Breast cancer screening – a complicated puzzle
Group picture from WP 9 meeting in Zagreb.
Breast cancer is the most common cancer worldwide and in Europe, where nearly half a million women get breast cancer annually. How to reduce its burden?
One way to reduce mortality is to find breast cancers early and treat them effectively. There is no simple way. Breast cancer screenings are complicated health care programmes and vary from country to country. Even though population-based breast cancer screening programmes have proven their effectiveness open questions still remain.
This report is from Cancon WP 9 Screening meeting held on 17 and 18 of September in Zagreb, Croatia, where experts met to assess the current practices and findings of breast cancer screening.
In several EU countries, particularly among the new member states, comprehensive population-based screening programmes have not yet been established, says Dr Ahti Anttila, WP 9 leader from the Finnish Cancer Registry. The best breast cancer screening programme minimises harms and maximises benefits.
So what do we know? Based on the experts' discussions there are at least 10 facts that should be taken into account when planning the breast cancer screenings. Here are three of them and last seven will be published on next Monday 28 of September.
1. Is it possible to screen breast cancer? Yes.
How do we know when screening is possible? In cancer screening, this particular disease must be an important health problem and there must be a latent phase that is detectable.
There must be a suitable test available to detect it early. Treatment must be available and acceptable and there must be agreement whom to treat as a result of screening.
There must be resources for testing and treatment. Screening and treatment costs must be economically balanced in relation to medical care as a whole.
Screening is a continuous process – it is not “once and for all”. It needs quality assurance.
2. It is hard to evaluate effectiveness without good cancer registration
In an ideal world a screening programme covers everyone. In real life, if the programme attendance is at least 75% of the target population, it is considered effective according to the current EU criteria. Screening should find cancer early, which is measured with tumour specifics – clear minority of screen-detected cancers should be over stage 2+ and majority without nodal involvement.
Without cancer and related cause-of-death registration linked to national population data it will be hard to monitor and evaluate the screening programmes. In many countries there is no cancer registration covering the whole population.
Research on effectiveness is based on different methodologies and the results vary from country to country. Therefore setting up a good population-based screening programme really requires registration with good coverage and systematic practices and methods.
3. Mammography is digital and expensive
Thus breast cancer screening is an investment. If a woman has to travel far away to be screened – even when the test itself was free – the coverage could be low. This is the case in many countries, for instance in Croatia.
Read the seven more facts on breast cancer screening.
More information:
- Cancon work package 9 Screening creates guidance and principles for good practices in the planning, implementation, management and evaluation of the population-based cancer screening, as a part of national cancer control policies. More information about the Screening work package from Ahti Anttila ahti.anttila@cancer.fi
- There is a chapter on screening in the revised version of European Guide for Quality National Cancer Control Programmes (pdf) that has just been published. You can order printed copies of the Guide from cancer.control@nijz.si
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