BARD: A national targeted breast screening programme for women who received radiotherapy to breast tissue when age under 36

Hodgkin lymphoma, the commonest cancer in young people, is diagnosed in ~2100 patients per year in the UK. Treatment often involves radiotherapy to the chest, and, in women under 36 years old, this substantially increases their risk of later developing breast cancer. In the UK, these women are eligible for annual breast screening starting eight years after treatment.

The increased risk of breast cancer in women treated for Hodgkin lymphoma with radiotherapy to the chest has been known about since the early 2000s. In 2003 there was a national recall of all patients in this cohort, informing them of the risk and the offer of enhanced breast screening. To improve screening access, patients / oncologists / Lymphoma Action were consulted, and, in response to feedback, the national Breast screening After Radiotherapy Dataset (BARD) was established.

Operational across England since 2020, BARD has revolutionised access to screening for women at risk of radiotherapy-related breast cancer. In 2020 BARD was included in the new national very high risk breast screening guidelines, since which time BARD has referred >220 patients for very high risk breast screening.

At the project launch, National Screening Director Professor Anne Mackie described BARD as “an exemplar for surveillance of clinically-identified high risk populations”, while two patients shared their personal experience and strongly endorsed the structure and purpose of BARD. The aim of enhanced breast screening is to identify a breast cancer in its early stages, when treatment options and survival outcomes are more favourable. Through identification of at-risk patients and their subsequent referrals for screening, BARD will undoubtedly save lives.

Managing a National Screening Project

As BARD Senior Project Manager, Dr Joanna Williams’ role is multifaceted, spanning logistical organisation of data collection and collation, through to identifying at-risk patients and referring them for screening.

Joanna works across multiple organisations (academic / NHS), and directs and leads colleagues in the BARD operations team. To ensure smooth project operations on a day-to-day basis she liaises with several organisational teams – for example, legal and financial colleagues, clinicians, data analysts, and national breast screening personnel (to name but a few!).

In October 2021, Joanna, along with Professor John Radford (BARD Chair) and Professor Richard Cowan (BARD Clinical Oncologist) hosted a BARD webinar as part of national breast cancer awareness month, which covered an overview of BARD, breast cancer and radiotherapy, implications for clinical practice, challenges and future aims.

The impact of BARD is already being felt nationally. Future aims include identifying all patients eligible for a referral through BARD at the time of radiotherapy, as well as to expand the dataset to include patients across all the devolved nations of the UK.

In short, BARD is the first national targeted screening programme in England, and is leading the way in this field!