Results of the Czech National Breast Cancer Screening Programme

Česká verzia

Authors: M. Skovajsová ¹; O. Májek ^2,3; J. Daneš ⁴; H. Bartoňková ⁵; O. Ngo ²; L. Dušek ²
Authors place of work: Breast Unit Prague, Mamma centrum Háje, Praha ¹; Institut bio statistiky a analýz, LF a PřF MU, Brno ²; Ústav zdravotnických informací a statistiky ČR, Praha ³; Radiodia gnostická klinika 1. LF UK a VFN v Praze ⁴; Oddělení radiologie, Masarykův onkologický ústav, Brno ⁵
Published in the journal: Klin Onkol 2014; 27(Supplementum 2): 69-78
doi: https://doi.org/10.14735/amko20142S69

Summary

Introduction:
Breast cancer screening based on mammography is an effective tool for lowering mortality rates from this disease. The organised and nationwide Breast Cancer Screening Programme has been underway in the Czech Republic since 2002.

Material and Methods:
Monitoring of the programme is based on data from the Czech National Cancer Registry (CNCR), Breast Cancer Screening Registry, and the Czech National Reference Centre (CNRC). These data sources make it possible to evaluate early performance indicators according to international standards, and to monitor the cancer burden in the Czech population. The CNRC data allow us to document the high validity of the available data as well as to map non-organised mammography examinations (so-called opportunistic screening).

Results:
Until the mid-1990s, breast cancer incidence and mortality rates saw a slight but continuous increase. In the last 15 years, however, incidence rates have grown more substantially; by contrast, mortality rates have stalled and even started to decline since the 2000s. In the mid-1990s, the proportion of cancers diagnosed at stage I was below 20%; this situation has dramatically improved since then, as more than 40% cases of breast cancer were diagnosed at stage I in 2011. Breast cancer screening coverage currently amounts to 50%; this value reached a plateau in the period 2007–2008, and unfortunately has not shown any further significant increase.

Conclusion:
Over the last few decades, the breast cancer burden among the Czech population has been significantly reduced – despite the growing incidence rates, mortality rates have decreased, which can be largely attributed to earlier detection of breast cancer based on the screening programme. Further improvements in the programme’s effectiveness can only be achieved if the population coverage becomes higher; the programme of personalised invitations to mammography examinations, which was introduced in early 2014, should contribute to the accomplishment of this goal.

Key words:
breast neoplasms – mass screening – mammography – health care quality indicators

This study was supported by the project 36/14//NAP “Development and implementation of methodology for the evaluation of effectiveness of personalised invitations of citizens to cancer screening programmes” as part of the programme of the Czech Ministry of Health “National action plans and conceptions”.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
12. 9. 2014

Accepted:
27. 10. 2014

Zdroje

1. Paci E, EUROSCREEN Working Group. Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet. J Med Screen 2012; 19 (Suppl 1): 5– 13.

2. Shapiro S, Venet W, Strax P et al. Ten‑ to fourteen‑year effect of screening on breast cancer mortality. J Natl Cancer Inst 1982; 69(2): 349– 355.

3. Baker LH. Breast cancer detection demonstration project: 5‑year summary report. CA Cancer J Clin 1982; 32(4): 194– 225.

4. Nyström L, Rutqvist L, Wall S et al. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 1993; 341(8851): 973– 978.

5. Duffy SW, Chen HH, Tabar L et al. Estimation of mean sojourn time in breast cancer screening using a Markov chain model of both entry to and exit from the preclinical detectable phase. Stat Med 1995; 14(14): 1531– 1543.

6. Dušek L, Mužík J, Kubásek M et al (eds). Epidemiologie zhoubných nádorů v České republice [Internet]. Brno: Masarykova univerzita; 2005 [citováno 30. srpna 2014]. Dostupný z: http:/ / www.svod.cz.

7. Dušek L, Mužík J, Gelnarová E et al. Cancer incidence and mortality in the Czech Republic. Klin Onkol 2010; 23(5): 311– 324.

8. Perry N, Broeders M, de Wolf C et al (eds). European guidelines for quality assurance in breast cancer screening and diagnosis. 4th ed. Luxembourg: Office for Official Publications of the EC 2006.

9. Majek O, Danes J, Zavoral M et al. Czech National Cancer Screening Programmes in 2010. Klin Onkol 2010; 23(5): 343– 353.

10. dos Santos Silva I. Cancer epidemiology: principles and methods. Lyon: International Agency for Research on Cancer 1999.

11. Pavlík T, Dušek L, Májek O et al. Five‑year survival rates of cancer patients in the Czech Republic. In: Dušek L et al (eds). Czech cancer care in numbers 2008– 2009. Praha: Grada Publishing 2009.

12. Majek O, Danes J, Skovajsova M et al. Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme. BMC Public Health 2011; 11: 288. doi: 10.1186/ 1471‑ 2458‑ 11‑ 288.

13. Dušek L, Májek O, Mužík J et al. Vývoj epidemiologie zhoubných nádorů prsu u žen dle nových dat Národního onkologického registru ČR a dalších datových zdrojů. Prakt Gyn 2013; 17(1): 31– 39.

14. Pavlik T, Majek O, Buchler T et al. Trends in stage‑ specific population‑based survival of cancer patients in the Czech Republic in the period 2000– 2008. Cancer Epidemiol 2014; 38(1): 28– 34. doi: 10.1016/ j.canep.2013.11.002.

15. Giordano L, von Karsa L, Tomatis M et al. Mammographic screening programmes in Europe: organization, coverage and participation. J Med Screen 2012; 19 (Suppl 1):72– 82.

16. Gram IT, Funkhouser E, Tabar L. The Tabar classification of mammographic parenchymal patterns. Eur J Radiol 1997; 24(2): 131– 136.

17. de Gelder R, Bulliard JL, de Wolf C et al. Cost‑effectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer 2009; 45(1): 127– 138. doi: 10.1016/ j.ejca.2008.09.015.

18. Broeders M, Moss S, Nystrom L et al. The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen 2012; 19 (Suppl 1): 14– 25.

19. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast‑ cancer incidence. New Engl J Med 2012; 367(21): 1998– 2005. doi: 10.1056/ NEJMoa1206809.

20. Jorgensen KJ, Gotzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009; 339: b2587. doi: 10.1136/ bmj.b2587.

21. Puliti D, Duffy SW, Miccinesi G et al. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen 2012; 19 (Suppl 1): 42– 56.

22. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet 2012; 380(9855): 1778– 1786. doi: 10.1016/ S0140‑ 6736(12)61611‑ 0.

23. Májek O, Daneš J, Skovajsová M et al (eds). Mamo.cz – Program mamografického screeningu v České republice [Internet]. Brno: Masarykova univerzita; 2014 [citováno 29. srpna 2014]. Dostupný z: http:/ / www.mamo.cz.