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This year, the National Health Service Breast Screening Programme in the UK (NHSBSP) celebrates its 20th anniversary. Since 1988, it has evolved with the help of randomized control studies to become more efficient at picking up in-situ disease and small invasive cancers. This review will address these new developments and discuss their impact on screening.The introduction of extra mammographic views, the reading of films by two specialists and digital mammography as well as age extension have all made significant differences to the detection of breast cancer through screening. A discussion of how less obvious factors such as organization and structure as well as rigorous national audit have improved matters is also included. Controversial topics such as the screening interval and screening women under 50 will also be addressed in this review.Population-based breast screening will continue to evolve in England. It is unique and with its annual national audit it continues to drive the development of breast services nationally.