Changes in Canadian women's mammography rates since the implementation of mass screening programs.

Grasse, Catherine E. De; O'Connor, A.; Boulet, Jack; Edwards, Nancy; Bryant, Heather; Breithaupt, Krista

doi:10.2105/ajph.89.6.927

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…12 Our results are also concordant with Canadian data where no increase in the number of diagnostic mammographies among women aged 40 -49 was observed. 13 For women aged 50 -69 years, the use of diagnostic mammography was, as expected, significantly lower (1.47%) in the 2 screening regions than in the rest of the counties (3.43%). In the 9 counties without organised screening, the official policy on access to diagnostic mammography had, surprisingly, no impact on the use.…”

Section: Discussionsupporting

confidence: 67%

Do nonattenders in mammography screening programmes seek mammography elsewhere?

Jensen

Olsen

Euler‐Chelpin

et al. 2004

Intl Journal of Cancer

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The objectives of our study were to analyse the use of diagnostic mammography among nonattenders and attenders in organised mammography screening in Denmark in 2000, to assess the contamination from organised screening of noninvited age groups and to measure the impact of local policy on opportunistic screening. Data on all diagnostic mammographies performed in Denmark in 2000 and data on women targeted by the 2 organised mammography screening programmes in Copenhagen and the county of Fyn were collected. All data were linked by the Danish personal identification number. Information on the official policy in 2000 with regard to opportunistic screening was collected from all counties. The proportion of women using diagnostic mammography was only 1-3% for both attenders and nonattenders in organised mammography screening, but it was significantly higher in Copenhagen than in Fyn, due to availability of mammography in private clinics. The proportion of women using diagnostic mammography varied from 1-4% across counties. The official policy on access to diagnostic mammography and contamination from organised mammography screening of adjacent age groups had no impact on the use. Instead, urbanisation was positively correlated with use of diagnostic mammography. In conclusion, our results clearly showed that nonattenders in organised mammography screening programmes do not seek mammography outside the programme. Since a positive policy toward opportunistic screening did not have any effect, our results add further evidence to existing knowledge that the only reasonable way to achieve high mammography coverage is through a well-organised screening programme.Key words: mammography; screening; breast cancer; diagnosis; opportunistic To operate effectively, an organised mammography screening programme requires high attendance, as low attendance will hamper the possibility of a long-term breast cancer mortality reduction in the target population. 1-3 Attendance rate is therefore an important performance indicator for newly started mammography screening programmes.It is well known that attendance rates in organised mammography screening programmes differ between urban and rural areas. In a number of European countries, it has been observed that programmes in rural areas obtained or exceeded the EU desirable attendance rate of 75%, whereas programmes in urban areas did not. 4 Such patterns have been observed in Sweden, Denmark, Norway, Italy, Spain, England and the Netherlands. 3,[5][6][7] In Sweden, the programme in the capital Stockholm had an attendance rate of only 69%, whereas rates of 89 -90% were found in Norrbotten and Västernorrland. 3 It is thus noteworthy that the highest European attendance rates were found in the areas with the lowest population density. 8 The urban-rural pattern has been explained by the availability of alternative possibilities of mammography examinations in large cities, primarily in private clinics. 2 In 1999, the Danish Parliament passed a law requiring all regions to offer organised mammog...

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Section: Discussionsupporting

confidence: 67%

Do nonattenders in mammography screening programmes seek mammography elsewhere?

Jensen

Olsen

Euler‐Chelpin

et al. 2004

Intl Journal of Cancer

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“…30 This concurs with the findings of Gaudette et al who reported that the highest mammography rates were observed in those provinces with well established breast screening programmes 31 and further supported by De Grasse et al who showed that the rise in mammography rates in Canadian provinces with screening programmes was twice that of provinces without screening programmes (20% versus 10%). 32 The participation rates across the province vary greatly from a high of 41% in north western Ontario to a low of 5% in the central eastern part of the province and 9% in Metropolitan Toronto. This may be related to the number of facilities where mammography is available in each region.…”

Section: Discussionmentioning

confidence: 99%

Results from the Ontario breast screening program, 1990–1995

1998

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Objective-The Ontario breast screening program (OBSP) is a provincial breast screening programme oVering two view mammography, clinical breast examination, instruction in breast self examination, and systematic two year recall to Ontario women 50 years and older. This paper presents the results of the programme's intermediate outcomes from 1990 to 1995 and compares them with recommended standards and other published programmes. Methods-Programme data from a provincial screening programme in a large Canadian province were collated from 18 sites in operation between July 1990 and December 1995. Results-In its first five years of operation, 215 738 screens were performed on 142 173 women. The referral rates for initial and rescreens are 13.8% and 8.6% respectively. A total of 1718 women were diagnosed with cancer, 1325 at initial screens and 393 at rescreens, resulting in cancer detection rates of 9.3 and 5.3/1000. The cancer detection rates for invasive cancers were 8.3/1000 at initial screens and 4.5/1000 at rescreens. The benign to malignant biopsy ratio was 1.5:1 at initial screens and 1.3:1 at rescreens. Of the 1358 cancers diagnosed at initial screens, 11.6% were in situ and 50.3% of invasive cancers of known size were <15 mm. For women with invasive cancer where nodal status was known, 71.3% were node negative. The proportions at rescreens were 15.7%, 60.0%, and 76.0% respectively. Conclusions-While the OBSP has achieved the standards suggested by other studies and programmes during its first five years of operation, there is work to be done to increase participation and obtain more complete data on tumour size and nodal status. (J Med Screen 1998;5:73-80)

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“…[ 48 ] There has been evidence that provinces and territories that initiated programmatic screening early were more effective in reaching the target population. [ 49 ] The programs report on their outcomes nationally and show a high degree of compliance with international standards for cancer detection rates, referral rates and other quality indicators. [ 48 ]…”

Section: Resultsmentioning

confidence: 99%

Breast Cancer in Canadian Women

Bryant

2004

BMC Women's Health

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Health issue: Although lung cancer is the leading cause of cancer deaths for Canadian women, breast cancer is the most frequently diagnosed. About 5400 women are expected to die from this disease in 2003. In 1998, a woman's lifetime risk of breast cancer was about one in nine.Key findings: A number of risk factors for breast cancer have been identified. These include advancing age, hormonal factors (eg. early menarche, late menopause and late age at first full-term pregnancy), familial risk, BRCA-1 and BRCA-2 gene mutations, diet and postmenopausal obesity.Several interventions have been introduced to assist women at high risk for breast cancer, including genetic counseling and testing for women who have strong family histories of breast cancer; selective estrogen receptor modifiers, such as tamoxifen, that has been shown to reduce breast cancer rates; prophylactic mastectomy and screening. Data gaps and recommendations:Guidelines are unclear in several areas, particularly in screening. Where clinical guidelines are available, health services research or ongoing monitoring (by provincial/territorial cancer agencies) is needed to assess compliance with the guidelines and to ensure equity of access within the provinces/territories. Key components of organized screening programs need to be established, in part to ensure that screening is carried out in high-quality, co-ordinated programs. There is also a need to develop ways to involve women fully in informed decision-making and to address several policy issues to prevent disparities in access to high-quality services. Patenting issues associated with genetic tests also need to be clarified.

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Changes in Canadian women's mammography rates since the implementation of mass screening programs.

Cited by 10 publications

References 5 publications

Do nonattenders in mammography screening programmes seek mammography elsewhere?

Do nonattenders in mammography screening programmes seek mammography elsewhere?

Results from the Ontario breast screening program, 1990–1995

Breast Cancer in Canadian Women

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