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Variation in performance in low-volume mammography screening programmes: experience from Switzerland
J-L Bulliard1, C Ducros, E Dayer
1Unité d'épidémiologie du cancer, Institut de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Switzerland. Jean-Luc.Bulliard@chuv.ch
Cancer Epidemiology
|August 24, 2010
Summary
Mammography screening performance varies significantly in low-volume programs. A restrictive second reader selection strategy improved detection of early-stage cancers, suggesting key areas for enhancing screening effectiveness.
Area of Science:
- Oncology
- Public Health
- Radiology
Background:
- Mammography screening performance is linked to reading volume.
- Low-volume screening programs in Switzerland were compared for quality and effectiveness.
- Program comparability was maximized by similar screening procedures, differing mainly in second reader accreditation strategies.
Purpose of the Study:
- To compare quality and effectiveness across low-volume mammography screening programs.
- To explore variations in performance and identify determinants for improvement.
- To optimize mammography screening in decentralized healthcare systems.
Main Methods:
- Analysis of approximately 200,000 mammograms from 1999-2006 across three Swiss cantonal programs.
- Assessment of quality and effectiveness indicators against European standards.
- Identification of interval cancers via linkage with cancer registries.
Main Results:
- Swiss programs generally met European performance standards, showing a favorable cancer stage shift.
- Significant two-fold variations in performance indicators were observed.
- A non-restrictive second reader strategy was associated with lower detection of in situ and small cancers (≤1cm) and higher detection of advanced lesions (stage II+).
Conclusions:
- Performance differences were partly attributed to second reader selection strategies and prior screening experience.
- Opportunistic screening levels and program attendance did not explain performance variations.
- Findings offer insights for enhancing mammography screening performance in low-volume settings.
