Breast imaging was a relatively rare activity before the advent of the National Health Service Breast Screening Programme (NHSBSP) in 1988. A few centers had developed expertise, and this had been put to use in the UK Trial of the Early Detection of Breast Cancer, which completed as the screening program began. A major task for the new screening program was to equip embryonic breast screening units with state-of-the-art mammography sets, to train the radiographers to use them and the radiologists to interpret the films. Over 20 years later, many of the lessons learned from the screening program are being widely applied.

Training of experienced staff in new skills proved challenging in the time available, but the existence of specialist training centers proved invaluable as the screening service matured. As the use of high quality mammography and ultrasound spread from the screening program into symptomatic practice, many staff attended courses in breast imaging and breast cancer management, taking advantage of the specialist expertise that had built up.

Audit and quality assurance were new issues then and ones that the new service took to its heart. As questions of policy and practice arose, the databases were searched and national analyses undertaken to find answers. Links were shown between technical standards and clinical outcomes as the multidisciplinary approach really took hold. Quality gradually improved as the learning curve was worked through and all units reached a standard shown by trials to be necessary for the screening program to be effective.

Equipment purchased was closely monitored. Beginning with conversations at meetings over lunch, a database of all equipment in use in the program was later developed and all the various faults were centrally recorded. This still exists and has proved tremendously powerful in conversations with manufacturers and suppliers.