BARD

BARD is a confidential database of women in England who have received radiotherapy involving breast tissue when aged between 10 and 35 years for whom there is an increased risk of developing breast cancer. It has been set up to make sure eligible patients can be informed of screening options at the right time.

1. Current national guidelines recommend that annual screening should start 8 years after radiotherapy to breast tissue or at age 25 or 30 (depending on circumstances), whichever occurs later.
2. Under these guidelines, patients who receive TBI (total body irradiation) are currently not eligible for screening.

Women who have had radiotherapy to the chest area involving breast tissue (excluding TBI, see ‘How does BARD work?’) when aged between 10 and 35 years are eligible for annual screening and are included on BARD. It is likely that BARD and the recommendation for screening will have already been discussed with patients at the time of radiotherapy.

• Radiotherapy to this area is most commonly given for Hodgkin or non-Hodgkin lymphoma but it can sometimes be used to treat other cancers too. Women receiving radiotherapy for a cancer other than lymphoma are also eligible for screening. In these cases a Consultant Clinical Oncologist should submit a BARD non-lymphoma patient referral form [Word, 18.2 KB] confirming that radiotherapy involving breast tissue was given between the ages of 10 and 35 years.
• Patients who were diagnosed and treated outside of an English NHS setting but who now reside in England can be added to the BARD database. To do this, BARD requires information about the cancer diagnosis and the radiotherapy treatment. Please contact the BARD email address in these instances (chn-tr.BARD@nhs.net).

Using all available data, the BARD team has worked hard to make sure at-risk patients have been identified and receive screening appointments at the right time. If you think that you are eligible for screening and want to check, please get in touch with us (chn-tr.BARD@nhs.net) and we will confirm if your name and contact details are in the database.

The BARD database includes data for patients identified through the following means:

• Patients diagnosed with Hodgkin lymphoma before 2003 and treated with radiotherapy to the chest area were invited to dedicated clinics during a national recall exercise. At these clinics the possible late effects of radiotherapy and eligibility for screening were discussed.
• Data for patients diagnosed with lymphoma between 2003 and 2013 was extracted from the national cancer registry (National Disease Registration Service (NDRS)) and manually linked to radiotherapy data from providers across England.
• Data for patients diagnosed with lymphoma between 2014 and 2019 was extracted from the national cancer registry and electronically linked to records in the national radiotherapy dataset (RTDS).

The BARD database will be updated for patients diagnosed in 2020 onwards as and when these data are available in the cancer registry and RTDS.

Every woman is at risk of developing breast cancer at some stage in her life. Having radiotherapy involving breast tissue at a younger age means there is a higher risk of developing breast cancer later in life. 

The increase in risk varies based on a number of factors including age when radiotherapy was given, the size (area) of the radiation field, and the dose of radiation received. The increased risk doesn’t occur straight after the radiotherapy and takes some years to develop.

For women who were treated as young adults, there is thought to be no additional risk until approximately 10 years after treatment.

Patients will be offered screening according to national guidelines, using either MRI or mammography.

Screening with mammography can be safely performed during pregnancy but as the breast tissue becomes more dense during pregnancy and breastfeeding, it is more difficult to diagnose cancer. You can be screened during breastfeeding but you are advised to breastfeed or express milk prior to the examination. Shielding is not considered necessary due to the low radiation dose of mammography.

MRI during pregnancy is not recommended as the diagnostic image quality will be lower compared to when you are not pregnant or breastfeeding. However, you will be reviewed and your clinician will decide if MRI is necessary.

If you choose to postpone screening due to pregnancy or breastfeeding, MRI screening should restart 3 months after giving birth or following the end of breastfeeding.

No screening method can detect every cancer and cancer can sometimes develop in between screening appointments. If you notice any unusual changes in your breasts, please speak to your GP as soon as possible. Do not wait for your next screening appointment.

Having breast screening from an earlier age because of previous radiotherapy is entirely your choice. If you do not wish your name to be included on BARD please let us know you wish to opt out by sending an email to chn-tr.bard@nhs.net – please include your name and NHS number.

If you have your name removed from BARD, you will still receive an invitation for routine breast screening starting between the ages of 50 and before your 53rd birthday as part of the screening offered to all women. Routine breast screening is offered every 3 years to women in England aged between 50 and their 71st birthday. 

If you decide not to have screening from an earlier age now, but later change your mind, you can still be screened from that date. All you need to do is contact BARD (email address: chn-tr.bard@nhs.net) who will add your name to the list.

Due to the nature of cancer registration processes, it is recognised that NDRS (National Disease Registration Service) cannot guarantee to hold data on all patients that would be eligible for inclusion in the BARD project screening. NDRS would not be held liable for any patient omitted from screening due to missing data and the BARD project is responsible for identification of the screening cohort.

Areas where NDRS may be missing data on patients may include (but is not limited to): 

1. Incomplete or inaccurate data received from health care providers
2. Patients who have opted-out from disease registration
3. Transgender patients who may be recorded as male on the NDRS database and therefore not identified as being eligible for inclusion

More information about BARD is available:

• In our patient information leaflet (above)
• Newsletters
• NHS breast screening Breast screening: high risk women - GOV.UK (www.gov.uk)
• NDRS webpage (data story) ndrs.nhs.uk

You can also contact the BARD team. The email address is chn-tr.BARD@nhs.net. Or, you can write to:

BARD
Professor John Radford/Dr Joanna Williams
Department 26,
The Christie NHS Foundation Trust,
Wilmslow Road,
Manchester,
M20 4BX