ARCHIVED - Organized Breast Cancer Screening Programs in Canada - Report on Program Performance in 2003 and 2004

 

Executive Summary

Breast cancer is the most common type of cancer and the second leading cancer cause of death among Canadian women with an estimated 22,400 diagnoses and 5,300 deaths in 2008 (1). Incidence rose until 1999 when it stabilized and began to show non-significant decreases. Deaths attributable to breast cancer have declined by 25% over the past twenty years (2). Although breast cancer can occur at any age, roughly half of new cases occur among women between 50 and 69 years. Early detection, through programmatic screening combined with effective treatment remains the best option available to continue reducing deaths from breast cancer in this age group; however, primary prevention through the more modifiable risk factors holds promise for the future.

The monitoring and evaluation of organized breast cancer screening programs provides an opportunity to understand their impact on breast cancer morbidity and mortality, as well as the potential harms associated with screening. Systematic evaluation of organized programs helps to ensure that Canadian women have access to high-quality breast cancer screening programs. This document presents an evaluation of the performance of organized breast cancer screening programs in Canada for the years 2003 and 2004 using data from the Canadian Breast Cancer Screening Database from ten provinces and one territory.

The societal benefits from breast cancer screening are based on the assumption that 70% of eligible women participate in biennial screening mammography; however, meeting this challenge remains elusive for organized screening programs across Canada. While many programs continue to see increases in participation rates, several mature programs have reached a plateau with participation rates just above 50%. The importance of the availability of timely diagnostic imaging was recognized in the 2004 First Ministers’ 10-Year Action Plan to Strengthen Health Care which subsequently resulted in the establishment of ‘Wait Time Guarantees’ for mammography in a number of jurisdictions (3).

The primary goal of organized cancer screening programs is to detect cancers as early as possible in order to minimize treatment required and reduce the likelihood of death. Indicators of program success include the proportion of cancers that are small and the proportion that have not spread outside of the breast. All programs in Canada, where information is available, meet the targets for tumour size and nodal status, an indicator that women who attend these programs can benefit from these services.

The majority of Canadian women between 50 and 69 who participate in breast cancer screening return on a biennial basis; however, this varies by a number of characteristics. These characteristics include whether this is a woman’s initial screen, whether there has been a false positive result in the past, whether a woman reports a family history of breast cancer, and which provincial program they attend. An examination of the associations between these characteristics and screening outcomes represents a worthwhile avenue for future analysis.

Organized breast cancer screening programs will continue to provide high quality screening to Canadian women in the coming years. Programs strive to achieve reductions in the morbidity and mortality associated with breast cancer through program evaluation, ongoing research, and adaptation of program policy to reflect new evidence and technologies. The Canadian Breast Cancer Screening Initiative, which supports the production of this report, provides a venue for information sharing to solve screening program challenges. The information provided in this report is available to support governments, cancer agencies, screening program managers, health professionals, and other breast cancer stakeholders to enhance organized screening across Canada.

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