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Evolution of the National Breast Screening Programme in Ireland: Two-year interval analysis (2004-2013) of
Patricia E Fitzpatrick1,2, Gráinne Greehy1, Marie T Mooney1
11 National Screening Service, Dublin, Ireland.
Insights
This review of Ireland's national breast screening programme found that while invasive cancer detection rates remained strong, screening uptake declined below 70% by 2013. Digital mammography implementation showed evolving performance indicators.
Area of Science:
- Public Health
- Radiology
- Oncology
Background:
- Effective monitoring of breast screening programmes is crucial for quality assurance.
- BreastCheck, Ireland's national breast screening programme, began in 2000 and expanded nationally by 2007.
- Digital mammography was integrated into the programme in 2008.
Purpose of the Study:
- To evaluate the performance of the BreastCheck programme over a decade (2004-2013).
- To assess key performance indicators against national and European guidelines.
- To analyze trends following the introduction of digital mammography.
Main Methods:
- Utilized a customized clinical and administrative database for data collection.
- Extracted performance indicator data from 972,236 screening examinations.
- Compared collected data with established programme and European guideline standards.
Main Results:
- Screening uptake decreased to below 70% in 2012-2013 after initial increases.
- Initial recall rates rose post-digital mammography introduction (5.2% to 8.1%), while subsequent rates stayed below 3%.
- Invasive cancer detection rates averaged 6.6/1000 (initial) and 4.5/1000 (subsequent); detection of small cancers (<15mm and <10mm) and ductal carcinoma in situ remained significant.
Conclusions:
- The study highlights evolving performance metrics in the digital mammography era.
- Revised European guidelines are expected to incorporate indicators relevant to digital mammography.
- Continued monitoring is essential for optimizing breast cancer screening quality.
Objective:
Monitoring breast screening programmes is essential to ensure quality. BreastCheck, the national breast screening programme in the Republic of Ireland, commenced screening in 2000, with full national expansion in 2007, and digital mammography introduced in 2008. We aimed to review the performance of BreastCheck from 1 January 2004 to 31 December 2013.
Methods:
Using the customised clinical and administrative database, performance indicator data were collected from BreastCheck and compared with programme and European guideline standards.
Results:
Over the decade, 972,236 screening examinations were performed. Uptake initially rose following national expansion, but fell in the subsequent years to <70% in 2012-2013. Following the introduction of digital mammography, initial recall rates increased from 5.2% in 2004-2005 to 8.1% in 2012-2013. Subsequent recall rates remained within the target of <3%. On average, invasive cancer detection rates were 6.6/1000 for initial and 4.5/1000 for subsequent women. Small cancer detection rates were for <15 mm 43.4% (initial women) and 51.7% (subsequent) and for ≤10 mm 24.0% (initial) and 29.5% (subsequent). Ductal carcinoma in situ detection as a percentage of all cancers averaged 21.2% for initial and 20.0% for subsequent women. The majority were intermediate or high-grade ductal carcinoma in situ. The positive predictive value was 11.9% for initial and 21.8% for subsequent women. Standardized detection ratios remained above the programme target.
Conclusion:
Revised indicators to reflect the digital mammography era are anticipated in revised European Guidelines on breast cancer screening.
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