review and says delivering many of them is already underway.

A new Breast Screening Modernisation Programme Board, chaired by consultant radiologist Dr Marzi Davies, will start work in driving improvements to deliver a sustainable, more person-centred service.

Public Health and Women’s Health Minister Maree Todd said:

“I welcome this report and I am very grateful for the work that went into it while our NHS faced immense pressures in responding to the pandemic.

“It sets out a number of key learning points and opportunities for improving how we do things, and while it was commissioned pre-covid-19, it’s important to note that the breast screening programme is still recovering from the impacts of the pandemic.

“Among our immediate priorities is ensuring that there is sufficient capacity for women aged between 50-70, the recommended screening population, to be invited for screening every three years.”

The Scottish Breast Screening Programme was paused because of covid-19 between March and August 2020.

A pause on self-referrals of women over the age of 71 still remains, despite self-referral being recommenced in England and Northern Ireland.

Age Scotland and About Dementia told the Scottish parliament’s Covid-19 Recovery Committee that this, and the resultant impact on waiting times for treatment courses to start, may have contributed to excess deaths during the pandemic.

The Scottish government says work is underway to restart the self-referral route by Autumn 2022.