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Open Access Research article

Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme

Ondrej Majek1, Jan Danes2, Miroslava Skovajsova3, Helena Bartonkova4, Lucie Buresova1, Daniel Klimes1, Petr Brabec1, Pavel Kozeny5 and Ladislav Dusek1*

Author Affiliations

1 Institute of Biostatistics and Analyses, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic

2 Department of Radiology, First Faculty of Medicine, Charles University in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic

3 Association of Czech Breast Radiologists, Roskotova 1717/2, 140 44 Prague, Czech Republic

4 Department of Radiology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53 Brno, Czech Republic

5 National Reference Centre, Vinohradska 112, 130 00 Prague, Czech Republic

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BMC Public Health 2011, 11:288  doi:10.1186/1471-2458-11-288

Published: 10 May 2011

Abstract

Background

The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme.

Methods

The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring.

Results

Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines.

Conclusions

Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.