Organized Breast Cancer Screening Programs in Canada

1999 and 2000 Report

Monitoring and Evaluation

To achieve reductions in breast cancer mortality and morbidity, and to minimize the unwanted effects of screening, delivery of organized screening must be of high quality. 

A standardized method of evaluation for all Canadian breast screening programs has been repeatedly identified as a necessity. With the CBCSD fully implemented, consistent program data are available
for evaluation. In 1999, with this infrastructure in place, the CBCSI's Quality Assurance Working Group, Database Technical Subcommittee, and Database Management Subcommittee formed the Evaluation Indicators Working Group (EIWG) to formalize a set of performance measures and targets. 

In February 2000, representatives of Health Canada and the breast screening evaluation community met at a national workshop as a first step towards developing a set of Canadian core indicators and targets for evaluating the performance and quality of organized breast screening programs. Ultimately, nine categories were selected: 

• Recruitment and retention 
• Client experience 
• Technical aspects 
• Mammography interpretation 
• Diagnostic assessment and diagnosis 
• Treatment 
• Survival and mortality 
• Data quality assurance 
• Program management 

Standardized methods of evaluation will promote the delivery of high-quality organized screening programs.

Using the nine categories as a guide, performance and quality indicators were gathered through a review of national documents from various countries, published research literature, Canadian federal documents and Canadian provincial/territorial screening program annual reports. The review focused on indicators that were currently available for breast cancer screening programs in publicly funded health care systems. With this review, the participants of the 2000 workshop identified 30 core performance and quality indicators, target outcomes for some of the indicators and recommendations on practical means to gather and report these data¹⁰. The EIWG then selected key indicators on the basis of outcomes, pragmatic considerations and efficiency. Subsequent meetings of the EIWG resulted in the following guidelines for reporting a key set of performance measures (Table 2)¹¹. The 11 performance measures detailed here generally met the following criteria: 

• Data for the measure were regularly available. 
• Data available for the measure were of high quality. 
• Meaningful targets could be defined on an evidentiary basis*. 
• Measures and targets would be useful for national comparison. 
• Monitoring on an annual basis would be valuable. 
• Each measure was widely accepted for use in program evaluation. 

Monitoring screening programs requires reliable, standardized information that is comparable across provinces/territories. Some follow-up data must be obtained from external sources, which thereby complicates the evaluation process. Many, but not all, programs are directly linked to their provincial/territorial cancer registries in order to obtain cancer outcome data. Further complicating the evaluation process, some programs experience delays in obtaining registry data. 

* No targets were set for in situ cancer detection rate, given the controversy surrounding the natural history of the condition.

Table 2
Performance measures and targets for breast cancer screening programs in Canada

Source: Health Canada. Report from the Evaluation Indicators Working Group: Guidelines for Monitoring Breast Cancer Screening Program Performance. Ottawa: Minister of Public Works and Government Services Canada, 2002.

Note: Table adapted from the Quality Determinants of Organized Breast Cancer Screening Programs Report.

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