Cancon

28.09.2015

Breast cancer screening, part II

The best breast cancer screening programme minimises harms and maximises benefits. The breast cancer screening experts met to assess the current practices and findings in Cancon WP 9 Screening meeting held on 17 and 18 of September in Zagreb, Croatia.

Cancon: Visual image of Croatian breast cancer screening programme

Based on the experts' discussions there are at least 10 facts that should be taken into account when planning the screenings. Here are seven facts and first three were published on last week.

Image: Visual image of Croatian breast cancer screening programme.
 

4. Breast cancer screening is not an opinion – it is a health care programme with ongoing research

Once breast cancer screening programme is set up, it needs to be followed-up. As screening process is a chain of events; one event leading to another, the whole chain is under scrutiny.

Cancers occur also between the screening rounds. There is a need to inform women with balanced manner and clear language about the benefits and harms of screening.

In many programmes appropriate evaluation is not yet integrated into the activity. Without integrated evaluation, it will be very difficult, if not impossible, to address to the balances of the benefit and harm of the on-going programme.

5. Breast cancer is increasing in the future – so recommendations needed

Many cancers are getting rare. Breast cancer trend is increasing. Mortality from breast cancers has fortunately started to decrease in many countries during the recent years. There are still many questions to be asked. For instance, what is the right age group targeted to screening. As people live older, many countries have extended the age of screening mammogram over 69.

6. Not just any test

Screening experts are very much aware that sometimes it is hard to explain that screening is a programme, just not another test. Nobody knows how many women take additional breast cancer mammograms between the screening rounds and nobody can estimate effectiveness or cost of these interval tests.

7. Legislation is an institutional frame for screening

To safeguard best possible breast cancer screening, there must be appropriate legislation and health care guidelines in place. Legislation is required to enable careful evaluation based e.g. on data linkages. It is no use to start an intensive and expensive programme without good basis. Any programme is slow to start. There is a real option that countries start screening without proper planning ahead.

8. Experts need networking to exchange their views

Cancon joint action provides a platform for discussion about screening and sharing experiences among partners and experts. But what will happen after the joint action is over in 2017? This is an open question that needs to be addressed further.

9. Nothing is perfect – need of comprehensive quality assurance

Breast cancer screening programmes have proved their effectiveness but they are not perfect. There is a possibility for overdiagnosis, ie. diagnosis of breast cancers that would not have come to clinical attention if screening had not taken place. There is also a possibility that badly implemented programme causes more harm than benefits. This is why quality criteria for breast cancer screening programmes must be in place.

10. Communication – remembering patients and survivors

Every stakeholder of the breast cancer screening process benefits from clear communication. Both patients and screenees in general need to be addressed from their perspectives. Experts among themselves need another kind of an approach. Cancon guidelines should be addressing their messages for the most important stakeholders. Above all, the communication and its accessibility should be tailored carefully.

Read the three more facts on breast cancer screening. 

More information:  

 

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