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Evaluating the breast screening programme: the need for surgical audit
F Kee1, D Gorman, W Odling-Smee
1Department of Public Health Medicine, Northern Health & Social Services Board, Ballymena, N. Ireland.
Journal of the Royal Society of Medicine
|February 1, 1993
Summary
This study established baseline breast cancer presentation and survival rates in Northern Ireland before mammographic screening. Findings highlight data collection challenges that could impact future screening outcome assessments.
Area of Science:
- Oncology
- Public Health
- Epidemiology
Background:
- Mammographic screening aims to reduce breast cancer mortality by detecting cancers earlier.
- Assessing screening effectiveness requires data on cancer stage at diagnosis and case fatality.
- Baseline data is crucial for evaluating screening program impact.
Purpose of the Study:
- To determine the typical presentation and survival of breast cancer in Northern Ireland prior to screening implementation.
- To identify potential challenges in data collection for evaluating screening outcomes.
Main Methods:
- Retrospective casenote review and follow-up.
- Analysis of breast cancer cases diagnosed in Northern Ireland in 1986.
- Comparison of pathological staging rates between teaching and non-teaching hospitals.
Main Results:
- In 1986, 85% of breast cancer cases were diagnosed at Manchester stages I or II.
- Five-year survival varied significantly by stage, from 77.8% for stage I to 35.7% for stage IV.
- Pathological staging was missing for 43% of cases in non-teaching hospitals versus 20% in teaching hospitals (P < 0.001).
Conclusions:
- Established baseline data on breast cancer stage and survival before screening.
- Identified significant disparities in pathological staging data between hospital types.
- Recommended comprehensive surgical audit to improve data quality for screening evaluation.