Organized Breast Cancer Screening Programs in Canada

1999 and 2000 Report

Summary and Future Directions

The availability of performance measures and targets has allowed monitoring efforts to identify ways of continuously improving the quality of organized screening programs. Although most performance targets for organized programs were met, the current evaluation indicates three areas on which to concentrate future efforts for improvement: capacity, referral practices, and timeliness of diagnostic follow-up. 

None of the programs met the performance target of screening at least 70% of the target population. This suggests that the provinces are reaching the limits of their capacity to recruit additional women. Increased commitment to the screening of women through organized breast cancer screening programs and allocation of additional resources to recruit target-aged women could reduce barriers, such as waiting for appointments or lack of access. Revisiting the policies on screening women outside the target age range may provide a means to increase capacity for the women most likely to benefit from screening. 

Although the performance indicator for retention indicates that programs are successfully maintaining the participation of women currently in the screening program, more detailed analysis suggests that retention is significantly poorer among women new to the program. It is critical to increase retention among these women because the benefits of a single screen are small. 

The availability of performance measures and targets has allowed monitoring efforts to identify ways of continuously improving the quality of organized screening programs. The current evaluation indicates three areas on which to concentrate future efforts for improvement: capacity, referral practices, and timeliness of diagnostic follow-up.

For the period covered in this report, abnormal recall rates did
not meet targets set for performance. One project currently under way (the Pan-Canadian Study of Radiologist Reading Volumes) is attempting to address this issue by investigating the number of readings a radiologist should conduct annually to maximize cancer detection while maintaining conservative abnormal recall rates. However, other factors that contribute to high abnormal recall rates also merit consideration. Increases in the proportion of women waiting in excess of 30 months to return to screening will increase abnormal recall rates, tying this once again to the issue of capacity. The inclusion of CBE also increases abnormal recall rates but contributes only a small amount to the early detection of breast cancer. 

Although timeliness of diagnostic follow-up appears to have diminished between 1996 and 2000, several individual programs have made remarkable strides in expediting the diagnostic work-up after an abnormal screening examination. In order to achieve performance targets set for diagnostic follow-up, further evaluation and exchange of the various strategies that have been effective may allow other programs to enhance their own processes. 

The goal of monitoring and evaluating organized breast cancer screening programs in Canada is to promote high-quality screening, ultimately leading to reductions in breast cancer mortality and morbidity and to the minimization of the unwanted effects of screening. With recent questioning of the value of screening mammography, the importance of such monitoring efforts is even more critical in order to provide women with an accurate picture of the benefits and harms of participation in screening programs. Ongoing monitoring and evaluation is a necessary mechanism that provides direction for programs in their continuous efforts to provide high-quality screening and to reduce the burden of breast cancer mortality among Canadian women and their families. 

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