Family history patch (#167)

* Update 2025-06-30-defining-family-history-breast-screening.md

Amended two errors spotted by SME

* Update 2025-06-30-defining-family-history-breast-screening.md

Author: dannychadburn

app/posts/manage-breast-screening/2025/06/2025-06-30-defining-family-history-breast-screening.md

@@ -126,7 +126,7 @@ The image reading process is also the same, with the only difference being the s
 
 ## Genetics and family history involvement in screening 
 
-The involvement of genetics and family history in the screening of moderate and high-risk participants is mainly at the beginning of their pathway. Once they have completed the risk assessment, the screening office manages the participant through the screening process (a family history admin role, within the BSO, manages the admin process). 
+The involvement of genetics and family history in the screening of moderate and high-risk participants is mainly at the beginning of their pathway. Once they have completed the risk assessment, the local breast imaging admin team manages the participant through the screening process. 
 
 At most units we spoke with, genetics and family history aren't informed of appointment attendance or screening outcomes. They only become involved again if the participant is referred back to them (for changes or concerns with their health or family history) via the GP. 
 
@@ -148,10 +148,10 @@ Here are the key pain points we have uncovered during our deep dive into Family
 - **Risk tools** – Different trusts and sites use different risk tools to calculate the risk of breast cancer, which can provide differing outcomes 
 - **Cohorts** – Stored locally, sometimes only on paper. This data then has to be manually uploaded to the local RIS. They rely on an administrator to remember to check who is coming due for screening each month and remember to manually book those appointments in. For those under 40 years, the burden may be placed on the participants themselves to remember to get themselves referred to screening (via their GP). 
 - **Losing participants** – Because cohorts are managed locally, there is a risk that if a participant moves out of that area, they will effectively be ‘lost’ as it relies on the participant to get re-referred to a new screening office (via the GP) 
-- **Manual referrals** – Referrals to family history screening must currently be a physical artefact (such as a card or letter) as a qualified clinician must sign-off the radiation exposure (due to [IRMA](https://www.gov.uk/government/publications/ionising-radiation-medical-exposure-regulations-2017-guidance) requirements) for each yearly mammogram. In the National BSP, this happens automatically as it has been built into the requirements of the service. 
+- **Manual referrals** – Referrals to family history screening must currently be a physical artefact (such as a card or letter) as a qualified clinician must sign-off the radiation exposure (due to [IRMER](https://www.gov.uk/government/publications/ionising-radiation-medical-exposure-regulations-2017-guidance) requirements) for each yearly mammogram. In the National BSP, this happens automatically as it has been built into the requirements of the service. 
 - **Manual letters** – Local radiology systems often do not have letter templates setup for family history screening (they are not designed for this process and often not prioritised). So admin staff have to create each letter manually, having to double check names, addresses and outcomes, for accuracy. 
 - **Dual invites** – When family history screening participants approach 50 years, they are automatically invited to the routine screening program. This causes confusion for participants and can mean they attend the wrong appointment or cancel their family history screening accidentally. There is currently no way to manage this overlap on current systems. 
 - **Inappropriate invitations** – Participants being invited to screening when they have a cancer diagnosis causing distress to themselves and family members. Some admins are manually checking this information for each participant prior to sending out invitations, as current systems do not cross-check this information. 
-- **Local systems** – Staff feel they at the mercy of the local radiology system, in that a system which was not designed for screening has been shoe-horned into the process and it shows. For example, on EPIC significant cancer symptoms cannot be flagged to image readers, screening letters are not automated, and EPIC does not support a second read queue. 
+- **Local systems** – Staff feel they are at the mercy of the local radiology system, in that a system which was not designed for screening has been shoe-horned into the process and it shows. For example, on EPIC significant cancer symptoms cannot be flagged to image readers, screening letters are not automated, and EPIC does not support a second read queue. 
 - **No link between family history diagnosis and screening** – Family history diagnosis and screening have very little interaction once the referral for screening has taken place. If a participant has an update to their family history or if they are diagnosed with cancer, this information is not automatically shared but relies on the participant to visit their GP to ask for a referral to family history for a re-evaluation. 
 - **Manual breast density readings** – Some units are carrying out manual breast density assessments due to lack of functionality in their current mammogram machines (there are systems on the market which can automate this reading).