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Evaluating breast cancer screening performance without registries using medico-administrative data.

Emilien Jemelen1,2, Francisco Orchard3, William Madie3

  • 1French Institute for Research in Computer Science and Automation (INRIA), Paris, France. emilien.jemelen@inria.fr.

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|July 11, 2025
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Summary

This study evaluated breast cancer screening performance in France using health administrative data, finding a cancer detection rate of 10.9 per 1000 exams. This method offers a viable alternative for assessing screening effectiveness where cancer registries are unavailable.

Keywords:
Cancer registriesData linkageEuropean health policyFull-field digital mammography (FFDM)Interval cancer rateOrganized breast cancer screeningPerformance assessmentSNDS (National Health Data System) administrative data

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Area of Science:

  • Oncology
  • Public Health
  • Health Informatics

Background:

  • The French Breast Cancer Screening Program (DOCS) aims for early breast cancer (BC) detection.
  • Key performance indicators (KPIs) like sensitivity and cancer detection rate (CDR) are crucial for evaluating screening programs.
  • Access to BC registries for linking screening data is limited in France, hindering performance metric calculation.

Purpose of the Study:

  • To assess the feasibility and effectiveness of using medico-administrative data, specifically the French National Health Data System (SNDS), to calculate BC screening performance metrics.
  • To establish an alternative methodology for evaluating screening programs in regions lacking accessible cancer registries.

Main Methods:

  • Linked regional digital mammography screening data (2011-2020) with the French National Health Data System (SNDS).
  • Followed women for 24 months post-screening to identify screen-detected and interval cancers.
  • Calculated key performance indicators: sensitivity (SE), positive predictive value (PPV), cancer detection rate (CDR), and interval cancer rate (ICR).

Main Results:

  • Analyzed 252,786 screening exams from women with a mean age of 61.
  • Achieved a sensitivity (SE) of 77.9% and a positive predictive value (PPV) of 19.8%.
  • Reported a cancer detection rate (CDR) of 10.9 per 1000 exams and an interval cancer rate (ICR) of 2.4 per 1000 exams.

Conclusions:

  • Medico-administrative data (SNDS) provides a reproducible method for calculating breast cancer screening performance metrics in France.
  • This approach serves as a valuable alternative in areas with limited or inaccessible cancer registries.
  • Further validation in registry-covered regions is recommended to confirm the methodology's broader applicability.