Performance measures from 10 years of breast screening in the Ontario Breast Screening Program, 1990/91 to 2000

Abstract

Performance measures for the Ontario Breast Screening Program (OBSP) by age group, time period and screening modality from 10 years of breast screening were evaluated. Data were available from routine information collected on 283,962 women aged 50 to 69 screened at 73 screening centres between 1 July 1990 and 31 December 2000. Although, initially, participation in the OBSP was low, this rate increased over time and the majority of women screened returned for subsequent screening. Abnormal call rates increased slightly over the time period, were higher in women aged 50 to 59, and for women with mammographic abnormalities. Detection rates of invasive cancer were higher and prognostic features of cancers were better for women age 60 to 69, and those referred by mammography. Along with the prognostic features of cancers, the benign to malignant surgical ratio and diagnostic interval improved over the time periods and for women aged 60 to 69. Greater proportions of women had shorter diagnostic intervals and were more likely to have a diagnosis of breast cancer after surgery if they were referred by both clinical breast examination and mammography. Although some enhancements of the programme are necessary, the OBSP met or exceeded Canadian targets for most performance measures.

The impact of false positive breast cancer screening mammograms on screening retention: A retrospective population cohort study in Alberta, Canada

“…Women who had an open biopsy were 2.3 times less likely to be rescreened within 30 months after their diagnostic resolution compared to those who had a normal index screen. The negative effect of false positives on screening retention is consistent with the findings from two-decade-old Canadian studies 11,21 and a more recent study conducted in Spain, where breast cancer screening is also free and is recommended biennially. 22 Retention rates were higher in the Spanish study than in ours: retention rates for women with false positive vs. normal results were 78.3% vs. 81.9%, compared to ours which were 68.1% vs. 68.7% respectively.…”

Improving Work-Up of the Abnormal Mammogram Through Organized Assessment: Results From the Ontario Breast Screening Program

“…This diagnostic interval has remained constant through the UC pathway, with 50.2% of patients having a diagnosis within the targeted 7 weeks between 1991 and 2000. 6 This represents a 20% improvement in achieving more timely resolution of mammographically identified abnormalities requiring biopsy through the BAA pathway compared with UC. Identifying the precise element of the BAA that may be critical in reducing wait times to diagnosis is difficult, given that the BAAs are not restricted in their methods of providing organized assessment; therefore, the reduction in wait times may be attributable to a variety of local patterns and resources.…”

“…A complete description of the details of the operation of the OBSP has been previously published. 6 In 2004, the OBSP, with guidance from the OBACG, introduced the Breast Assessment Initiative, which provided incentives for facilities to establish care during the diagnostic interval according to Canadian Association of Radiologist standards, in addition to offering multidisciplinary expertise (radiologic biopsy and surgical support) and patient navigation to facilitate the patient's experience through her work-up. Facilities that qualify are designated BAAs and serve to provide work-up of an abnormal mammogram through a formal, defined pathway without requiring a specific referral from the patient's primary care physician, with the aim of providing high-quality timely care during the diagnostic interval.…”

“…Although the majority of women participating in screening mammography will have a normal result, approximately 10% of these women will have an abnormal test requiring further diagnostic work-up or assessment. 6,7 It is also recommended that an abnormal mammogram be followed up through an effective referral system or organized pathway. 8,9 Typically, the patient and her primary care physician are notified of the abnormal result, and the primary care physician subsequently organizes any referrals and recommended tests to achieve a diagnosis.…”

Influence of Nurses on Compliance with Breast Screening Recommendations in an Organized Breast Screening Program

“…Therefore, during the study period, 66 (71.7%) of the 92 OBSP centers had a nurse and 26 (28.3%) did not. A complete description of the details of the operation of the OBSP has been published (24,25).…”