BackgroundThe Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme.MethodsThe CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring.ResultsBreast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines.ConclusionsMammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

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Úvod: Screening karcinomu prsu prostřednictvím mamografi e je fungující nástroj ke snižování úmrtnosti na toto onemocnění. V ČR probíhá od roku 2002 organizovaný Národní program screeningu karcinomu prsu. Materiál a metody: Monitoring programu je založen na datech Národního onkologického registru ČR, Registru Národního programu screeningu karcinomu prsu a na datech Národního referenčního centra (NRC). Uvedené datové zdroje umožňují hodnocení časných indikátorů kvality dle mezinárodních standardů, stejně jako monitoring zátěže populace zhoubnými nádory. Data NRC umožňují doložit vysokou validitu dostupných dat a mapování neorganizované mamografi e (tzv. šedého screeningu). Výsledky: Do poloviny 90. let 20. století docházelo k setrvalému mírnému nárůstu incidence i mortality zhoubných nádorů prsu, v posledních 15 letech incidence roste výrazněji. Mortalita naopak v tomto období přestala růst a v novém tisíciletí pozvolna klesá. Ve srovnání s první polovinou 90. let 20. století, kdy podíl nádorů dia gnostikovaných v I. stadiu dosahoval necelých 20 %, došlo k výraznému nárůstu časné dia gnostiky, když v roce 2011 bylo v I. stadiu dia gnostikováno více než 40 % nádorů prsu. Pokrytí mamografi ckým screeningem aktuálně dosahuje hodnoty 50 %, tato hodnota se ustálila v letech 2007-2008 a dále bohužel výrazněji neroste. Závěr: V průběhu posledních dekád se v ČR podařilo zásadně snížit zátěž populace karcinomem prsu-přes nárůst incidence dochází k poklesu úmrtnosti, na čemž má významnou zásluhu časnější záchyt prostřednictvím screeningového programu. Další zvýšení účinnosti programu je podmíněno navýšením pokrytí populace screeningem, k čemuž by mělo přispět adresné zvaní žen k vyšetření, které bylo zahájeno začátkem roku 2014. Klíčová slova nádory prsu-plošný screening-mamografi e-ukazatele kvality zdravotní péče Práce byla podpořena v rámci projektu 36/14/ /NAP "Vývoj a implementace metodiky hodnocení účinnosti adresného zvaní občanů do onkologických screeningových programů ČR" v rámci programu "Národní akční plány a koncepce" Ministerstva zdravotnictví ČR na rok 2014. This study was supported by the project 36/14/ /NAP "Development and implementation of meth odology for the evaluation of eff ectiveness of personalised invitations of citizens to cancer screening programmes" as part of the programme of the Czech Ministry of Health "National action plans and conceptions". Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do bi omedicínských časopisů. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers.