SUMMARY AND FUTURE DIRECTIONS

Canadian organized breast cancer screening programs have grown considerably in the last 10 years. Organized screening ensures that meticulous quality assurance practices are in place and allows monitoring and evaluation of screening performance.

The substantial increase in the number of women screened through organized programs and the establishment of new programs heightens the importance of quality screening. This biennial report of the 1997 and 1998 screen years demonstrates that organized breast cancer screening programs continue to meet or exceed a majority of the standards set by other countries.

Despite an increase in the number of women screened through organized programs, participation of women in the target age group remains sub-optimal, ranging by province from 11.5% to 54.7%. In order to reach a 70% participation rate among women aged 50 to 69, additional resources are required to establish new programs and expand existing ones. Another concern is the significant number of women who continue to receive screening in diagnostic settings across Canada. It is expected that participation rates will continue to improve with the growth of organized screening and the recognition of the benefits of breast screening in an organized setting.

Overall, the 1997 and 1998 results show that organized breast screening programs in Canada compare favourably with the standards set by other countries. Among women aged 50 to 69, 37.6% of invasive cancers were <= 10 mm in diameter, and 78.5% of invasive cancers did not have lymph node metastasis. Detecting invasive cancers when they are small and unlikely to have spread beyond the breast is necessary to achieve a reduction in breast cancer mortality.

The Canadian Breast Cancer Screening Database (CBCSD) continues to expand with the growth of organized breast screening programs. Ongoing efforts to improve the quality of the database ensure accurate monitoring and evaluating of screening performance. Collaboration with partners to organize a breast cancer staging training workshop in 2001 will help to address discrepancies in tumour data collected for the CBCSD. In addition, efforts continue in developing a set of indicators for evaluating the performance and quality of organized screening programs in Canada. The CBCSD is gradually expanding its research capacity with research projects initiated in a number of priority areas. This further encourages the broad, creative, and optimal use of the CBCSD for the evaluation of breast cancer screening in Canada.

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