Flemish breast screening program needs improvement

2016 09 15 16 37 49 921 Mammogram Calendar 400

Belgian researchers have found that the Flemish breast cancer screening program's attendance rate could use some improvement, although key performance indicators do hit European Union benchmark targets, according to a study published on 28 October in BMC Cancer.

A team led by Dr. Mathieu Goossens of Vrije Universiteit Brussel in Belgium analyzed 15 years of performance indicator data from the population-based mammography screening program in Flanders. Screening data from individual women were linked to the country's cancer registry to ascertain whether women had undergone follow-up. The researchers compared performance indicator results to targets set by European Union guidelines.

The program's coverage increased over the 15-year period by about 7.5% annually, but this increase fell to 1.6% after invitation coverage hit its limit, the investigators found. The study also showed the following:

  • In 2016, the program's coverage was at 50% and opportunistic coverage -- that is, screening requested by the patient or suggested by a doctor -- was at 14.1%, for total screening coverage of 64.2%.
  • Women's response to screening invitations in 2016 was 49.8%.

Recall rates decreased significantly over the study time frame, while cancer detection rates remained stable -- resulting in an increased positive predictive value. Overall program sensitivity was 65.1% in 2014.

Additionally, in 2015, the proportion of ductal carcinoma in situ (DCIS) out of all initial screen-detected cancers was 18.2%, while the proportion of stage II or higher cancers was 31.2% and node-negative invasive cancers was 61.6%. Successive regular screening proportions were 14% for DCIS, 24.8% for stage II or higher cancers, and 65.4% for node-negative invasive cancers.

The study findings suggest several future directions for improving the Flemish screening mammography program, the group concluded.

"There are several priorities for further investigation such as a critical evaluation of strategies to increase screening participation, organizing a biennial radiological review of interval cancers, analyzing the effect that preceding opportunistic screening has on the [key performance indicators] for initial screenings, and efforts to estimate the impact on breast cancer mortality," the researchers wrote.

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