Breast cancer screening and management

Women's patterns of participation in mammography screening in Denmark

The objective of the study is to analyse individual women's participation patterns in mammography screening in Denmark. The study is set in the capital of Copenhagen and the county of Fyn representing around 95,000 women aged 50-69. The Central Population Register (CPR) was used to define the total target group, and supply information on migrations and deaths. Invitation and participation data came from the mammography screening programmes in Copenhagen (1991-1999) and Fyn (1993-2001), containing personal identification number, data on invitation date, participation and examination date for each screening round. In Copenhagen the coverage went from 70.5% in the first round to 63.1% in the fourth round, and the equivalent data for Fyn is 84.6% in the first round and 82.8% in the fourth round. Of the women eligible for at least three invitation rounds, 52.6% in Copenhagen and 76.4% in Fyn were faithful users, i.e. had participated in all screenings they were invited to. The conclusion is that the programme participation rates tend to overestimate the protection of the individual women covered by the programme. Behind the urban-rural gradient in programme participation is an even greater gradient in programme protection.

Evaluation of the organised mammographic screening programme in Australia

An organised approach to mammographic screening in Australia commenced in 1992 as a free service for asymptomatic women in the target age range 50-69 years and accessible to all women aged >/=40 years. Screening is performed by two-view mammography, women aged 50-69 years being sent reminders every 2 years for repeat screens. National Accreditation Standards have been agreed and BreastScreen Australia has developed mechanisms to monitor and report performance including systems and standards for data collection. The national report includes participation rates, small cancer detection rates and programme sensitivities. These indicate that BreastScreen Australia is meeting its accreditation standards with respect to most measures. Routinely collected outcome data reflect an increasing trend in the proportion of women receiving breast conserving surgery; a decline in the proportion of women diagnosed with ductal carcinoma in situ undergoing axillary dissection and an increasing use of combination therapies with a corresponding decrease in the use of hormonal therapy alone. There have been increases in breast cancer incidence and falls in mortality with the largest changes in women aged 50-69 years. As the BreastScreen Australia database is routinely linked in future to population cancer registries, the mortality reduction due to mammographic screening may be estimated more precisely.