The Singapore National Breast Screening Programme: principles and implementation

The Singapore Breast Screening Project (1993-1996) showed that mammographic screening in Singaporean women shifts the size and stage of screen-detected breast cancers downwards and markedly increases the rate of detection of ductal carcinoma in situ, with acceptable recall, needle biopsy and interval cancer rates. Breast cancer is the leading cause of death in Singaporean women. Singapore has one of the highest age-adjusted breast cancer incidences in Asia. Although this is much lower than in the West, for women aged 45-49 years, the breast cancer incidence in Singapore is the same as for women in Australia, Canada or the United States. The latest Singapore Cancer Registry data shows that the age of peak incidence of breast cancer in Singaporean women has risen from 45-49 years in the period 1993-1997 to 50-55 years in the period 1998-1999. This suggests that the age-specific incidence of breast cancer in Singaporean women is shifting more to a pattern usually seen in Western nations. These factors, together with reconfirmed evidence of mortality benefit from breast cancer screening trials, led the Singapore government to establish the first population-based mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore). It uses a distributed model of mammography service, with centralised reading and assessment, co-ordinated by the Singapore Health Promotion Board. It is unique in that women co-pay at each step of the screening and assessment process. The programme, launched in January 2002, has adopted international standards of breast screening practice and breast cancer detection. To date, the initial targets for the first year have been met. Several key policies and issues over the programme's implementation are presented.